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Incontinence After Childbirth

Making Healthy, Informed Choices During Delivery and Beyond

By Kelly Burgess

n to assume there will be any long-term, irreversible consequences to the pelvic floor," says Dr. Goldberg. "But there are a variety of factors that increase the risk of pelvic floor damage, such as use of forceps, how the woman pushes, her length of labor, the size of the baby and the size of her pelvis, to name just a few. A C-section is merely one important tool – and only one – in the spectrum of preventive strategies."

Dr. Goldberg's ideal scenario is one in which a woman, working with her doctor, plans for every possibility during labor. He says there are ways to predict possible problems and to attempt to avoid them. In the case of women like Kristen Jansen, that could help her avoid more serious problems down the road.

Jansen, of Richfield, Utah, also has three children. She had no problems with her first birth, but her second child weighed more than 10 pounds at birth, and it took her an unusually long time to recover physically from the delivery. With her pelvic floor already weakened by that difficult birth, the damage done when her third child was born several years later required rather extensive surgical correction – after an uncomfortable postpartum period of both urinary and fecal incontinence.

"When I was pregnant with my third child, I tried to discuss with my doctor the possibility of more damage, and he just kind of pooh-poohed my concerns," says Jansen. "His attitude seemed to be that we'd just see how it all came out."

Dr. Goldberg says giving women the whole picture is what he's hoping the ultimate result of his study will be. In addition, an increased focus on the long-term damage that can be caused by prolonged and difficult labors can help the woman and her medial provider decide in advance when a C-section should be done to prevent severe damage.

"Ideally, this should be part of the initial visit, something the woman and her doctor talk about," says Dr. Goldberg. "Just as they discuss prenatal vitamins and Lamaze classes, they should discuss criteria for when a C-section should be a choice. Women should feel comfortable discussing this."

Want to see more?

• The Right to Choose: Elective Cesarean Sections
• Should Women Having Large Babies Expect to Deliver by Cesarean?
• Just in Case: Making a Plan for Cesarean Birth
• Talk about it!