I only had a minor childbirth injury so why am I incontinent?

Incontinence

Yesterday I wrote about childbirth injuries. They’re common, lead to life long disability and distress and are a subject of deep embarrassment for many women.

I discussed the two most serious forms of childbirth injury: obstetric fistula, a hole between the vagina and the bladder or rectum or both; and severe vaginal tears that can result in the vagina and rectum becoming one passage. It’s not difficult to envision why either of those injuries lead to incontinence since urine and stool are released directly into the vagina and then dribble out.

As I explained, such injuries are now relatively uncommon. Fistulas are usually the result of prolonged obstructed labor and with the easy availability of C-sections they are rare. Vaginal tears, including severe vaginal tears, are still common but carefully repairing them with extensive suturing generally prevents incontinence.

Many readers might have wondered: I only had a minor childbirth injury so why am I incontinent?

The reason is because childbirth causes injuries that may not be visible, or the repair of a visible injury may be inadequate.

To understand the problem you need to understand how we achieve continence in the first place.

Outflow from both the bladder and the rectum is controlled by sphincters. A sphincter is a ring of muscle that can open and close in response to conscious or unconscious signals.

Babies are incontinent of both urine and stool, but neither is constantly dribbling. That’s because unconscious signals keep both the bladder and rectum closed until they are full. Only then will the appropriate sphincter open, releasing the contents. Then the sphincter will close until the organ is once again full.

Over time toddlers acquire the mature neurological function need to take conscious control of the bladder and anal sphincters. When continent children and adults feel the urge to void they can override the unconscious signals for the sphincters to open. In other words, they can “hold it.” But in order for them to do so, the sphincters themselves must be undamaged. Childbirth can lead to invisible injuries to the sphincters.

There’s a critical distinction to keep in mind. Bowel incontinence is nearly always the result of an injury that can be repaired while incontinence of urine may be the result of an injury that cannot be easily repaired.

The image below shows a third degree vaginal tear. You can see the muscles of the vagina have torn as well as the sphincter around the anus. Unless the sphincter is repaired, the woman will have permanent bowel incontinence. It’s relatively easy to tell the difference between the vaginal muscles and the anal sphincter in the picture, but in real life it can be quite difficult.

image

If there is any question, the provider should put a finger in the anus to determine if the sphincter is intact. If it has been torn, it can be repaired with sutures. An inexperienced provider may fail to recognize that the sphincter has been torn and may repair only the vaginal muscles. If you were to look at the repaired area with a mirror, it would look perfectly normal, but because the sphincter has been torn, there is no way to prevent the contents of the rectum from leaking out or being expelled. If that’s the cause of the bowel incontinence, it must be completely repaired, typically requiring surgery.

Urinary incontinence is different.

Urinary continence is controlled by the urethral sphincter. As shown in the image below, the sphincter’s ability to close off the bladder depends in large part on the relationship between the bladder and the urethra. The bladder is held in place by the ligaments and muscles of the pelvic floor. Vaginal birth (and to a lesser extent pregnancy itself) can stretch these ligaments and muscles causing the bladder to fall. The sphincter is still intact so urine doesn’t dribble out. But when the pressure on the bladder is increased by coughing, sneezing or physical exercise urine may escape. This is known as stress urinary incontinence and is the most common form of incontinence in women of childbearing age.

image

The maximum stretching of ligaments and muscles occurs at the time of vaginal birth. In the aftermath, the ligaments and muscles can regain some of their tone. That’s why incontinence in the first few days or weeks after birth can eventually resolve. If you are incontinent of urine at your 6 week check up, you should definitely tell your provider. He or she may suggest that you wait a little longer to see if you recover more muscle tone. Alternatively your provider may recommend Kegel exercises or pelvic physical therapy to strengthen the muscles of the pelvic floor.

How do childbirth interventions affect childbirth injuries? On the one hand, C-sections can prevent many childbirth injuries entirely. On the other hand, interventions like forceps can dramatically increase the risk of childbirth injuries. That’s not surprising when you consider that it is the passage of the baby’s head that leads to the injuries. When you apply forceps to the head, the effective size is increased and the risk of injury is increased, too. Forceps rotations (turning the baby’s head from an incorrect position to a correct position with the forceps) increases the risk of childbirth injury even more.

How about episiotomies?

The rationale for episiotomy is the belief that cutting through the perineal muscles to enlarge the vaginal opening would reduce both the stretching of the muscles and prevent major tears. Unfortunately, that’s not what happens. Cutting into the perineal muscles appears to increase the risk of severe tears; that’s why routine episiotomy is no longer recommended.

There is one exception, though. A mediolateral episiotomy (a cut angled toward the side) reduces the risk of childbirth injuries. Mediolateral episiotomies are much more painful than typical (median) episiotomies so they are rarely used.

So the role of childbirth interventions is paradoxical. C-sections reduce the risk of childbirth injuries, while vaginal delivery increases the risk of injury and forceps and episiotomy increase that risk even further. Women should be counseled about the risks of vaginal delivery in the same way they are counseled about the risks of C-section.

Moreover, efforts to decrease the C-section rate by replacing C-sections with forceps deliveries are not necessarily in women’s best interest. Yes, surgery has real risks, but the risk of incontinence (not to mention pelvic pain and sexual dysfunction) is one that cannot and should not be ignored.

It should be up to individual women to decide, based on their personal priorities, which mode of birth they prefer. A woman who prioritizes avoiding childbirth injuries should be able to choose a C-section in the absence of other medical indications.

Childbirth is inherently dangerous for babies and for mothers and the risk of death is not the only risk. The right to bodily autonomy means that women should weigh the risks for themselves, and that vaginal birth should be recognized not as a goal, but as an option with significant downsides.

  • guest(same one as below)

    Since that guest aren’t allow to edit their comment, and I forgot to add something very important. HAVING A WOMAN GIVING BIRTH ON HER BACK IS GOING TO MAKE IT 10 TIMES WORSER! Excuse for the caplocks, but how can you not know that? Didn’t they taught you that at whatever college or university you went to? No. Well shame on them. Yes. Well shame on you. The baby big head makes it hard to pass through, but the lying back position makes it even harder.

    • Box of Salt

      “that guest aren’t allow to edit”
      If you sign up for Disqus, you can edit.
      No Disqus, no editing. This is a universal “feature” of Disqus.

  • guest(same one as below)

    Ugh! I forgot to put in link. Well here they are → http://trimestertalk.com/10-reasons-give-birth-back/http://www.giving-birth-naturally.net/avoid-tearing.html#pushing

    However I rather do a natural labor and childbirth(if I can) in a birth center or better yet a hospital then at home.

    • guest

      “Giving Birth Naturally” provides no evidence for its claims and therefore does not support your argument. Where’s the science that these forms of pushing cause more tears? I’ve heard that before, too, but it needs evidence to be true. Not to mention, while a few hospitals may insist on directing pushing or being on your back (usually for a specific reason, like fetal monitoring multiples), many of them don’t.

  • guest

    You also forgot to mention that lying on your back and directed or purple pushing also causes tearing too.

    • sdsures

      What’s purple pushing? Directed pushing? As opposed to what?

    • sdsures

      What’s purple pushing? Directed pushing? As opposed to what?

  • Gimme Some Loki

    I had a 4th degree tear with my second, repaired right away by my very good OB. She told me she basically had to rebuild the anal sphincter, and the only fallout from that is that I’m kind of a tightass now, hahaha. Had a small coccyx fracture that went unnoticed until I slipped on a wet floor a few years later and broke it again (now I have traumatic arthritis of the ass). And some stress incontinence of urine ever since.

    I can’t (OK well I *could* but the doctor told me not to) have any more babies, but if I did I think I’d go ahead and ask for a C-section. That birth *felt* very easy to me right up to the end (as opposed to my first birth, where I thought I was dying but it was all very normal, LOL), but there were a host of things going on down below that I had no idea about until afterward. Funny thing too, I was actually induced a couple of weeks early because the boy had kind of used up all of the placenta and it was falling apart. THANK YOU MEDICALIZED CHILDBIRTH. So glad my husband talked me out of homebirth with that one.

    • sdsures

      OUCH! Coccyx pain is the worst!! 🙁

  • Mainly_lurking

    Hi there, I have been dealing with stress incontinence (I guess that’s the correct term) for a few years now, I had 2.5kg’s of pedunculated fibroids removed last year and still have about 20 smaller intramural ones left. I have been seeing a women’s health physio recently and she says that my problem is NOT a lack of muscle tone in my Pelvic Floor (PF) but too much, as in I’m hypertonic. She has been doing some massage which has helped and I’ve been doing some other exercises but it has become apparent to me that I hold onto a lot of my stress in my nether regions! It is a lifelong thing I think, and I think I have always had a weak transverse abdominis (TVA) as I have always had a belly and this has exacerbated the compensation by my PF.
    Anyhoo, that’s the back story, my question is, if I’m so lucky as to have a successful pregnancy at this late stage of my game, I am wondering if my hypertonic PF (which more than likely will not be fully resolved before I give birth) would increase my chances of having a tear and other injuries if I were to opt for vaginal birth? I have had so many things I have had to recover from in the last couple of years that I really don’t want to have to deal with fistulas etc but I also would like to pass on my microbiome to my child so would prefer to go vaj, if poss 😀 Is there any data or anecdotal evidence as to what’s worse during childbirth, a weak PF or a hypertonic one?

    • Roadstergal

      “I also would like to pass on my microbiome to my child”

      You’ll do that no matter how the kid comes out. It’ll develop a microbiome to match your household as it settles in and start getting things in its mouth. There are good reasons some folk want to try for a VB, but I wouldn’t put that on the list…

  • Poogles

    And some of us are just extra “lucky” and have stress incontinence without ever having even been pregnant (I’ve had it pretty much my entire life, at least as young as 9 years old) :-/

    • sdsures

      Me too – both bladder and bowels, unfortunately. I’ve not been pregnant yet (age 36), but I have spastic quadriplegic cerebral palsy which mostly affects me from the waist down. Tightness in my muscles means that I walk more slowly, with an abnormal gait (much better now from physiotherapy as a kid, but still considered ataxic). Logic suggests that the CP has affected the neuronal connections from brain to PC muscles.

      Poor balance + slow walking so I don’t fall on my face can sometimes mean I don’t make it to the toilet on time, because my nervous system doesn’t always give me enough warning. If I tried to clench my PF muscles to hold in the pee, the walking gets even SLOWER, which can cause accidents. Fortunately, my husband has helped clean up my pee and poop more than once, and loves me anyways. <3 Humiliating, but sh*t happens, right?

  • Aine

    Can I ask the people with expertise here what is the story with kegel exercises? Pregnant again after my first birth and I am noticing leaking when I walk fast or run or cough etc. I was neve very good at actually doing the elaborate Kegel routines I read about. I have started a version that I appear to be able to actually make a regular routine. So my question s are :

    – is there genuinely a proven benefit to these exercises?
    – what is the recommended routine and frequency?
    – is this version ok? I have been aiming to do 1 x 10 second tight squeeze, 10 short quick pulses, and then one of the three-floor ‘elevator’ exercise. I find this easier to actually stick to than the bigger routines I had tried previously. Should I make changes? When should I expect to see an improvement? I feel I might be improving already after three weeks.
    – any thing else I should be thinking of? I find it humiliating to smell of leaked urine and really would like to address this.

    • Elaine

      Wondering the same general thing. I had 2 babies and 2 bog-standard vaginal births. I pushed for about an hour with my first and for about 3 minutes with my second (and apparently this is not uncommon). With baby #1 I had stress incontinence from 20 weeks onward, but after birth it went away. It came back about week 8 of pregnancy with the second one. He’s now 2 and I (think I) still have it. I cross my legs reflexively now when I cough or sneeze, which seems to do as a workaround, so I haven’t really tested it lately.

  • Jennifer

    If men got pregnant, every birth would be by elective cesarean.

    • Daleth

      I actually think the current NCB craze is a lot like the BS that men used to be fed–and are still fed, though not nearly as much–about war. Honor! Glory! and all these other vague superlatives about something that actually is a combination of intense aliveness, abject terror, physical misery and the risk of being maimed or killed.

      What we need is women poets writing about childbirth the way Wilfred Owen and his ilk wrote about war:
      http://www.warpoetry.co.uk/owen1.html

      • sdsures

        But if you manage to survive the intense aliveness, abject terror, physical misery and the risk of being maimed or killed – you get to brag about it for the rest of your life, eh?

        • Daleth

          That seems to be the case. It is so ridiculous.

          Dulce et decorum est
          Pro matria pati.*

          * Pati = patior = suffer

    • TheArtistFormerlyKnownAsYoya

      You betcha. And there would be none of this working up until a month before the birth, or less.

    • Amy

      And abortion would be a sacrament.

    • sdsures

      Epidurals would be standard.

  • Heidi

    You know young women experiencing incontinence is an issue because there are now incontinence products being targeted towards young women. Poise is even using Brooke Burke as their spokeswoman. Always came out with their own bladder pads and underwear. I also recall some butterfly shaped pads for fecal incontinence. Women aren’t going to be convinced to buy incontinence supplies if they weren’t experiencing incontinence. If the problem wasn’t that big, there wouldn’t be a need to advertise for it so much and it would be reserved to the old Depends commercials targeting only the elderly.

    • Who?

      I’m sure that’s right. There are almost the same number of shelves devoted to the incontinence products as to tampons etc at my local supermarket. It would be super-irritating to need both.

    • Irène Delse

      Isn’t there another factor, obesity, linked to urinary incontinence? Even without pregnancy? I seem to remember reading something to that effect.

      ETA: Which wouldn’t explain all of this, of course. But it wouldn’t surprise me if excess of abdominal weight in any form was found to be a risk factor for incontinence. Stress the muscles supporting the bladder and all that.

      • Heidi

        I’m sure there is. And probably the risk increases when obese women get pregnant and then increases more when they have a vaginal birth.

    • The Computer Ate My Nym

      Women aren’t going to be convinced to buy incontinence supplies if they weren’t experiencing incontinence.

      Sorry, but I read this and thought about all the propaganda around how women are easily convinced to buy formula, whether they “need” it or not. Now I am imagining a campaign to convince women that incontinence is natural and normal and demands to hide the bladder pads and underwear so that women wouldn’t be tempted to use them “unnecessarily” (while insisting that of course they don’t mean to keep them from women who really need them…)

      • Heidi

        Well, probably the formula companies and incontinence companies are in cahoots! We all know how formula (and Gerber rice cereal!) causes obesity and there’s a link between obesity and stress incontinence! Someone call up Mike Adams! We have a natural news story.

    • sdsures

      I have incontinence from cerebral palsy (I’m 36, no pregnancy yet) and I ended up using Always Nighttime Pads instead of Depends because the Depends feel way too bulky.

  • BeatriceC

    On topic: long term, I have far more issues from my vaginal birth than I have from my c-sections. Heck, you can’t even see the CS scars anymore, but I can’t sneeze without wetting myself and some mornings I go running to the toilet free-flowing because I can’t hold it in. Every once in a blue moon I have to change the sheets in the middle of the night. None of that happened pre-childbirth. It’s awful. It wasn’t until I was after I had kids and started experiencing problems that the older women started talking about these things. I wish I knew before I had kids what might happen.

    • AnnaPDE

      Ouch, so sorry about these symptoms!
      I’ve also noticed how older women only start talking about these things once they’ve happened to someone too, as opposed to before. I remember my family doctor grandpa talking about how many women can’t quite hold it in when they sneeze but always thought it was some kind of sex specific ageing thing. When I got pregnant, the grandmas had pretty different opinions: the “deal with pain” one had had a VB and a CS, and was “go CS, listen to me just this once”. The other had both kids with not too nice tearing and was scared that CS would hurt the baby (cos naaaatural).
      And there was this one Halloween conversation with some mums from my stepkids’ friend group. They were a bit tipsy so instead of not wanting to scare me, the answers were honest. Turns out, 3 out of 3 had some incontinence right after, and for 2 it only resolved after years. Curiously, the ones who had a VB still yhooi should try for that as much as possible. The one with the emergency CS after 15 hrs labour was all “why didn’t I do this right away?”

      • BeatriceC

        There’s not really a sense of urgency. It’s when my bladder gets really full overnight (even when I spend 10 minutes on the toilet right before bed making sure it’s as empty as possible), sometimes the muscles just don’t work and I can’t hold it in.

    • The urinary urgency might be caused by bladder spasticity — a not uncommon issue in older women. There are very effective medications which will let you get to the bathroom in time. Ask your doctor. Stress incontinence, losing urine when sneezing, for example, is something else.

      • fiftyfifty1

        “There are very effective medications which will let you get to the bathroom in time.”

        I doubt I could find a single one of my patients who would call them “very effective”. “Barely helpful” or “Better than nothing” is more like what they say.

        • I have had an excellent result with Spasmex 30 mg QD — and I’d gotten to the point of keeping a bucket by my bed, since, with my arthritic knees, I often couldn’t get to the bathroom fast enough at night, and during the day literally planning my lfe around having bathrooms nearby everywhere I went. But, of course, YMMV.

          • sdsures

            I know where all the public restrooms are when I go out to do errands. :-/

        • Dr Kitty

          Or “I preferred the incontinence to the constipation and dry mouth”.

          Being NHS I work cheap-> expensive for OAB drugs, and everyone gets advice on avoiding bladder irritants and physio referral for bladder drills.

          Typically: tolterodine->oxybutynin->solifenacin->mirabegron.
          Everyone seems to end up on Mirabegron eventually, although usually with some residual symptoms.

          Botox seems to help some, and intermittent self catheterisation helps others.
          Thankfully I have an excellent uro-gynae service I can refer to if (when) the tablets don’t do the trick.

          • sdsures

            I’m on Botox for migraines (NHS). It’s also being used to help kids with cerebral palsy and toe-walking, have a more normal gait without needing the extensive ortho tendon release surgery I had when I was 8. It’s administered around every 12 weeks for migraine, so perhaps the protocol for CP tendon release is similar?

        • sdsures

          Oxybutynin has helped me with bladder spasms.

  • BeatriceC

    Off topic “awww” moment: MrC sharing his lunch with Charlotte. This is about as close as we can usually get without her transfer perch in our hands.

    http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_0069_zpsunntgpdw.jpg

    • BeatriceC

      I lied. MrC can get close to her now. She actually got up on his arm this evening. I’m really glad they had that breakthrough moment because she proceeded to fall off her perch and break off the tip of her beak. The bleeding proved impossible for us to get stopped on our own so off to the emergency vet we went. She let him handle her to do everything that needed to be done. She should be fine unless the bleeding starts again over night. Wanna guess who’s not getting any sleep tonight?

      • The Computer Ate My Nym

        Glad to know Mr. C was able to bond with Charlotte. Sorry that she was hurt and that you’re ending up staying up all night with her. Hope she’s okay!

        • BeatriceC

          She should be fine. She’s a little bit more timid than she was yesterday, more like how she was the first day, but she’s eating okay and drinking enough water, and the bleeding has stopped. I’m going to keep her on soft foods for a few days to give the injury time to heal. And just to show her off a little, this is what happened a few minutes before the fall:

          http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_0076_zps8d7gxdvo.jpg

          • Irène Delse

            They’re beautiful! <3

    • Kesiana

      Awww! Do you have an Instagram or something for showing off cute bird pics/stories?

      • BeatriceC

        No, I just have my personal Facebook page, though I have a running thread on “parrotforums” (different from “theparrotforum”). I use the same name there as here.

  • Guest from Suisse no more

    Preventing occult damage to my anal sphincter was why I had two maternal-request c-sections. I had a strong case: I have a J-pouch (shaped like sock, made from the end of the ileum folded upon itself, and cut and sewn together), not a rectum or colon. I didn’t go through all that surgery to have a J-pouch constructed only to lose it to childbirth.

    But all women should know the risks, and should have the same choice, because incontinence is a real risk of childbirth.

    My mother-in-law developed fecal incontinence in her 70s, the result of occult sphincter damage during childbirth.

  • Inmara

    Am I the only one who starts doing Kegels almost involuntarily when reading these latest posts?

    • BeatriceC

      I’ve done more kegels in the last two days than I have in the whole last month.

    • demodocus

      um, nope

  • TheArtistFormerlyKnownAsYoya

    I’ve had stress incontinence for a few years now, not due to childbirth. My only guess is the 5cm fibroid that was discovered recently? Now, to throw you all for a loop – my stress incontinence seems to have disappeared now that I’m 5 1/2 months pregnant. I haven’t mentioned it to my OB yet, but it’s very odd isn’t it? Is it possible the fibroid moved away from my bladder area with the expansion of my uterus?

    • fiftyfifty1

      Pelvic floor/organ prolapse symptoms can indeed improve in pregnancy once the uterus is large enough to be stuck up above the pelvis. Think of a grape vs a plum in an upside down bottle. The grape will fall into the neck of the bottle, but the plum stays up higher. Sadly, it’s only temporary. Once the baby is out, it all hangs low again.

  • Clorinda

    I saw in a conversation with some about birth that “natural tears” are better than episiotomies because jagged edges heal better than straight cuts. They didn’t say whether or not stitching would happen with the jagged edges. I wasn’t sure what to think about that.

    • CSN0116

      It was always my understanding that tearing vs episiotomy preference is totally subjective and a call that has to be made in the moment. I had an episiotomy with my first vaginal birth, a very small one (9lb baby), and my mother, nurses, and doctor all agreed it was 100% the right call for the moment. I was doing OK until his shoulders, then my fast-thinking OB intervened and kept me at a 2nd degree repair :/

      • Irène Delse

        That’s basically what happened to my mom when I was born. She healed easily and never questioned that the OB acted in her interest. But i wonder if she wasn’t simply among the lucky ones, whose episiotomies didn’t tear?
        But she certainly didn’t enjoy her “natural” 2nd degree tear with the second child, that’s for sure!

    • Linden

      I like Dara O’Briain’s take on that. “Oh yes, quite true. That’s why, these days, most surgeons will make the initial incision… with a BEAR!”

    • Dr Kitty

      Nope.
      Nope.
      Nope.

      Have you seen people with scars from trauma?
      Car accidents, falls, that sort of thing?
      Have you seen people with surgical scars?
      Which scars tend to look better?

      Tears don’t heal better than cuts.

    • AlisonCummins

      It depends. Fifty years ago a common practice was the “routine episiotomy” where every woman would get an episiotomy during every vaginal delivery on the apparently reasonable theory that this would reduce tearing.

      Obstetricians followed up by doing the studies and discovered the theory was wrong, and now episiotomies are not done routinely. Now they are only done where indicated.

      So today, if someone’s giving birth and the baby is stuck and needs to come out NOW, it’s entirely possible that the OB will perform a nice big episiotomy. That’s because studies have shown this will lead to a better outcome than the alternatives of letting the baby stay stuck, or letting it stay stuck until they can do an emergency C-section, or letting it stay stuck until the mother eventually pushes it out but too late and with lots of tearing.

      The same OB who performed an episiotomy for a stuck baby is not going around performing episiotomies routinely for every vaginal delivery.

  • niteseer

    I was born with a birth defect of the anus (imperforate anus) that was corrected with two surgeries as an infant. No one thought to caution my parents that continence issues could arise due to pregnancy and vaginal delivery. Problems started immediately after my first child, and worsened over the years, until I finally had to have a colostomy due to bowel incontinence. I wonder how things might have been different if I’d had scheduled C-sections, rather than vaginal deliveries with episiotomies and tearing.

    I was a member of a support and discussion group for colostomates, and there was always at least a couple of women active in the forum that had rectovaginal fistulas due to birth injuries. These were the more severe fistulas, that had already had several unsuccessful attempts to repair with a one step procedure. For these ladies, a colostomy was done to totally divert stool from the rectum so that the repair could heal, in the hopes that the fistula would not recur. For some, it took years for a successful surgery and healing to take place. For a few, it never was successful, with each repair breaking down again until they gave up and resigned themselves to a permanent colostomy.

    I don’t think that increasing the use of forceps in order to reduce the incidence of C-section is in the best interests of the mother, AT ALL, unless some severe medical issue makes C-section very risky. And I think that the added risks of prolonged labor, possible shoulder dystocia, and possible forceps injuries makes this a poor choice for the baby as well.

    • fiftyfifty1

      “I don’t think that increasing the use of forceps in order to reduce the incidence of C-section is in the best interests of the mother, AT ALL, unless some severe medical issue makes C-section very risky.”

      I agree. We shouldn’t be promoting forceps to bring down the general CS rate. That said, there are some women for whom a forceps delivery rather than a CS delivery is a good choice. Like women who want large families.

    • Guest from Suisse no more

      I am so angry that no one told you of the risks! But, in fact, no one told me of the risks either — I had to figure it out for myself. When I chose an OB, he just happened to be the head of uro-gyn (pure fluke), and said that I made a wise choice which would have been his recommendation too. But it’s true — my first surgeons never mentioned it, and it never occurred to my GP or my first OB (who did not deliver my baby).

      I think that is because they have such little experience with cases such as ours, they don’t connect the dots.

    • Daleth

      I don’t think that increasing the use of forceps in order to reduce the incidence of C-section is in the best interests of the mother, AT ALL, unless some severe medical issue makes C-section very risky. And I think that the added risks of prolonged labor, possible shoulder
      dystocia, and possible forceps injuries makes this a poor choice for the baby as well.

      I COULD NOT AGREE MORE. In addition to the exponential increase in the risk of pelvic floor damage, forceps can be devastating to babies. An OB in, I think, Texas recently killed a perfectly healthy little girl trying to get her out with forceps. And my mother was permanently handicapped due to forceps-induced nerve and spinal cord damage at her own birth.

  • EllenL

    This is fascinating.
    And it makes me very glad that I’m finishing having children.

  • Are you nuts

    I will never forget a day or two after having a baby pulling down my pants to discover my bladder had already emptied itself unvoluntarily. It was such a scary moment of – is this the rest of my life? Luckily that level of incontinence quickly went away and I’m now to the stress incontinence phase of my life!!

  • Jennifer

    I had no incontinence during or after pregnancy. Should I be concerned this could pop up later?

    • fiftyfifty1

      Hopefully not, but it could. Some women experience no incontinence until after menopause when the pelvic tissues become less robust because of lack of estrogen. My mother had no incontinence until menopause but has mild incontinence now. Some women have none and develop none.

      • Phascogale

        I didn’t either but I had found that I do get a bit of stress incontinence now. It’s probably been happening for the last 4 or 5 years but it’s very, very minor. I don’t like getting sick with a cough as that is unrelenting. But if I tense (when about to sneeze) I tend not to leak. I should also do some kegels too. I’m a bit slack on that front. I’m not going through perimenopause either. Youngest child is 10

      • Elizabeth Neely

        I have hit menopause and I do have some difficulties emptying my bladder, but taking replacement hormones and using a vaginal moisturizer does keep things in check most of the time.

        • Who?

          Interesting-I have just had my first uti in more than 20 years, and sounds like I’m at about the same stage as you, and am on hrt and using pessaries. I wonder if I’m not emptying as well as I think I am?

          All crossed it is a one-off I’d forgotten how Extremely Unpleasant a uti is.

    • Lena

      Anecdotal, but the vast majority of women in my family who have had vaginal births develop incontinence and often bladder prolapse after menopause. My 66-year old mother with her three c-sections is fine; her sisters with their vaginal delivers are all looking at surgery. Don’t even get me started on my grandmother and her sisters–all had homebirths in the Caribbean.

  • crazy grad mama

    Very interesting. I don’t have incontinence issues (thanks, scheduled C-section!), but my bladder has never been the same since pregnancy. It hurt a lot the first few weeks (my doctor ruled out a UTI and then basically told me to wait it out). Now it just aches sometimes, and it can take a lot of coaxing to fully empty it.

    We really don’t talk about how much pregnancy and birth can permanently change women’s bodies. On the one side it’s “ew lady issues” and on the other it’s “birth is natural, nothing could go wrong!”

    • sdsures

      Not just “Ew, lady issues” – men can become incontinent.

  • mostlyclueless

    Welp now I’m terrified of even a successful VBAC. 10 weeks to go.

    • fiftyfifty1

      Good luck! It may go great. For many women it does. And there are real upsides to having a successful VBAC, especially if you are planning a large family.

    • CSN0116

      I had 2 scheduled cesareans followed by two VBA2Cs. Yes, “things” were changed after the VBA2Cs that did not change after the cesareans – duh. However, so long as you’re not some die-hard VBAC-er who is anti interventions or a repeat cesarean, if needed – you’re in a much better position. We wanted a large family (and we got it!), so the VBA2Cs were definitely worth it. Good luck to you!

  • demodocus

    Stress incontinence is such fun, compared to more serious kinds anyway.