Pelvic-Floor Disorders Linked to Mode of Delivery Among First-Time Mothers

By Jane Farrell

The risk of pelvic floor disorders among first-time mothers is strongly linked to how the baby is delivered, a new study shows.

Pelvic floor disorders are believed to result from weakening or injury of the muscles, ligaments and connective tissue in the lowest part of the pelvis.

The study was funded by National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and was led by Victoria Handa, M.D., of Johns Hopkins Bayview Medical Center, Baltimore.

Researchers enrolled more than 1,500 women into the study after their first birth; 778 of the women delivered by cesarean, 565 by spontaneous vaginal delivery, and 185 by operative vaginal birth (delivery assisted by forceps or other devices to extract the fetus).

Treatments for pelvic floor disorders include exercises to strengthen pelvic floor muscles.

After up to nine years of observation, researchers found that women who delivered by cesarean were at approximately half the risk of developing stress urinary incontinence (incontinence resulting after a cough, sneeze or other activity) and overactive bladder, compared to women who had a spontaneous vaginal birth. Their risk of pelvic organ prolapse (when the cervix and uterus drop into the vagina and protrude through the vaginal opening) was 70 percent lower, compared to the same group. Women who had operative vaginal delivery were almost twice as likely to experience anal incontinence and pelvic organ prolapse, compared to those who delivered by cesarean.

According to the study authors, earlier studies had linked pelvic floor disorders to childbirth, but little was known about how the mode of delivery might influence their development. Treatments for pelvic floor disorders include exercises to strengthen pelvic floor muscles, medication for bladder control problems and surgery to repair the pelvic floor and provide support for internal organs.

The study appeared in the Journal of the American Medical Association.