There is a great deal of controversy around the mode of birth and the outcomes related to long term pelvic floor health.

We’re often asked whether a c-section can cause pelvic floor dysfunction or whether it’s better for the pelvic floor.  And it seems like every few months there is an article claiming that either a caesarean birth or a vaginal birth is optimal for preserving the muscles in your pelvic floor. For better or for worse, it’s not that straight forward. 

This article is here to help clue you in to some possible effects of birth on your pelvic floor.There is no “right” way to give birth and having a caesarean or vaginal birth is not always up to choice. 

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 caesarean, 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 normally, and have the added pressure from 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 labour, 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 a less-than-optimal way in labour 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. 
• Don’t underplay the link between pelvic floor health and mental health in your birth prep.
• Do talk to your Midwife or OB about pelvic floor prep for birth. 
• Don’t forget to stretch! Pelvic floor strength is not just about squeezing. 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 you have this sort of tool used to help with birthing, it’s called an “operative vaginal delivery.” 

These interventions often do more damage to the pelvic floor muscles than non-operative vaginal births. They may also be less damaging to the pelvic floor than a caesarean birth. It’s not very straightforward and outcomes will vary mother-to-mother. All risks and benefits must 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 in to standard postpartum care, but you may have to take the added step of asking for it if not offered. 

Caesarean Birth : Your Pelvic Floor After C-Section

There is a misconception about caesarean birth that it will keep your vagina perfectly intact by avoiding vaginal birth. That’s not exactly the case. 

There are instances where caesarean births are safer and protect your pelvic floor more — one recent study suggests this is true for VBACs and others show a possible lower risk for caesarean 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. 

Caesarean birth is major surgery and involves cutting through major muscle groups. Our bodies are incredible healing machines and caesarean 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 her 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 caesarean 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 specialist 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 not good to have continued past the first two weeks postpartum. 
• Work on your breath and mental health. Sounds 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.