Eek! A Leak!

By Sarah Bowen Shea

Giving birth to my older daughter, now 6, required six hours of pushing. During my postpartum checkup, my doctor told me that my pelvic-floor muscles seemed lax and I might want to see a physical therapist about strengthening them. At first, I scoffed at the idea—who had time for P.T. appointments with a newborn, and how would I exercise those mysterious, invisible muscles anyway? Then my doctor told me, "If you ignore the problem, it could lead to incontinence." That got my attention.

Like me, about 10 percent of women who give birth vaginally each year experience an injury during labor and delivery that can potentially result in pelvic-floor disorders; these include urinary and fecal incontinence and pelvic organ prolapse (when the uterus or bladder drops into the vagina). "Twice as many women suffer a major injury to the muscles near the birth canal per hour of labor as suffer injuries per hour of play in major college athletics," says John O.L. DeLancey, M.D., director of the Pelvic Floor Research Group and a professor of obstetrics and gynecology at the University of Michigan, Ann Arbor. Though experts aren't sure what causes pelvic-floor disorders, giving birth vaginally is linked to far more problems than having a Cesarean section. Use of forceps compounds the risk. In fact, DeLancey says, "What's most associated with muscle damage is a forceps delivery."

Injuries happen more frequently during a woman's first delivery, although problems can arise from subsequent births. Your risk of developing incontinence rises only slightly if you have given birth more than once, but having several children boosts your odds of developing the more serious problem of prolapse. For example, delivering one baby vaginally makes you four times more likely to have pelvic-organ prolapse, while having two bumps your odds up eight times, and bearing three babies jumps your chances up 10 times.

Some women blame pelvic-floor problems on having a vaginal birth after a C-section (VBAC), but this is not the case. "A VBAC is like any other vaginal delivery," explains Mark D. Walters, M.D., a professor and vice chairman of gynecology at the Cleveland Clinic in Ohio, adding that the reason a woman had to have a C-section might cause a problem when she delivers vaginally later. For instance, a woman with a tight pelvis would avoid trouble during delivery by undergoing a C-section. However, if she has a subsequent vaginal delivery, she might then have a problem. So any damage that occurs is not the "fault" of the VBAC itself but the result of delivering vaginally.

Preventing the problem

There is controversy over scheduling a C-section solely to avoid pelvic-floor disorders. "I am very much against everyone having C-sections," says DeLancey, who points out that for every 10 C-sections performed, only one case of pelvic-floor injury would be prevented.