Will a Cesarean Surgery Save Your Pelvic Floor?


Pregnancy is a time of so many important decisions. Which birthplace should you choose? How do you pick your birth team? And an important choice to make is desired mode of birth. 

With more awareness about the pelvic floor and vaginal problems that can arise in postpartum, there is an apprehension in women about vaginal birth. Some wonder if they should opt for cesarean surgery to avoid these problems. After all, if the baby doesn’t push out of your vagina, your pelvic floor is spared from all the trauma. Right?

1. Bladder Leakage 

Although the chance of bladder leakage is around 40% after vaginal birth, 15% of cesarean moms still experience this. Further, five years after delivery, the difference shrinks, and the overall incidence of leaking lingers at 20% for vaginal births and 15% for cesarean births. As you approach your fifties, the incidence of leaking seems to level out for both groups.

2. Pain with Intercourse

More than 60% of moms experience pain with intercourse after childbirth and six weeks postpartum, and initially, there is no difference between vaginal or cesarean births. However, as time passes (at five years postpartum), women with cesarean births seem to have slightly more pain than women with vaginal birth.

3. Organ Prolapse

Pelvic organ prolapse is more prevalent in vaginal births and what tips the scale is the use of instruments (vacuum or forceps) during vaginal birth, more than the type of birth itself. 

4. Uterine Health

Cesarean involves cutting through the uterus wall to help deliver the baby. This brings a range of possible complications with it. The most common complication is an infection, the development of adhesions at the scar, and endometriosis. Rare complications are rupture of the uterus or intensive bleeding.

5. Future Fertility 

Scarring at the uterus may hinder future fertility chances and create complications in the placenta when pregnancy does happen. 

Pregnancy itself is a risk factor for pelvic floor weakness. The hormonal changes of pregnancy are what drive the changes to the pelvic floor. These muscles will stretch progressively for nine months of pregnancy and weaken about 25% before labor. 

You can go to a pelvic floor therapist during pregnancy to prepare these muscles for labor. Perineal massage, a technique where the small muscles of the vaginal opening are stretched in preparation for birth, has been shown to reduce the risk of tearing. A pelvic floor physical therapist can help you improve your pelvic health during and after pregnancy. 

One of the most significant risk factors for having pelvic floor problems after pregnancy is having these problems before or during pregnancy. So the biggest service you can do yourself is taking care of your pelvic floor NOW!

Taking a birth class to understand how labor works and how you can work with your body to enable the smooth exit of your baby will also be beneficial. Prenatal yoga, movement during labor, and effective breathing strategies have been shown to reduce the risk of tearing. 

Or get a doula. A doula is a birth support practitioner who is trained to provide you with comfort measures, beneficial movement, and support throughout labor. Research has shown Doula care reduces the incidence of emergency cesarean surgery and birth injuries.

Despite the choice you make and the preparation that goes into it, labor and birth are completely out of our control. And if your baby does decide to make their way earthside through the belly, remember not to ignore your pelvic floor and its needs. 

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Nidhi lives in Mamaroneck with her husband Chandan and their baby Ishaan. She is a Women’s Health Physical Therapist and specializes in working with women during pregnancy, after childbirth, and the years beyond. She understands (through clinical and personal experience) how hard pregnancy and motherhood can be on a woman’s body. Her passion is to empower women to prevent problems before they happen, know when (and how) to get the care, and always feel at home in their bodies. Nidhi practices locally in Mamaroneck NY and in Midtown Manhattan. Along with helping women in her clinic, she also speaks at local libraries, childbirth education classes, and hospitals to debunk common myths and spread awareness about pelvic health. In her free time (which there isn’t a lot of), she loves exercising, hiking, learning ballet, and planning vacations. Connect with Nidhi through her Instagram page @thinkbeyondpain (and learn everything about pelvic floor and pregnancy) or visit her clinic website to work with her at www.funcphysio.com.


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