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Evidence LibraryPostpartum and the first yearThe real timeline
Evidence Library · The real timeline

A cesarean does not buy you an easier recovery, and a vaginal birth does not promise one

At six, twelve and eighteen months, the number of women carrying three or more health problems was the same whichever way they gave birth.

Two stories get told, and both of them are wrong in the same way.

Women who had a cesarean are told the long recovery is the price of major surgery, as though it were a bill they agreed to. Women who had a vaginal birth are told they should be fine by now, as though nothing had happened to them.

The Melbourne cohort was followed at three, six, twelve and eighteen months, and the women were compared by how they gave birth. At six, twelve and eighteen months there was no significant difference in the proportion of women reporting three or more health problems by mode of birth.

Where there were differences, they did not run the way people assume. Compared with a spontaneous vaginal birth, women who had a cesarean were more likely to report extreme tiredness at six and twelve months, and more likely to report back pain at the same points. They were less likely to report urinary incontinence at three, six and twelve months. That is the whole trade, and it is not the trade most women are told about.

The authors put it in two sentences: Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for women's health. And: Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth.

What the numbers here are, and are notThe exact three-month percentages in this guide come from the earlier report of the same cohort. This eighteen-month follow-up gives comparisons between groups rather than plain percentages, and symptom-by-symptom rates at six, twelve and eighteen months were not available for this guide, so no table of them is built here. The direction is solid. If you are shown a month-by-month grid, ask which paper each row came from.
If you are being told your recovery is on schedule and it does not feel like it"Is that based on what usually happens, or on how I am doing?"
"What would make you think this is not just slow recovery?"
Where this comes from:
555. Woolhouse H, Perlen S, Gartland D, Brown SJ. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity? Birth. 2012;39(3):221-9.
554. Woolhouse H, Gartland D, Perlen S, Donath S, Brown SJ. Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study. Midwifery. 2014;30(3):378-84.

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