Pelvic Floor Damage Due to Childbirth: Introduction

Abstract

There is ample scientific evidence that the vaginal childbirth process is associated with neuromuscular and soft tissue injuries to the pelvic floor that are associated with the development of anal and urinary incontinence and pelvic organ prolapse. There is little ongoing debate about these findings, and the focus has been on risk factor assessment and injury-reducing interventions. As would seem natural, the concept of offering all pregnant women an elective cesarean section at term has been the focus of many recent debates and publications. A large clinical trial is probably not needed to document the benefits of prophylactic cesarean section on the pelvic floor — and women are in general very accepting of this proposal, if for no other reason than the practicality of a scheduled cesarean. Indeed, the availability of modern anesthetic techniques, accurate gestational age assessment, and minimization of morbidity associated with cesarean section make an obstetric management protocol of 100% cesarean section rate a feasible and acceptable proposal.