Pregnancy

The effects of pregnancy and childbirth on the pelvis are finally getting some well-deserved attention, both in the scientific community and in popular culture. In turn, an educated expectant mother is better able to understand what happens to her body and is able to communicate her concerns to her healthcare provider.

Effects of pregnancy on the pelvic region:
Although your pelvis appears to be a fairly rigid circle of bone, it is actually a group of four separate bones: the sacrum and coccyx at the back and the Ilia, or hipbones, on either side. The hipbones curve to meet in the front, forming a joint called the symphysis pubis. During pregnancy, a hormone called relaxin is secreted to soften (and eventually open) the pelvic joints in preparation for childbirth. This change in the pelvic bones and joints may cause a feeling of instability and can contribute to back pain and a loss of balance.

The pelvic region also includes a web of muscles, nerves, and ligaments. During pregnancy, the muscles of the pelvic floor are stressed, especially in the later months, when the weight of the fetus, amniotic fluid and placenta are at their heaviest. This added pressure may cause you to leak urine. Pregnancy can also alter the strength and elasticity of the pelvic muscles and ligaments, damage nerves in the pelvic region, or, in rare cases, alter the position of organs. These issues can, in turn, affect bladder health after the pregnancy is complete.

Effects of childbirth on the pelvic region:
As the fetus descends through the birth canal, the dilation of the pelvic opening affects the vagina, bladder, and urethra as well as the surrounding muscles ligaments, and nerves. The intense pressure and stretching of the vagina and perineum may cause nerve damage and/or muscle detachment and weakness. In some instances, the perineal tissue can tear. For women who have experienced a perineal injury with their first delivery, the risk of spontaneous tears increases with subsequent deliveries.

Other factors may increase the risk of pelvic floor injury, including:

Prolonged second stage of labor
Use of forceps or vacuum extraction delivery
Larger than average babies (also referred to as fetal weight)
Twins or higher-multiple pregnancies
Advanced maternal age
Episiotomy. This procedure, which involves cutting the perineal tissue, can also increase the risk of pelvic floor injury and should be discussed with your physician, healthcare provider, or midwife before delivery
Epidurals. This procedure, which involves the injection of anesthesia a catheter placed into the outmost part of the spinal canal, can slow labor or numb the sensation of natural contractions, increasing the need for forceps, vacuum delivery, or even Cesarean section.

The more severe the injury to the pelvic floor, the higher the likelihood that symptoms will persist beyond the normal post-partum recovery period.

Cesarean delivery vs. Vaginal Birth:
One area of intense debate and research is the risk of vaginal delivery vs. C-section. Some studies cite a significant reduction in pelvic floor injury with childbirth by Cesarean delivery, but most pelvic health professionals note that the risks associated with surgery, both for the mother and the baby, may outweigh the benefits. These risks must be carefully evaluated before making a decision. The choice between vaginal or Cesarean birth is highly personal and should be discussed with your physician, healthcare provider, or midwife well before childbirth.

Other Considerations for Childbirth:

Some hospitals and birthing centers offer less-traditional options for labor and delivery. These options include:

Water birth
Non-continuous fetal monitoring
Alternate birthing positions
Pushing only according to natural urges
Perineal massage and stretching to avoid episiotomy

Did You Know?

Postmenopausal women who have delivered at least one child are twice as likely to experience organ prolapse that those who have had no children.

Pregnancy may cause symptoms of stress incontinence, even if you have never leaked before getting pregnant. Studies indicate that these symptoms peak at 38 weeks gestation.