I think most of us have always assumed that having a vaginal birth does some damage in the ladybits area. One of the most depressing thoughts for any woman during pregnancy is the idea the process of “pushing a baby out” will damage the pelvic floor so badly that from that moment on, she’ll be at risk of stress incontinence for the rest of her life.
Unfunny joke: How do you tell a mother from a non-mother? Make them sneeze and see what happens.
Well, it turns out this idea, that a vaginal birth messes up your pelvic floor, is yet another myth…probably (I speculate) deriving from the days of American “twilight labour” when drugged women were tied to beds and had babies pulled from their supine bodies with forceps as a matter of routine. (I am not exaggerating.)
The real truth is: risk factors increasing likelihood of stress urinary incontinence (SUI) include having an epidural (Thanks, Transition to Parenthood) having a forceps or assisted delivery, inadequate attention paid to emptying the bladder so that the urethra is stretched (I’m always banging on about this in classes) and THE PREGNANCY ITSELF.
Let’s look at this research from Spain which you can find with the following reference:
Arrue M; Diez-Itza I; Ibanez L; et al Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum. International Journal of Gynecology and Obstetrics, vol 115, no 3, December 2011, pp 256-259.
OBJECTIVE: To identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to 2 years post partum.
METHOD: In a longitudinal study at Donostia Hospital, San Sebastián, Spain, 458 primigravid women were recruited from April to October 2007. SUI was diagnosed via the 2002 International Continence Society definition. Severity was assessed via the Incontinence Severity Index, and impact on quality of life via the International Consultation on Incontinence Questionnaire. Means (Student t test and analysis of variance) and percentages (÷(2) and Fisher exact tests) were compared, and multiple logistic regression analysis was performed with variables that were significant or close to significant in a univariate analysis (P<0.2). [I know, I don’t really understand this bit either.}
RESULTS: Among 272 eligible women attending follow-up at 2 years post partum, 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. A higher body mass index (BMI) in pregnant women at term was the only factor found to be associated with persistent SUI (odds ratio 1.19; 95% confidence interval 1.08-1.32).
CONCLUSION: Higher BMI in pregnant women at term was an independent risk factor for the persistence of SUI from pregnancy to 2 years post partum.
Spain has a pretty high reputation for encouraging epidurals and a poor reputation for encouraging active birthing methods and yet even here the fact of high BMI was the jumping-out independent risk factor for SUI. In other words, the more weight pressing down on the pelvic floor the more likely the mum is to suffer stress incontinence after the birth. Which is interesting as it suggests that it is the pregnancy itself which puts the strain on the pelvic floor – not the method of delivery. If you want a baby and you want to keep your firm pelvic floor muscles, get on with those Kegel exercises!