Its been a while since I posted on this subject and I thought I'd try and pass on what I've noticed during my quarter of a century of managing birth and its consequences.
Essentially your pelvic floor is a wrap of muscles that hold your abdominal contents from falling down.
There are openings in that muscle for the bowel, vagina and urethra. Incredibly during birth those muscles, in a woman, stretch to allow a baby out and then recover gradually.
Its not well understood at present but I've seen that collagen (which is the tissue that holds us together) plays an important role in how all of this goes.
Sometimes my patients who have had the easiest, nicest births are the ones who report later that they feel they have a prolapse. Why? Because they have that stretchier collagen that for millenia has been the best collagen to have. While other women would be dying in childbirth they would be having their 8 kids and dying at 50 with it all falling out. Now because we want to live better and longer these tissues are more problematic. There is also the fact that due to the mesh fiasco we are actually going backwards in Women's health and all the while babies are getting bigger.
In my practice I've tried to balance getting babies out safely while causing the least damage possible. I'm working on a Star Trek like teleporter to get them out..... ETA 2028.
So if I see a baby with a head over the 90th centile in a first birth I will discuss an elective ceasar. Some choose this and others do not. Even with a big baby I'll always go along with what my patient wants to do and be with them during what is often a battle. Its how I get to show off my moves! I also feel that an obstetrician is defined - to a degree - as someone who takes you through the journey when it is tough and you are content after its over. I am not, and hope never will be, a glorified midwife who can just do ceasareans.
As a pelvic floor surgeon I do not see ceasars as a panacea for pelvic floor worries and my own ceasar rate is always significantly lower than the hospital average - while being aware of protecting your pelvic floor.
Ceasars can causing scarring in the abdomen and make treatments for any gynaecology problem down the track harder to deal with - for example if a woman needs a hysterectomy later in life vaginal births allow the ( less invasive and better supporting of the vagina after ) option of a vaginal hysterectomy. Previous ceasarseans may well mean a reopening of the cut and a tricky procedure.
But having said that they are protective for stress incontinence and for women who take the gym very seriously or do tough workouts like crossfit an elective ceasarean section should be thought of as a mode of delivery. Many women I see don't think about their pelvic floor under after babies and then its the most important thing in the world to them!
Even with less intervention and more forceps in the "Good Old Days" we have to remember that only 1 in 11 women end up needing surgery for incontinence or prolapse so we should remember the amazing capacity for recovery and the wonder of pelvic floor exercises.
Its all about informed choice and as my wife says "We Women have just got to do what we have to do! - you just be there."
Onwards and Upwards!