Much has been made of the research indicating that a Caesarean section has a protective effect on the pelvic floor, with some women requesting a CS in order to avoid pelvic floor dysfunction (PFD). This practices raises concern about an elective approach to CS versus natural vaginal birth, as CS are by no means without risk to the mother, the fetus, and to the neuromusculoskeletal system. Recent research contributes to this discussion by assessing several variables including quality of life factors and pelvic dysfunction following either a CS or natural vaginal birth. Twenty one women who had given birth in the prior 36 months were recruited from daycare facilities. Subjects were categorized into normal vaginal delivery (NVD) or Caesarean section (CS). Subjects were only included if they gave birth to singletons, had not previously participated in pelvic rehabilitation, or if they did not had a history of pelvic surgery, neurologic issues or trauma that affected bowel and bladder function. Outcomes tools included the SF-36, and the Pelvic Floor Distress Inventory (PFDI). Within the PFDI, outcomes tools assessed urinary, colorectal, prolapse, and pelvic floor functional impact.
Nearly 70% of the women in the group studied were between the ages of 30 and 39, with ages ranging from 21-45. The number of subjects who had given birth vaginally was 16, by Caesarean section, 5. The authors report that approximately 75% of their subjects were Caucasian, had a household income of 70,000 or more, and nearly 80% had at least a four-year degree. The women in the CS group reported higher rates of urinary incontinence and pelvic pain (90% and 67%, respectively) when compared to the NVD group (50% and 23%). Women who gave birth via CS also had higher mean scores on the Urinary Distress Inventory, Colorectal-Anal Distress Inventory, and the Pelvic Organ Prolapse Distress Inventory. The authors also noted a correlation between pelvic organ prolapse and body mass index (BMI) greater than 25.
This research contributes to the literature about birth mode and pelvic dysfunction, and the study conflicts with other data that describes a protective effect of Caesarean birth mode on the pelvic floor. While avoiding vaginal delivery may indeed help reduce some injury to the pelvic floor, this study, even though the sample size was not large, reminds us that CS delivery can be associated with pelvic dysfunction and symptoms. This study was different from many prior reports in that the subjects were surveyed in the chronic rather than immediate postpartum period. If you are interested in learning more about postpartum rehabilitation, check out the Institute's offerings on this page: http://hermanwallace.com/postpartum.