Incontinence After Vaginal Birth

Assumption: Incontinence and other pelvic floor disorders are more common after a vaginal birth than a cesarean birth.

TRUE????
This study says that pelvic floor disorders are more common in women who have delivered vaginally than in those who have had cesarean sections or who have not given birth to a baby larger than 2 kg.

Emily S. Lukacz, MD, Jean M. Lawrence, ScD, MPH, et al., Parity, Mode of Delivery, and Pelvic Floor Disorders, Obstet Gynecol 2006;107:1253–60

My Views:
Unfortunately, this study actually gives us almost no usable information.  While it does come to the conclusion listed above, there are many events that contribute to pelvic floor dysfunction that were not considered as a part of the study.  There are so many differences in vaginal births that lumping them all together for a study like this actually makes the results unusable.  The authors of the study themselves assert, “we did not attempt to further delineate delivery events, such as episiotomy, assisted delivery, and birth weight, for the primary analysis.”  Episiotomy (an actual CUT in the pelvic floor) and assisted delivery (putting an instrument inside the woman to pull the baby out) are going to make a huge difference in how the pelvic floor heals!  I would also like to know which of the women with pelvic floor disorders pushed while on their backs (“uphill”) and which used a more gravity-friendly position to push the baby out.  I’d like to know which were coached to push and hold as told and which were able to push with their body’s own urges.  If you pulled out the women who gave birth vaginally with no episiotomy, no instruments, no coached pushing, and a gravity-friendly pushing position, how many have pelvic floor disorders?  I’d like to see this group compared to the cesarean moms and those who have not given birth.  This is the only way we could determine whether vaginal birth itself is to blame for pelvic floor dysfunctions or whether it is our society’s version of a vaginal birth that is to blame.

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