One of the Forum members sent me a message on the side asking about pelvic floor and vaginal recovery after childbirth. I thought other readers might be interested in this issue, so here is how I responded:

The extent to which you go back to where you were depends on some factors that relate to your care provider's policies and practices and some that relate to you. You are least likely to experience injury or pelvic floor weakness if:

* Your caregiver has a high "intact perineum" rate. This means either no injury or just little "skid marks" that don't need stitching.

* You don't have a vaginal instrumental delivery. Epidurals, BTW, increase your likelihood of having a vacuum extraction or forceps delivery.

* You don't have an episiotomy. Anal sphincter injuries almost never occur except as extensions of midline episiotomies (the usual type in the U.S. and Canada). Women have stronger pelvic floors even after perineal tears that need stitching compared with episiotomy of whatever type.

* You push according to your natural urges, breathing and making noise spontaneously. This is another reason to avoid epidurals. They numb you so you will almost certainly need coached pushing.

* You push and give birth in whatever positions you find comfortable and effective. You avoid pushing, and especially giving birth while lying flat on your back or nearly flat on your back or with your legs in stirrups. You give birth with your legs comfortably apart.

* You birth the head gently and in a controlled manner in between contractions.

* You practice your pelvic floor contractions (also called "Kegel" contractions after the ob who thought he invented them) in pregnancy and especially in the weeks and months after the birth. (If you don't know what this is, most good "how to" childbirth books such as The Official Lamaze Guide: Giving Birth with Confidence will tell you how to do these, and I'll bet you could also find instructions on the 'net.)

* You get regular exercise.

It will take several months to recover completely, so be patient. Also, know that the notion being promoted by many obstetricians that elective cesarean surgery will protect your pelvic floor is not true. First of all, studies concluding this do not take into account all the injurious practices and policies common to obstetric management of vaginal birth. Even so, by 6 mos or more after the birth, differences between women birthing vaginally and women delivering by c/sec have almost disappeared. Finally, no study finds any differences after age 50 or so. Problems with incontinence in later life are due to other factors.

-- Henci
By: Henci Goer