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Your Pelvic Floor: How Will Childbirth Affect It? Or Will It?

Yikes. An Australian study suggests that as many as 1 in 5 women will need surgery for pelvic organ prolapse at some point in their lives. A pelvic organ prolapse happens when the pelvic floor muscles have been weakened and the organs– the uterus, bladder or rectum– can slip down and protrude into the vagina.

The severity of organ prolapse varies. Exercise and weight loss help strengthen those muscles to keep organs in place. Pessaries–small devices that are inserted into the vagina– can also help. In more severe cases, surgery is necessary.

There are lots of factors that make prolapse more likely: obesity, smoking, chronic constipation, constant heavy lifting, genes and, according to the Reuters coverage of this study, vaginal birth: “Pregnancy and particularly vaginal birth are prime risk factors for pelvic organ prolapse as well.”

But I don’t think it’s actually true that vaginal births lead to more prolapses. Or, I think the category of “vaginal” birth needs to be broken down a bit more for us to get an accurate picture of what’s going on.According to the thorough research complied by the advocacy group Childbirth Connection:

“It is increasingly common to hear that “vaginal birth” causes pelvic floor problems. However, a recent review of the research found no studies that attempted to avoid or limit use of the practices that can injure a woman’s pelvic floor listed above in order to determine whether vaginal birth itself plays a role. It is wrong to conclude at this time that vaginal birth is the cause of pelvic floor dysfunction.

There are practices used in vaginal births that can increase the likelihood of pelvic floor dysfunction, including prolapse and they are: continuous electronic fetal monitoring (this prevents mom from getting into gravity-friendly positions in labor); epidurals (which put mom on her back, a more stressful position for pushing); vacuum extraction or forceps delivery; episiotomy (which cuts into not just the skin but the pelvic floor muscle; particular kinds of caregiver-directed pushing or “purple pushing” which can put too much strain on mom’s muscles; and fundal pressure (when mom’s belly is pushed down to help get the baby out).

The folks at Childbirth Connection conclude, “when there is no clear, compelling and well-supported medical need for surgical birth, the best choice is a vaginal birth that avoids use of practices and procedures that may contribute to pelvic floor dysfunction.

I think it’s important to look at this stuff closely because even the use of the practices listed above by no means guarantees problems with your pelvic floor!!

The fact is that most women push on their backs, and most women were given episiotomies for decades. And most women don’t have organ prolapse.  Women are very frightened– understandably– that their vaginas will be permanently altered by childbirth, but the vagina itself was absolutely meant to stretch and open and then close again. That’s what it does.

It’s so important to remember that there are other factors leading to pelvic floor problems than just childbirth. But it’s also important, I think, to not throw it out there that “vaginal birth” is bad for the pelvic floor when it is, in fact, some of the more over (or unnecessarily) used procedures that can increase those odds.

What woman doesn’t love her pelvic floor? We should get proper information about how to protect it.

According to lead researcher of this new study, Fiona Smith, of the University of Western Australia in Perth, we don’t know enough about how to prevent prolapse and more research needs to be done. Especially since this “un-discussed” condition seems to be so prevalent.

To that I say, let’s look at routine hospital practices and how they impact the pelvic floor. Let’s find out more about what women can do– did the women in the Australian study know about the benefits of kegels and other exercises? And how does postpartum pelvic floor therapy help prevent future problems? This has become more common in France– what are their prolapse statistics like? I want to know more.

photo: phil denton/flickr

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