By Cora Tomowich, MScPT, Hons B Kin
As many of you know, the pelvic floor is a group of muscles that line the base of the abdomen and pelvis. Along with the other deep core muscles of the body, the pelvic floor helps to form a solid foundation upon which the rest of the body can function. But what happens when it’s not working properly?
There are many forms of pelvic floor dysfunction that can creep into our lives, such as, incontinence of bowel or bladder, pelvic organ prolapse, muscle tightness, persistent pain, etc. We know that 1 in 3 women will experience urinary incontinence at some point in their lives and the risk increases if a woman has had children. If that’s the case, then is there a delivery method that could potentially reduce that risk? It has come to my attention that there are many queries as to which birthing method saves the pelvic floor and many misconceptions surrounding how each method might impact the incidence of pelvic floor dysfunction.
In my practice, I see many new mums during pregnancy and post-partum recovery. I have heard everything from “C-sections prevent urinary incontinence” to “a rectus diastasis only happens with vaginal delivery”. Some women believe that a scheduled C-section is better than a spontaneous vaginal delivery because the mother can better prepare for the baby’s arrival. Others believe that a vaginal delivery creates a stronger mother-baby bond.
And the debate train chugs along…
So, I thought it might be helpful to discuss some of the most common advantages and disadvantages of each birthing method to try and clear things up.
Vaginal delivery is the birthing of a baby through the vaginal canal. In this method, the mother is required to go through the early stages of labour and the push phase of labour to bring her baby into the world. Some of the advantages to having a vaginal delivery include:
- Mother may be able to hold her baby sooner and start breastfeeding earlier
- As baby passes through the birth canal, he or she gets a good dose of healthy bacteria, which can boost the baby’s immune system early on
- Because of the inherent risks associated with surgery, vaginal deliveries may provide faster recovery times for new mums post-partum
- Greater freedom for the mother to choose her birthing position
But, as with most things, there is a flip side. Some disadvantages to a vaginal delivery are:
- As baby passes through the birth canal, there may be vaginal tearing which can lead to prolapse, hypermobility, and/or incontinence
- Some doctors or midwives may suggest an episiotomy to further open the vaginal canal as opposed to a woman tearing naturally
- A long push-phase can significantly strain the perineum and cause avulsion of pelvic floor muscles
- Studies have shown that women who have multiple vaginal deliveries are at greater risk for experiencing urinary incontinence
C-section or Caesarean section is a birthing method by which surgery is used to delivery one or more babies. To perform a C-section, a cut (usually horizontal) is placed though the tissues of the lower abdomen to the uterus, where baby is then retrieved. Some advantages to having this type of birthing method over a vaginal delivery include:
- Lower risk of developing pudendal and perineal nerve injury as the baby does not move through the birth canal and compress these structures
- Lower risk of post-partum urethral or vaginal hypermobility
- Decreased overall delivery time
- And C-sections are a safer form of delivery if the mother has:
- Placenta Previa
- A sexually-transmitted disease (STD) or active herpes lesions
- A multifetal pregnancy (many babies to deliver)
- Premature onset of labour or early rupture of membrane
- Or, if the mother had another C-section delivery less than 19 months prior
Wow, seems like a C-section is the way to go, right?! Well, there are some significant disadvantages to having a Caesarean that might change your mind:
- The risk of urinary incontinence is not eliminated
- Mortality rates increase by 4X in C-section deliveries versus vaginal
- There is an increased risk of neonatal respiratory distress and laceration
- C-sections also leave quite a bit of scar tissue that does not stretch easily and can lead to pain and mobility restrictions
- And as with any form of surgery, there are the inherent risks of exposure to anesthesia, higher chance of infection, blood loss and/or clotting, and longer recovery times and hospital stays
For women who are concerned about having incontinence post-partum, studies have found that antenatal and post-partum stress incontinence are more likely caused by the physical and hormonal changes that occur as a result of pregnancy, not delivery method. It is also pregnancy that is responsible for the increased risk of developing prolapse, not delivery method.
So, we see that regardless of which method you choose, there’s always going to be risk involved. Seeking the advice of qualified professionals (doctors, midwives, and doulas) is the best way to educate yourself about your options. Also, having a pelvic floor physiotherapist treat you periodically throughout your pregnancy and post-partum recovery can ensure your pelvic floor stays strong and healthy for the demands of pregnancy and motherhood.
If you have any questions or concerns about your specific prenatal care or post-partum recovery, please feel free to call our clinic anytime, we’re happy to help!