Effect of Elective C-Section
How does pregnancy affect pelvic floor dysfunction?
Is there a sound scientific basis for the claim that having an elective c-section protects the pelvic floor?
Does elective c-section have any long-term protective effects against incontinence?
What factors do contribute to urinary incontinence later in life?
Do women who have c-sections ever have urinary or bowel problems after delivery?
Will elective c-section prevent sexual dissatisfaction during intercourse or uterine prolapse?
If I had an anal muscle tear at my last birth, should I plan a cesarean section to prevent a repeat injury?
Are there any circumstances when I might wish to consider elective c-section?
In recent years, the claim has been made that planned cesarean section will prevent pelvic floor problems. These include concerns such as urinary stress incontinence (leaking urine with increased abdominal pressure such as when coughing, laughing, sneezing, or lifting a heavy object), bowel incontinence (leaking gas or — more rarely — feces, or a sense of urgency about elimination), sexual dissatisfaction, and uterine prolapse (sagging of the uterus). However, as you will see below, a closer examination of the issue reveals many problems with this claim. It is also important to consider the considerable offsetting risks of having cesarean surgery, which you can find in detail in Options: C-Section.
Most women who experience urinary incontinence in pregnancy continue to have it after birth as well. Almost all women, though, will recover in the months after birth. Very few women still have serious problems 6 months to a year later.
You can reduce the likelihood of having urinary incontinence by undertaking a program of pelvic floor exercises (kegel exercises) in pregnancy or after your birth. These can help prevent, relieve, or reduce urinary incontinence.
Is there a sound scientific basis for the claim that having an elective c-section protects the pelvic floor?Not at this time. The medical studies cited in support of claims that elective cesarean will prevent urinary and bowel incontinence have many flaws. These include:
Listening to Mothers, a national Childbirth Connection survey, found that women who had had cesareans were more likely to complain of all types of urinary or bowel problems than women who had had vaginal births.
As for sexual dissatisfaction, the greater likelihood of ill health and longer recovery that follows surgical delivery (vs. vaginal birth), the tender abdominal wound, and the possibility of developing internal scar tissue (adhesions) and ongoing pelvic pain all have the potential to interfere with sexual relations.
If I had an anal muscle tear at my last birth, should I plan a cesarean section to prevent a repeat injury?As tears into the anal muscle are painful and can lead to bowel incontinence, it is important to avoid them. If you don't have an episiotomy this time around, your chances of having a repeat anal muscle tear with a vaginal birth are 1 in 50 or less. You will also want to weigh the risks of cesarean section against the risks of a repeat anal muscle tear. This website's Pregnancy Topic on cesarean section includes a detailed comparison of the risks of cesarean and vaginal birth in Best Evidence: C-Section .
If you had a c-section in the past, this website has a Pregnancy Topic to help you understand your options, make your birth plan, and reach your goals called VBAC or Repeat C-Section. If you have not had a c-section and are considering planning one now, the VBAC or Repeat C-Section topic can help you understand issues you would face in future pregnancies with a previous cesarean.
Most recent page update: 2/21/2006
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