Pelvic Floor After a C-Section or Vaginal Birth : Possible Effects

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There is some controversy around the mode of birth and the outcomes related to long-term pelvic floor health.

We’re often asked whether a c-section is ‘better’ for the pelvic floor than giving birth vaginally.  You may have read that a Cesarean birth is more likely to preserve the muscles in your pelvic floor, whilst a vaginal birth may cause pelvic floor dysfunction afterwards.

This article is to help clue you into some possible effects of any birth on your pelvic floor. There is no “right” way to give birth, and of course, whether we give birth by Cesarean or vaginal birth, is often not a choice! It’s important to feel educated on your situation, however your birth experience goes.

A little bit of preparation and awareness can go a long way

Each body is different and in the case of birth, there are (at least) two bodies at play here. This makes looking at statistics and research to tell what is “best” a little tricky.

A baby with a weight on the larger size might have more of an impact in pregnancy and birth on a woman’s pelvic floor than in other situations. Or, for example, a smaller baby sitting lower and for longer in the pelvic brim, or a birth with a longer pushing stage could have more of an impact on the pelvic muscles than a heavier baby born vaginally in an average amount of time. 

So, where research and statistics are helpful for setting up a gauge of what you might expect, it’s far from being a crystal ball. In considering that, it’s helpful to think about your pelvic floor health no matter if you have a planned Cesarean, a small baby, multiple babies, a homebirth, are planning for a second or third birth, or are high-risk. A little bit of preparation and awareness can go a long way.

The Impact of Pregnancy on Strength and Tone

Pregnancy itself can change the tone and strength of your pelvic floor.

As your uterus does its incredible expansion and you grow a baby in there (or a few of them at once), it is obviously going to put some added strain on the soft tissue in your pelvic floor. They are responsible for holding up your organs and experience the added pressure of supporting the weight of a baby.

You can read more about the changes to your pelvic floor in pregnancy, including pelvic floor exercises for pregnancy in our pelvic floor resources section of the website. 

Vaginal Birth and Your Pelvic Floor : Tips for Protection

Vaginal birth can cause strain to the pelvic floor in multiple ways.

Long pushing stages, prolonged labor, medications and other interventions (more below), baby not being in an optimal position, and lying in a position where you are tightening or pushing up against part of your pelvic floor in labor can all cause increase the likelihood of pelvic floor damage from vaginal birth. 

To potentially protect your pelvic floor and perineum in vaginal birth:

  • Do pelvic floor exercises in pregnancy. 
  • Take care of your mental health in your birth prep. Ask questions to feel informed and to ease anxiety.
  • Do talk to your Midwife or OB about pelvic floor prep for birth. 
  • Don’t forget to stretch and release – more on releasing your pelvic floor here. Pelvic floor strength is not just about squeezing and tightening, especially in birth prep. 
  • Do your research around birthing positions for pelvic floor protection. 

Operative Vaginal Birth

In some births where there are more complications, more interventions will be advised or needed.

This might come in the form of medications to quicken labour (pitocin, misoprostol) or instrumental interventions like catheters, cervical balloons, episiotomies (a surgical cut to your perineum), forceps, or vacuums. When these techniques are used to help with birthing, it’s called an “operative vaginal delivery.” 

Where these interventions are necessary, they can be life-saving, so please never feel shame around medical intervention. But forceps, vacuum etc can affect your pelvic floor muscles more than non-operative vaginal births. There’s no right or wrong, and outcomes will vary from mother to mother. All risks and benefits will be taken into consideration in making these decisions with your support team and primary care provider. 

If you have had an operative or otherwise more complicated vaginal birth, it’s a good idea to request follow-up care specifically focused on your pelvic floor. Luckily, this is becoming something more built into standard postpartum care, but you may have to take the added step of asking for it if not offered. 

Cesarean Birth : Your Pelvic Floor After C-Section

There is sometimes a belief that Cesarean birth will leave your pelvic floor intact by avoiding vaginal birth. But it may not be that simple. 

There are instances where Cesarean births protect your pelvic floor more — one recent study suggests this is true for VBACs and others show a possible lower risk for Cesarean surgery over some operative vaginal births. In low-risk situations, vaginal birth with minimal or no instrumental interventions, but in water or with a focus on passive pushing, etc., vaginal birth may have less of an impact on pelvic floor health than surgery. There are a lot of factors at play! 

As mentioned, pregnancy itself typically changes the tone of your pelvic floor muscles, as well as all the muscles in your core. That’s true, so you can have pelvic floor issues after a c-section or a vaginal birth. 

Cesarean birth is a major surgery and involves incisions through major muscle groups. Our bodies are incredible healing machines and Cesarean births keep getting safer and safer, but it is surgery nonetheless and you will have a prolonged period of recovery. This should include focusing on your pelvic floor after a c-section (vaginal muscles included) when recovering. 

Read our article here for more tips on pelvic floor exercises after a c section including how to do them, when to start and even dietary tips.

Caring for your Pelvic Floor in Postpartum

Whether you’ve had a vaginal or Cesarean birth, paying attention to the strength and stretch of your pelvic floor in postpartum is ideal.

Here are some tips:

  • Check-in with a pelvic floor physical therapist after birth.
  • Be easy with yourself. Don’t focus on “bouncing back” so much as bringing yourself back to a strong center. 
  • Don’t ignore symptoms like leaking or pain. They’re common, but there are many strategies and solutions to alleviate and fix these issues, so don’t suffer in silence. Your pelvic floor physical therapist and MUTU will help!  
  • Try to take the time for breath-work (the foundations of MUTU Core© exercises), rest and relaxation, and take care of your mental health. Might sound woo-woo, but it’s truly part of having a healthy pelvic floor, we promise 💜.

Learn more about caring for your pelvic floor from pregnancy to postpartum here. 

Emily Flynn
Emily Flynn
Emily Flynn is a birth and postpartum doula, author, and researcher based in California, USA. She writes about reproductive technologies, maternal mental health, infant sleep, and postpartum fitness. You can find her writing through MUTU System and her substack, Doula Thinking.

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