Happy (early) mothers’ day to all the amazing individuals in our lives who have shaped who we are today. Fitting with this month’s major holiday, this blog will debunk a common myth surround cesarean birth:

C-sections spare the pelvic floor.

This would be a wonderful thing if true, and as a pelvic health therapist I’d have a whole lot less work to do, but it is false. At Hudson Valley Physical Therapy, we see postpartum women for a variety of conditions including but not limited to pelvic pain, prolapse, urinary incontinence, fecal incontinence, diastasis recti, constipation, and SIJ/low back pain.  And these issues occur in women who have delivered vaginally or via cesarean birth.

Research conducted in 2014 showed that c-section may offer temporary protection from urinary incontinence, but as age increased that “protection” decreased (Rotveit & Hannestad, 2014). An earlier review examined over three thousand individuals including women who delivered vaginally or via c-section. Results showed that any pregnancy over 20 weeks regardless of mode of delivery significantly increased risk of pelvic floor dysfunction (PFD). (MacLennan et. al, 2000). Recent literature cited C section as a risk factor for the microtrauma that contributes to pelvic organ prolapse (Caudwell-Hall et. al 2018).

Why isn’t the pelvic floor spared with a c-section?

I am by no means an expert in all things c-section so this will be a far from complete analysis of what causes PFD following c-section. PFD can stem from events pre-delivery. When a female is pregnant, her body’s hormone composition changes. These hormones relax the connective tissue in the body to make room for the growing fetus. While this is great for baby, it takes a toll on mom. Now add several pounds of pressure in the third trimester to loose pelvic ligaments and the pelvic organs and floor muscles begin to suffer the consequences.

Why did the C-section occur? Sometimes baby just has a mind of his/her own, and things frequently don’t go according to mom’s plan. C-sections can occur after significant time spent pushing and straining which puts a ton of stress on the pelvic floor. In addition, a c-section is a surgical procedure, and just like any other surgical procedure scar tissue forms. These adhesions could affect the mobility of the pelvic organs or the length tension relationship of pelvic floor muscles.

My goal here is NOT to scare everyone away from having babies or to steer moms away from cesarean birth. The bottom line is that all women who carry a child regardless of type of delivery can experience pelvic floor dysfunction and deserve access to quality pelvic floor care. 

Megan Fosko PT, DPT

Caudwell‐Hall J, Kamisan Atan I, Brown C, Guzman Rojas R, Langer S, Shek KL (2018). Can pelvic floor trauma be predicted antenatally?. Acta Obstet Gynecol Scand, 97:751–757.

MacLennan AH, Taylor AW, Wilson DH, Wilson D. (2000). The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG, 107, 1460-70. doi:10.1111/j.1471-0528.2000.tb11669.x pmid:11192101.

 Rortveit G, Hannestad YS (2014). Association between mode of delivery and pelvic floor dysfunction. Tidsskr Nor Laegeforen, 34(19), 1848–1852. https://doi.org/10.4045/tidsskr.13.0860.