Pregnancy is a time of so many important decisions. Which birthplace should you choose? How do you pick your birth team? And an important choice to make is desired mode of birth.
With more awareness about the pelvic floor and vaginal problems that can arise in postpartum, there is an apprehension in women about vaginal birth. Some wonder if they should opt for cesarean surgery to avoid these problems. After all, if the baby doesn’t push out of your vagina, your pelvic floor is spared from all the trauma. Right?
1. Bladder Leakage
Although the chance of bladder leakage is around 40% after vaginal birth, 15% of cesarean moms still experience this. Further, five years after delivery, the difference shrinks, and the overall incidence of leaking lingers at 20% for vaginal births and 15% for cesarean births. As you approach your fifties, the incidence of leaking seems to level out for both groups.
2. Pain with Intercourse
More than 60% of moms experience pain with intercourse after childbirth and six weeks postpartum, and initially, there is no difference between vaginal or cesarean births. However, as time passes (at five years postpartum), women with cesarean births seem to have slightly more pain than women with vaginal birth.
3. Organ Prolapse
Pelvic organ prolapse is more prevalent in vaginal births and what tips the scale is the use of instruments (vacuum or forceps) during vaginal birth, more than the type of birth itself.
4. Uterine Health
Cesarean involves cutting through the uterus wall to help deliver the baby. This brings a range of possible complications with it. The most common complication is an infection, the development of adhesions at the scar, and endometriosis. Rare complications are rupture of the uterus or intensive bleeding.
5. Future Fertility
Scarring at the uterus may hinder future fertility chances and create complications in the placenta when pregnancy does happen.
Pregnancy itself is a risk factor for pelvic floor weakness. The hormonal changes of pregnancy are what drive the changes to the pelvic floor. These muscles will stretch progressively for nine months of pregnancy and weaken about 25% before labor.
You can go to a pelvic floor therapist during pregnancy to prepare these muscles for labor. Perineal massage, a technique where the small muscles of the vaginal opening are stretched in preparation for birth, has been shown to reduce the risk of tearing. A pelvic floor physical therapist can help you improve your pelvic health during and after pregnancy.
One of the most significant risk factors for having pelvic floor problems after pregnancy is having these problems before or during pregnancy. So the biggest service you can do yourself is taking care of your pelvic floor NOW!
Taking a birth class to understand how labor works and how you can work with your body to enable the smooth exit of your baby will also be beneficial. Prenatal yoga, movement during labor, and effective breathing strategies have been shown to reduce the risk of tearing.
Or get a doula. A doula is a birth support practitioner who is trained to provide you with comfort measures, beneficial movement, and support throughout labor. Research has shown Doula care reduces the incidence of emergency cesarean surgery and birth injuries.
