It is a well known fact that women who have delivered children through the vaginal route are at higher risk for genital organ prolapse and urinary incontinence later on in life.

Vaginal birth especially those associated with long labours, forceps or assisted deliveries may damage the pelvic floor irreversibly. The damage seems to be the maximum during the first vaginal delivery.

In a recent report from the journal Obstetrics and Gynecology, investigators evaluated more than 1000 women, who delivered 5-10 years earlier, for symptoms of pelvic floor disorders and evidence of prolapse on pelvic examination. At enrollment, the average age of the women was 40 years, and almost three fourths of them had more than one vaginal deliveries.

They found that compared with cesarean without labour, spontaneous and operative vaginal birth were associated with 6 to 8 fold higher risks of prolapse and 3 to 4 fold higher risks of stress urinary incontinence. The likelihood of developing pelvic floor disorders was similar among all women who had delivered by cesarean, regardless of whether labour occurred before delivery.
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This report clarifies that vaginal birth, particularly when vacuum or forceps-assisted, is associated with substantially higher risk for pelvic floor disorders. However, other points should be considered before rushing to the conclusion that elective cesarean to protect the pelvic floor should become routine.

Most women with slight prolapse discovered on examination have few if any symptoms. Furthermore, multiple cesarean deliveries are associated with important morbidities including adherent placenta and organ injuries. Finally, pelvic floor disorders that occur shortly after delivery often improve on their own over time.

Women are also advised to improve their pelvic floor strength by continuously performing Kegel’s exercises during their antenatal and immediate post delivery period. This can help improve the symptoms of stress urinary incontinence substantially.