Pelvic Floor Muscle Damage

My pudendal nerve was injured during the forceps delivery of my second child, and I have a uterine prolapse. I'm 21-weeks pregnant with my third child and having a difficult time moving my bowels and urinating. My entire perineal area is swollen. We hope for more children, and I feel that another vaginal delivery will worsen my condition. My obstetrician agrees, but plans on a vaginal delivery with corrective surgery later because my insurer may deny benefits for a cesarean. Do many women with prolapses give birth vaginally without further complications?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Although I don't know the extent of your condition, the risks of a cesarean section generally are greater that those associated with vaginal delivery. The most common are prematurity and respiratory distress, which are sometimes overlooked. And babies may suffer the effects of medications and anesthesia given to the mother.

Some women with prolapses can deliver vaginally without further injury. However, parity (the number of births) and age are significant influences on pelvic floor muscles. Due to your concerns, I think you should get a second opinion.

In a recent article in "Obstetrics & Gynecology," 88(3):470-8, 1996, "Protecting the Pelvic Floor: Obstetric management to prevent incontinence and pelvic organ prolapse," the authors stated that "childbirth was found to be associated with a variety of muscular and neuromuscular injuries of the pelvic floor that are linked to the development of anal incontinence, urinary incontinence and pelvic organ prolapse. Risk factors for pelvic floor injury include forceps delivery, episiotomy, prolonged second-stage of labor and increased fetal size."

Cesarean delivery appears to be protective, especially if the patient does not labor before delivery. They concluded that "pelvic floor plays an important role in continence and pelvic organ support. Obstetricians may be able to reduce pelvic floor injuries by minimizing forceps deliveries and episiotomies, by allowing passive descent in the second stage -- allowing the involuntary contractions of the uterus to do the most of the work -- and by selectively recommending elective caesarean delivery."

If you and your obstetrician agree on the need for a cesarean, a journal article, similar to the one I mention above (attached with the request for pre-approval), may assist you in getting insurance coverage for the surgery. I hope this helps and I wish you the best.

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