Doctors are required by law to inform women about potential problems that could happen during a cesarean section. However, when the delivery will be vaginal, this type of direct conversation rarely occurs. And childbirth classes tend to gloss over it, as do many popular pregnancy books.1
Studies show that around 50 to 80 percent of women who give birth experience tearing of the pelvic skin and muscles and, for more than 1 in 10 women, the tearing is severe enough that it damages the anal sphincter. Subsequently, this can lead to loss of bowel and/or bladder control.1 A Canadian study conducted in 2015 found that half of all mothers were still reporting urinary incontinence one year after the birth and more than three quarters had residual back pain.2
Overall, according to a study conducted in 2008 at the California HMO Kaiser Permanente, around one third of women suffer from a pelvic floor condition (such as pelvic organ prolapse, fecal incontinence, and urinary incontinence) and approximately 80 percent of these women are mothers. Women who deliver vaginally are twice as likely to experience these injuries than women who have not given birth or women who have undergone a cesarean section. In addition, for 1 in 10 women, the problem is severe enough to require surgery.3
Unfortunately, it is hard to determine the contribution of childbirth to pelvic floor disorders, partly because the majority of hospitals do not track what happens to a new mother after the birth. Additionally, some pelvic floor injuries take a while to become apparent. Some women make it through the delivery without complications, only to suffer incontinence or prolapse years or decades later.1
The risk of complications during childbirth increases greatly with age. One reason is that older mothers are more likely to go past their due date. Also, older mothers tend to have less effective contractions, which can result in longer labors and extended pushing – situations which are strongly linked to pelvic floor injuries.1
How can I avoid these injuries?
The first issue to consider is whether you are at high risk for injury. If you are older than 35 years of age, have a narrow pelvis, or are carrying a very large baby, your risk of childbirth injury increases. In addition, pushing for more than two and a half hours has been found to increase the risk. If you identify yourself with any of these characteristics, discuss with your doctor or midwife whether a cesarean section is advisable. If your baby is very large and you would like a vaginal birth, an early induction might be appropriate. Interestingly, a study published in 2010 found that epidural anesthesia appears to protect women against damage to their pelvic muscles. The use of forceps was associated with a three- to four-fold increase in risk of pelvic muscle injury, whereas vacuum delivery was not.4 Therefore, these are important factors to consider when discussing your upcoming birth with your doctor or midwife.
At the end of the day, it is your body and you deserve to be appropriately communicate the potential risks associated with all types of birth, whether you will have a cesarean section, induction, or vaginal birth. Only then, you will be able to make an informed decision that is right for you.