Should I have a C-Section Birth so I don’t Make my Prolapse Worse?

Should I have a c-section for my next birth?

If you have experienced pelvic organ prolapse following birth, this is a really normal and logical question to be asking. And we deeply understand why you may want to have a c-section birth. You may have fear about how a second pregnancy or birth is going to impact your pelvic floor. You may feel a deep resistance to pushing or bearing down. You may wonder how your body is going to cope or whether all the hard work you’ve done to heal your body is just going to go to waste.

We know. Because we have both experienced this ourselves and also supported hundreds of women through pregnancy and birth after prolapse.

As one of the only programs to offer an in-depth week-by-week prolapse safe exercise program, we have a lot of members who are living with pelvic organ prolapse and who are planning a second or subsequent pregnancy.

Pregnancy with prolapse can be an incredibly emotional, fear-provoking and at times overwhelming process. It takes a lot of resilience and mental strength to maintain confidence in your body and yourself -when so much of that has been stripped away from you.

Even the thought of pregnancy with prolapse can leave you feeling conflicted and fearful. And this itself feels unfair. Why should this incredible time be clouded by doubts and insecurities?

When it comes to the choice of birth for your subsequent pregnancies, there is no right answer. It is a deeply personal choice and one that we recommend chatting through in-depth with your antenatal health care team and spending a lot of time considering what YOU most want.

You may also want to watch our video here on navigating pregnancy with prolapse.

Your personal preferences surrounding your birth are the MOST important consideration when making the choice about how you would like to bring your baby into the world.

Our mission is to help women to feel more informed and empowered through every stage of their pregnancy, birth and postnatal journey. And this starts with education. So we hope that by sharing some of the latest research on birthing with prolapse, we will help you to feel more informed and empowered for this decision.

Pregnancy and the Pelvic Floor

The process of pregnancy itself places a significant load on the pelvic floor. During pregnancy, the levator hiatus (the pelvic floor outlet through which the urethra, vagina, and rectum pass through) increases in width as the muscles of the pelvic floor start to thin and stretch. In addition, there is an increased mechanical load on the pelvic floor from the weight of your baby, the weight of the uterus and placenta and the increased blood volume and body weight.

This happens prior to birth, which is why even if you had a cesarean birth, your pelvic floor will be in a weakened state and your levator hiatus will be wider than what it was pre-pregnancy.  

When women who have given birth by way of Caesarean section are examined postnatally, there is a clinically significant reduction in pelvic floor strength and also a descent of the pelvic floor by approximately 4.9mm. This shows that pregnancy itself rather than the mode of delivery has an impact on the pelvic floor which can be seen in the postnatal period.

However, it is also clear that women who give birth vaginally are 9 times more likely to experience prolapse over the course of their lifetime. They will also experience a greater descent of the pelvic floor in the postnatal period (on average a 9mm descent.)

From this, we know that pregnancy itself will place an increased demand on your pelvic floor.

If you are experiencing prolapse, this can make you feel more symptomatic. Note: An increase in symptoms does not mean your prolapse is getting worse.  There is a lot you can do during your pregnancy to protect your pelvic floor and set yourself up for optimal postnatal healing which we will share in this post.

The EMP Pregnancy Program includes specialised content for women with pelvic organ prolapse to help you to navigate pregnancy with prolapse whilst continuing to exercise safely and confidently - in order to set you up for the best postnatal recovery possible.

Subsequent Births and the Impact on your Pelvic Floor

The good news is that subsequent births (second or third births) do not tend to have a clinically significantly increased impact on prolapse in terms of rates and severity.  

And there is very little research or evidence to show that if you have a caesarean section birth for your second or third birth you will be increasing your risk of experiencing pelvic organ prolapse or of making your prolapse ‘worse’. (Please note that an increase in symptoms does not mean you are making your prolapse worse).

However, we know that for women living with prolapse, they don’t feel confident that they could undergo a vaginal birth again. A lot of this is due to the fear of pushing or bearing down as mentioned above.

This is why we believe that your personal preference for your mode of delivery is so important.

If your preference is to have a vaginal birth then there is SO much you can do. The Empowered Motherhood Program is designed to help you to prepare for birth with prolapse by understanding the birthing positions that will have the least impact on your body, how to push in a way that places less load on the pelvic floor, how to properly prepare your pelvic floor for birth and of course a complete week by week program to help you to heal from birth - for both vaginal and caesarean section births.

If you are living with prolapse and are pregnant or considering another pregnancy, we would love you support you. Because you deserve to feel confident in your body and your ability to bring another life into the world.