Most women are only vaguely aware of the potential for pelvic floor damage and incontinence that can follow pregnancy and birth. These issues are seen as something to deal with in the distant future, but over half of all women experience some form of incontinence, so it’s a reality all women should be aware of.
One of the most enduring myths surrounding birth is that a c-section prevents damage to the pelvic floor. Does this myth have any truth to it? How can women really avoid pelvic floor damage?
What Is Pelvic Floor Dysfunction?
The pelvic floor is a group of muscles, ligaments, and tissues, which support the organs of the pelvis: bladder, uterus and bowel. Each organ has an opening that passes through the pelvic floor: the urethra from the bladder, the vagina from the uterus, and the anus from the bowel.
The pelvic floor acts like a hammock and supports these organs, but if the muscles are weakened, or the ligaments and tissues are stretched or damaged, a number of problems can arise, such as:
- Urinary incontinence: loss of control over urine, especially with extra exertion, such as coughing or running (stress incontinence). It affects 30-50% of childbearing women by age 40.
- Fecal incontinence: loss of control over wind or stool. This affects up to 25% of childbearing women.
- Pelvic organ prolapse: this is when muscles, ligaments, and tissues are weakened and cause prolapse of the vagina, bladder, rectum, or uterus.
- Sexual problems: often causing pain or discomfort
- Chronic pain syndromes: ongoing pain and disability.
What Causes Pelvic Floor Damage?
Pelvic floor dysfunction (PFD) can result from a combination of factors, such as:
- Frequent pressure on the abdomen, such as lifting heavy objects, or straining during bowel movements.
It is very common for health professionals to blame vaginal birth for pelvic floor damage. Unfortunately, this approach doesn’t take into consideration how pregnancy affects a woman’s body before birth, or whether the other risk factors above are involved.
During pregnancy, the weight of your baby and your uterus increases, and places increased pressure on the supporting muscles and ligaments in your pelvic floor.
As your baby grows, the uterus becomes heavier, and these supporting structures are stretched and weakened. The hormone relaxin also contributes to this loosening of ligaments and muscles. Your pelvis needs to be flexible during birth so your baby can pass through the bony structure.
If you are pregnant, and then add other factors – such as being overweight, being an older mother, experiencing sluggish digestion and frequent constipation, or even exercising improperly – your pelvic floor can suffer.
Vaginal birth can result in pelvic floor damage, but the damage is often the result of interventions such as forceps, episiotomies, restricted movement during labour, or prolonged forceful pushing in the second stage.
Read more about how vaginal birth can contribute to pelvic floor damage.
Can A C-Section Prevent PFD?
The big question is, can avoiding vaginal birth protect the pelvic floor from damage? The short answer is, depends on how we look at it.
Research from the Norwegian EPINCONT study of 15,000 women, found the rates of incontinence after by age 50 years were similar, regardless of birth mode.
Pregnancy itself accounts for over 50% of cases of stress incontinence. Having stress incontinence before birth means you are more likely to experience afterward, regardless of how you gave birth.
Another study from South Australia of 1500 women found urinary incontinence increases with age, number of babies birthed, and instrumental delivery. C-section wasn’t associated with a significant reduction in pelvic floor disorders.
The two year follow up of the Term Breech Trial, which compared maternal outcomes after planned c-section with planned vaginal birth for breech presentation at term, showed no differences in the currency of urinary incontinence between the two groups.
Further research has shown it is necessary to perform 8-9 c-sections in order to avoid 1 case of urinary incontinence.
That means exposing 8 or 9 women and their babies to the potentially serious risks of surgery, in order to avoid a single case of urinary incontinence.
Should I Plan An Elective C-section To Avoid PFD?
C-section surgery is safer today than it was decades ago, but it’s important to know c-sections come with their own risks – both short and long term – for women, their babies, and any future babies.
Today many hospitals are endeavouring to reduce their c-section rates. Most care providers want to help women to achieve a vaginal birth where the benefits outweigh the risks.
In some situations, a difficult vaginal birth might be more physically traumatic than a c-section. It’s necessary to discuss the risks and benefits for both modes of birth, and determine which is the safest way to avoid damage.
You will have to deal with the effects pregnancy has on your body, whether you give birth vaginally or via c-section. It’s wise to focus on what you can do to prevent damage as early as possible during pregnancy.
Make sure you avoid excess weight gain, and find a pregnancy exercise specialist in your area – especially if you want to do any form of weight bearing exercise. Learn how to lift without putting pressure on your pelvic floor.
Pelvic floor muscle exercises are a must during pregnancy. Any muscles that aren’t used regularly tend to get slack and weak, and your pelvic floor is no different. A strong pelvic floor can help the process of natural birth.
If you don’t know how to train your pelvic floor, seek guidance from a women’s health physiotherapist, to make sure you are doing the exercises properly.
Focus on, and prepare for, a vaginal birth that doesn’t involve practices that work against your body. This means being informed about the benefits of a natural, undisturbed labour, and knowing how to use active positions so your body can work with gravity. Work to make sure your baby is in an optimal position for birth, so the process of labour and birth is easier.
Choose your care providers and birth setting according to how they will support your goal of having an intervention-free vaginal birth. Your care provider’s attitude toward birth (having a medical focus, or seeing birth as a natural process) has a big impact on how you will give birth. It can make all the difference when you are aiming to protect and support your pelvic floor during labour and birth.