RE: [ozmidwifery] Pelvic floor

[Mary Murphy]

I recently read this article and found it very interesting.  Worth a read and storing of the reference for those women asking about the risks of urinary and faecal incontinence following either mode of birth. MM “Returning to the key point that we have made throughout this review -- at least some of the less desirable pelvic floor outcomes attributed in this review to VB will have been due to obstetric practices that are in need of improvement. Routine and overuse of episiotomy,[56] routine use of epidurals,[57] prolonged closed glottis pushing,[58] lithotomy and other nonphysiologic positions for birth[59,60] all will cause differential increases for VB in the very perineal and pelvic floor problems to which this review has been directed. If these and other obstetric practices were improved, the reported differences between VB and CS pelvic floor outcomes would likely narrow substantially.” And It is striking that, even short term, severe UI is not different by mode of birth -- even coming from usual settings where VB is likely nonphysiologic. The occurrence of postpartum FI is very slightly increased after the experience of any birth, particularly related to the use of Instrumental Delivery. There is evidence that CS reduces the incidence of postpartum FI; however, this effect appears to be similar with respect to elective CS or CS performed during labor. Sexual dysfunction is common following any delivery; however, there is little evidence that CS reduces this risk long term. There is also some evidence that ID may have a greater impact on sexual dysfunction than either SVB or CS.