Does Vaginal Birth Damage The Pelvic Floor?

Does Vaginal Birth Damage The Pelvic Floor? The question of whether vaginal birth damages the pelvic floor is indeed complex and multi-faceted. To answer this, let’s delve into the details provided and the broader context.

Pelvic Floor and Childbirth

The pelvic floor is a group of muscles that support the bladder, uterus, and rectum. During pregnancy, these muscles bear the weight of the growing uterus and baby, which can lead to increased strain. Hormonal changes in pregnancy also contribute to the softening of tissues and joints, preparing the body for childbirth.

Pregnancy involves a range of physical changes, including altered joint and muscle feelings and even changes in gait (like the ‘waddle’). These changes are part of the body’s natural adaptation to accommodate the growing fetus.

Impact of Vaginal Birth on the Pelvic Floor

Recent research has indeed shown that vaginal childbirth can have a more traumatic impact on the mother’s body than previously understood. One significant form of trauma that is less recognized is the damage to the levator ani muscle, a part of the pelvic floor.

Levator Avulsion

• Incidence: Imaging studies suggest that levator avulsion, where the puborectalis muscle detaches from the os pubis, occurs in up to a third of women giving birth vaginally for the first time.
• Risk Factors: The use of forceps in delivery has been identified as a major risk factor, increasing the likelihood of levator avulsion significantly compared to vacuum-assisted or unassisted vaginal births.

Consequences of Pelvic Floor Damage

• Physical Effects: Pelvic floor trauma, including levator injuries, is closely linked to pelvic organ prolapse and treatment failure for the same.
• Psychological Impact: Such trauma can lead to serious psychological effects, including post-traumatic stress disorder (PTSD).

Obstetric Practices

The modification of obstetric practices, such as minimizing the use of forceps, could significantly reduce pelvic floor trauma and the subsequent need for surgeries related to prolapse.

Understanding Pelvic Floor Disorders Post-Childbirth

Pelvic floor disorders following childbirth can have severe and lasting effects on women’s health. Each year, these disorders compel over 300,000 women to undergo surgery. This figure represents about 10% of the 3 million women who have vaginal births annually. The most common disorder linked to childbirth is pelvic organ prolapse, a condition where the organs in the pelvic area drop due to weakened muscles. Vaginal birth is a significant risk factor for this condition and also contributes to stress urinary incontinence.

Comparing Risks and Injuries

These pelvic floor disorders are far more likely to necessitate surgical intervention than anal sphincter injuries, with the need for surgery being ten times higher. Imaging studies reveal that injuries to the levator ani muscle, perineal body, and membrane can occur in up to 19% of women giving birth for the first time. During childbirth, these tissues and the levator muscle must stretch significantly – more than three times their normal size. This extreme stretching, rather than compression or nerve damage, often leads to muscle tears. About 55% of women who develop prolapse later in life show this kind of injury, with a significantly higher risk compared to women without such injuries.

Factors Influencing Levator Muscle Damage

The risk factors for injuring the levator muscle are varied, including the use of forceps, giving birth to the baby facing upwards (occiput posterior), older age of the mother, a longer second stage of labor, and a baby weighing over 4000 grams. Interestingly, vacuum-assisted deliveries seem to reduce the likelihood of levator damage.

Potential Protective Measures

There are several strategies that might help lower the risk of these injuries. These include turning the baby from a posterior to an anterior position, delivering slowly and carefully, perineal massage or applying compresses, and possibly inducing labor early. Additionally, training women not to push against a contracted levator muscle during childbirth could also reduce injury risk.

The Importance of Awareness and Care

Early recognition and treatment, including physical therapy and focused recovery, are crucial in caring for women who have experienced difficult deliveries. Women should be informed about these risks during pregnancy. Educating them about the long-term effects of childbirth on pelvic floor health is essential, enabling them to make well-informed decisions about their labor and delivery process.

Comprehensive Strategies to Avoid Pelvic Floor Dysfunction

The decision to have an elective cesarean section (C-section) with the aim of preventing pelvic floor dysfunction (PFD) is complex. While it’s a common belief that a C-section can avert pelvic floor damage, it’s important to weigh this against the increased risks associated with the surgical procedure. Just like avoiding apples for fear of choking on a seed, avoiding vaginal birth solely for the potential benefit of preserving pelvic floor integrity might not be the most balanced approach. Furthermore, it’s important to note that women who undergo C-sections can still experience postpartum incontinence.

Natural Resolution of Incontinence

It’s encouraging to know that most women who develop incontinence after childbirth, regardless of the method of delivery, often find that these symptoms resolve within a few months. This suggests that the body has a remarkable capacity for recovery and healing.

Role of Nutrition and Lifestyle

A proactive approach to maintaining pelvic health involves more than just the method of childbirth; it encompasses overall health and lifestyle choices. A balanced diet rich in protein, good fats, nuts, seeds, vegetables, and leafy greens, combined with low sugar and grain intake, plays a critical role in supporting the body’s recovery and maintaining muscle integrity, including that of the pelvic floor. Additionally, lifestyle factors such as regular exercise and avoiding smoking are crucial for pelvic health.

Importance of Pelvic Floor Exercises

Engaging in pelvic floor exercises is a key element in preventing and managing pelvic floor dysfunction. These exercises, often referred to as Kegels, strengthen the pelvic floor muscles, which support the bladder, uterus, and rectum. Regularly performing these exercises can improve pelvic floor strength and endurance, reducing the likelihood of incontinence and other pelvic floor issues.

Introducing the Pelvic Floor Strong Program

For those seeking a structured and effective approach, the Pelvic Floor Strong program offers an excellent resource. This comprehensive program, which I came across, is more than a set of exercises; it’s a complete guide to regaining control over your body. Presented in an easily understandable informational video, it provides a clear pathway to address common postpartum issues like urine leakage and diastasis recti, a condition where the abdominal muscles separate during pregnancy. The program’s evidence-based approach has garnered endorsements from healthcare professionals, including doctors, midwives, and personal trainers, lending credibility and trust to its methods. By following this program, women can work towards improving their pelvic health in a guided, informed manner.

References:

Vaginal Birth and Pelvic Floor Trauma | Current Obstetrics and Gynecology Reports (springer.com)

Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? – American Journal of Obstetrics & Gynecology (ajog.org)