Labor and Delivery With a Prolapse

“Is it okay for me to try and have a vaginal delivery since I have a cystocele?”

“Should I schedule a c-section since I have a prolapse?”

“Is it safe for me to get pregnant since I have a prolapse or will it get worse?” 

 

Like most things surrounding birth, there isn’t one correct answer to these questions. We cannot predict birth. The answer truly depends on your body, your needs, your history, and your concerns. In the end, it is up to your BRAIN (Benefits, Risks, Alternatives, Intuition and what happens if we do Nothing) to decide what is best for your future birth.

 

Benefits and Risks of Vaginal Birth With a Prolapse

An overwhelming concern that women have is whether a prolapse will get worse during a vaginal delivery or if it is safe to have another vaginal birth. Unfortunately, the only thing we have learned from research is that we don’t know. On one side, there is a “marginal impact” on additional births in regard to both prolapse and levator (muscle) tearing(1, 2, 3). This is great news as research indicates that additional vaginal births were not associated with a greater risk of prolapse or muscle tears. On the other side, research says that the stage of a prolapse may worsen five years after vaginal childbirth even though there is no impact on quality of life or change in symptoms(4).  Basically, the more children you have, the greater the stage of prolapse. The catch here is that the stage is not directly related to the severity of symptoms. Since research is inconclusive on whether or not there is a risk to vaginal birth with a prolapse, let’s look at alternatives.

 

Alternatives/Considerations for Labor and Delivery With a Previous Prolapse:

  • Position/Mobile Pelvis(8)
    Similar to reducing the risk for perineal tearing, moving and being in different positions during the first and second stages of labor may reduce the risk of pelvic floor trauma. The lithotomy position, which involves lying on your back with your feet pushed upwards, has been shown to have the most risk of pelvic floor disorders. On the other hand, side-lying has been shown to reduce the number of perineal lacerations. Whether you choose to have an epidural or choose not use pain medication, having a mobile pelvis can benefit the pelvic floor.

    *For more information on moving during labor and how different labor positions can affect the pelvic floor, check out the blog Preparing Your Pelvic Floor for Labor Through Movement. 
  • Forceps(5,6,7)
    The use of forceps increases the risk of pelvic floor trauma and prolapse. However, it is important to know that forceps may not be avoidable to ensure the safety of your child. Talk to your provider before delivery to understand when they may need to utilize forceps during birth. This way, if forceps are needed for the safety of your child, you are able to give an informed decision.  
  • Induction with Pitocin(8,9)
    During labor our pelvic floor needs to relax and lengthen in order to allow the baby to descend. Without Pitocin, the pelvic floor works synergistically or together with uterine contractions to help push the baby downward. When Pitocin is utilized, the pelvic floor actually contracts more and creates a counter-pressure against these contractions. This counterpressure can cause increased force on the pelvic floor.

 

Intuition

Intuition (noun): the ability to understand something immediately, without the need for conscious reasoning. Mama bear instinct. Gut feeling. Sixth sense. Funny feeling. Whatever you want to call it, your intuition is important. Listen to your body, your brain, and your soul in order to help guide you to a decision. Sometimes it is hard to listen to our intuition when we are filled with fear. Finding a counselor you trust can help guide you through this healing journey. You can also sign up for The VBAC Link’s Fear Releasing Activity. While it was designed for mamas who are preparing for a VBAC, it is beneficial for all mamas who find themselves struggling to navigate the fears surrounding childbirth.

 

What Happens NEXT or What Happens If We Do Nothing?

We don’t currently know what will happen next or what will happen if you do nothing. What we do know is that support is available. Whatever you decide, I hope that you find comfort in your decision and receive the support you desire and deserve from your partner and provider. 

 

Lauren Keller, DC, DABCA

Elemental Chiropractic @mamaspelvicfloor 

 

References:

  1. PMID: 20506667
  2. https://pubmed.ncbi.nlm.nih.gov/29564511/
  3. https://doi.org/10.1007/s00192-018-3616-4
  4. https://europepmc.org/article/med/22955252
    5. https://ajog.org/retrieve/pii/S0002937809002841
  5. https://pubmed.ncbi.nlm.nih.gov/19481726/
  6. doi.org/10.1111/j.1471-0528.2010.02704.x
  7. doi.org/10.1016/0091-2182(96)00042-0
  8. https://pubmed.ncbi.nlm.nih.gov/29430972/

 

 

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