Richmond Practice - Too posh to push?

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Too posh to push?

~ the health implications of a vaginal delivery to the mother

By Alexandros Derpapas MD, DM, Consultant Obstetrician and Gynaecologist

Published in Parent News, November 2015

It is broadly acknowledged that trends in childbirth have changed significantly. This shift has had various implications, among which the rise in caesarean section rates are one of them. But, what are the reasons for mother’s wanting their babies to be delivered via caesarean section? Are mum’s to be simply too posh to push?  

Benefits of a vaginal delivery

The benefits of a vaginal delivery are well-known and it potentially outweighs the risks (trauma and tears) or medium to long-term consequences on the pelvic floor. Caesarean section carries a potentially serious risk to both mums and babies (prolonged hospital stay, increased risk of infection and bleeding and breathing difficulties for the newborn). All these factors require consideration when deciding on your preferred mode of delivery.

What are the potential adverse consequences of a vaginal delivery?

The percentage of women suffering from urinary incontinence and vaginal prolapse (loss of support for the uterus, bladder or bowel) after a vaginal delivery is 35% and 50% respectively according to reasonably sizeable epidemiological studies. There are a substantial numbers of women struggling with problems after a vaginal delivery and that could be attributed to the impact of pregnancy on the pelvic floor and their wish to deliver via caesarian section.

Childbirth is also an independent risk factor for developing prolapse; women who give birth to just one child have a two-fold increased risk of developing a lax vagina which might fall out of it’s normal position in comparison to those who have not had children. Each additional child birth adds a further 10-20% increase in risk. The link between childbirth and urinary incontinence is stronger; a single delivery increases a woman’s risk of developing urinary incontinence by 40% and this risk is further increased by almost 100% with a higher number after every delivery. More babies increases the chances of a woman developing urinary incontinence and/or vaginal prolapse at some point in her life.

Does a caesarean section protect your pelvic floor?

There is evidence to suggest that a caesarean section will significantly reduce your risk of developing stress incontinence by almost 50%. There is also a lesser risk of developing prolapse, in comparison to women who had a vaginal delivery.

Another point that needs to be made is that symptoms of a weakened pelvic floor manifest not only after childbirth, but also during pregnancy, which implies a link between incontinence and prolapse with pregnancy itself rather than mode of delivery alone.

In conclusion, although caesarean section seems to be protective of a woman’s pelvic floor, a decision for an elective caesarean delivery needs to be cautiously made after risks and benefits are thoroughly balanced against individual aims and risk factors. 

Consult your doctor or midwife:
  • For an objective appraisal on the advantages and disadvantages of a vaginal delivery
  • To discuss how you might prevent prolapse or incontinence in pregnancy and after child birth
  • At six weeks post-partum if there are concerns about prolapse or incontinence
  • If you develop incontinence or prolapse later on

At +richmond practice we offer consultations in pregnancy to 20 weeks and postnatal checks, six weeks post-partum to help you debrief after your delivery and to ensure that you are medically fit. We also offer consultations about prolapse and urinary incontinence which are taken by a consultant gynaecologist, who has the latest ultrasound technology available to her. Call for a same day appointment on 020 8940 5009 or email us at mail@richmondpractice.co.uk
 

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