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Mischa Bongers' CQUniversity Australia
It's commonly understood that having a baby can be a primary cause of later pelvic floor problems' such as bladder leakage. While giving birth can be a very special and joyful time' it can sometimes be difficult returning to day-to-day activity postpartum.
About one in three women who've have had a baby experience urinary incontinence. A similar proportion will have prolapse symptoms like vaginal heaviness or bulging.
You might guess that choosing a caesarean section – that is' a surgical birth via the abdomen – rather than a vaginal birth could be a sensible way to avoid such symptoms. You could assume doing so would avoid any direct stretching and trauma to the pelvic floor muscles.
However' it's not that simple. It turns out pregnancy itself' regardless of the mode of delivery' is a significant risk factor for pelvic floor dysfunction.
During pregnancy' there is a rapid increase in pressure and strain on the pelvic floor from the growing baby and increasing fluid load. Add to this a high likelihood of constipation during and after pregnancy causing straining that further weakens already stretched muscles.
A growing belly also stretches and weakens the muscles of the abdominal wall and changes our posture' impacting core stability and the function of the trunk and pelvis.
Changes in hormones during pregnancy soften our muscles' tendons and ligaments to allow the pelvis to widen during labour and delivery. This reduces the stability of the pelvic floor and supporting tissues.
So the risk for pelvic floor compromise is already there – well before any type of delivery.
After caesarean surgery you shouldn't lift anything heavier than your baby until the six-week check. | Shutterstock
Add to this other non pregnancy-related risk factors for pelvic floor weakness such as:
It's a long list of contributing factors to pelvic floor dysfunction that don't have anything to do with having a vaginal or caesarean delivery.
That said' a vaginal delivery (particularly a difficult one) does add risk factors. This is especially true if:
A caesarean is certainly not the "easy way out" either. Recovery from a C-section' even a planned one' can be challenging as it is major abdominal surgery. It means avoiding lifting anything heavier than your baby for six weeks' not driving until medically cleared' reduced mobility' and incision pain. As with any surgery' it carries the risk of complications such as infection' reaction to the anaesthetic' surgical injury and blood clots.
Exercise classes designed for pregnancy are a good idea. | Shutterstock
There are pros and cons to both modes of delivery when considering potential long-term impacts on function. Individualised counselling with your medical provider during pregnancy is highly recommended' as everyone's personal risk factors' circumstances and preferences are unique.
Using a risk calculator tool may be a useful starting point when discussing with your care team whether a vaginal or caesarean birth may be more suitable for you.
If you are planning a vaginal delivery' there are a few things research shows can reduce your risk of pelvic floor injury and dysfunction:
Whether you choose to birth vaginally or via caesarean is a decision that is very personal and involves many factors. Due to unforeseen complications' sometimes this decision can be taken out of our hands so it is beneficial to be well-informed on both options.
Regardless of mode of delivery' it's important to learn how to effectively exercise your pelvic floor muscles for prevention and treatment of pelvic floor symptoms such as incontinence and prolapse. Today's a great day to get started.
Mischa Bongers' Sessional Lecturer' CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
