Options: Pelvic Floor



What factors can help or hurt my pelvic floor while giving birth?

What does it mean to give "informed consent" or "informed refusal" about these and other practices?

What is likely to be the safest and most satisfying approach to giving birth?

How can I have this type of birth?



You may have concerns about effects of giving birth on your pelvic floor, and about developing pelvic floor problems such as urinary or bowel incontinence. Fortunately, you can influence most factors that affect the strength and integrity of your pelvic floor. This Pregnancy Topic helps you understand these factors and take steps in pregnancy, while giving birth, and at other times in your life to help prevent pelvic floor dysfunction and promote good elimination, pelvic support, and sexual functioning.

Research has found that a number of childbirth procedures including some that are widely used can harm your pelvic floor. Your choice of caregiver, choice of birth setting, and decisions that you and your caregivers make impact your pelvic floor health.

What factors can help or hurt my pelvic floor while giving birth?

One concept that is gaining ground is the idea that elective c-section (cesarean by choice) will prevent pelvic floor dysfunction by avoiding vaginal birth altogether. This approach involves many risks and questionable benefit; the topic is discussed in depth in

And to help prepare for a safe and healthy birth, see pages on how the following practices relate to pelvic floor health:


What does it mean to give "informed consent" or "informed refusal" about these and other practices?

Informed consent is a process to help you decide what will and will not be done to you and your body, including whether you accept the care practices noted above and others that may be offered to you. By law, you have a right to the truth about benefits, risks and alternatives of care that is offered to you (as best as it can be known at the time), to decide what options are or are not in your best interest, and to accept or refuse care. In the case of maternity care, informed consent also gives you the authority to decide about care that affects your baby.

You will want to talk over these issues with your care provider ahead of time, of course. You should also know that few situations involving interventions that can harm your pelvic floor will be emergencies. This means you will almost always have time to learn about them in advance and discuss them when they are proposed. (Learn more about informed consent.)

What is likely to be the safest and most satisfying approach to giving birth?

Without a clear and compelling need to do otherwise, the safest and most satisfying choices for you and your baby are likely to be:

  • having a vaginal birth
  • seeking alternatives to continuous electronic fetal monitoring and to epidural analgesia
  • pushing according to the natural dictates of your body
  • pushing in the position you find works best
  • avoiding episiotomy and assisted vaginal birth (with vacuum extraction or forceps).

Planning cesarean surgery simply to avoid the possibility of pelvic floor problems is unlikely to be in your self-interest. Cesarean surgery involves numerous extra risks to you and your baby. By contrast, the likelihood of continuing to experience bothersome symptoms after the postpartum recovery period with a vaginal birth is small. Moreover, some women with continuing problems can obtain relief or cure and avoid a corrective operation by an intensive regimen of pelvic floor exercises (kegels). It makes much better sense to avoid the procedures and practices that are known to cause problems in the first place.

How can I have this type of birth?

The best way to achieve this kind of birth is to choose a doctor or midwife and a place to have your baby where those attending you agree with this approach.

Good labor support is another important element. You and your partner may wish to arrange for a birth doula, friend or relative to provide continous supportive care during labor. Studies show that women who are accompanied in labor by non-medical female companions trained or experienced in labor support are less likely to have an epidural, an assisted vaginal birth, a cesarean, and dissatisfaction with their labor experience.


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Best Evidence: Pelvic Floor Dysfunction


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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 3/10/2006