Birth and Incontinence

I’ve read many articles and studies through the years on this topic — whether the incontinence is urinary or anal.

One early study looked at older women, and divided them into two groups: women who had never had a vaginal birth (either no children at all, or only by C-section), and those who had at least one vaginal birth. It concluded that women who had vaginal births had higher rates of urinary incontinence later in life. (Think of all the commercials for Depends and similar products.) But there is one problem which immediately presents itself to me. These women were likely to all have “given birth” vaginally in the standard highly medicalized format of 100% anesthesia, episiotomy and forceps births — “knock ’em out and drag ’em out” births. Do you think that maybe having steel forceps shoved into your vagina might cause some injury? Hmm?

Another study looked at pairs of sisters — one of whom had never had a vaginal birth and the other had. This study concluded that urinary incontinence was more strongly associated with genetics than with the type of birth. Roughly 1/3 of the “no vaginal birth” group had urinary incontinence, and their sisters also had urinary incontinence; and roughly 1/3 of the “vaginal birth” group had no incontinence, and their sisters also did not. But again, this is with women who had “knock ’em out, drag ’em out” births.

Moving into more recent times, there are other studies I’ve read that show that women who have vaginal births tend to have more incontinence (both urinary and anal) than women who have only had C-sections, but most of these studies only look at the first 3 or 6 months. Other studies have shown that in most cases, any difference between the groups disappears after 6-12 months.

Just speaking in general terms, I can see confounding factors including the following:

  • whether any of the C-section births had prior forceps or vacuum attempts (my sister-in-law did)
  • whether the women were instructed in pelvic floor exercises (Kegels) prior to birth or afterwards
  • prior incontinence
  • episiotomies
  • tearing
  • position of mother during pushing (it is logical to me that there would be a tremendous difference between a woman in a “stranded beetle” position and a woman who is upright)
  • duration of pushing
  • the woman’s general health and well-being prior to pregnancy and during pregnancy (some women just heal faster than others — whether due to genetic factors or better health)
  • length of time from birth until follow-up (many problems resolve on their own)
  • whether the birth was spontaneous, or whether a vacuum or forceps was used
  • if the woman was directed to “purple push” (which being unnatural may tend to more problems than mother-directed spontaneous and natural bearing down)
  • if the woman had an epidural (it is possible that women who can’t feel bodily discomfort while pushing are in a distinctly unnatural and even painful position — although they can’t feel it due to the drugs — which may affect their pelvic floors)
  • having the person who attends the birth manipulate the perineum like in this video — I could easily see that someone’s fingers shoved in the wrong place at the wrong time could injure the urethra or the muscles that control it

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