C-Section or Not? Choosing a Caesarean Section Delivery to Avoid Incontinence

Health Professional

Historically, a Caesarean Section or C-section for short had been performed in emergencies if a mother or baby had trouble during delivery. This procedure goes back to biblical times. In the last century, the incidence of the surgery increased profoundly. Now it accounts for at least one-third of births in this country. Some of them are performed for medical reasons including a breech delivery (which is also a relatively new trend in this country), where the baby is coming out feet first, but many of them are now elective for a variety of reasons. I have a friend who scheduled her c-section because she has a very busy job and work schedule, and for her, she felt it made sense to schedule her c-section. She discussed it with her doctor and that is what she had. When I talked to her about it, she told me that not only did she want a c-section for schedule reasons, but also because she didn't want to have incontinence from pelvic floor relaxation that we often see after a vaginal delivery.

This got me thinking; is it okay for women to choose to have a c-section for no other reason other than trying to prevent the risk of incontinence? Well, I know the answer for many women and obstetricians, the answer is yes I once spoke with a female urologist who is an expert on pelvic floor dysfunction and she truly believed that all women should have a c-section to prevent the "inevitable" injury to the pelvic floor during vaginal births. I thought this was a radical viewpoint but she made a valid point. The amount of money spent nationally on incontinence is staggering!! If someone could do something to prevent this disease, then is it appropriate?

One thing that a woman has to keep in mind is that a c-section is surgery and is not without basic surgical risks, however low they may be. Your hospital stay is prolonged to four to five days, where vaginally delivered women usually go home in two days. In general, it is felt that overall recovery is also easier with a vaginal delivery than getting over a surgical incision, but I think that point can be debated. One of my closest friends had her second child 2 weeks ago and had to have a c-section because her baby was breech. She had delivered her first child two years ago vaginally. She was so upset that she was going to have to have a c-section, and I spent a lot of time on the phone (she lives in another city), trying to reassure her, but to no avail. Now when I talk to her she tells me that her recovery is much easier than she was anticipating, and the only big issue for her is that she cannot pick up her 2 year old for a couple of months. She says that having the incision is better than having to sit on an ice pack and deal with the episiotomy stitches, which I think is more bothersome in general than people let on.

The other issue to keep in mind is that there is evidence starting to be reported in medical journals that pregnancy alone increases your risk of pelvic floor relaxation and subsequent urinary incontinence. Having a c-section does not guarantee that you will not have incontinence and having a vaginal delivery will not doom you either. I have many patients that I see for stress incontinence because of pelvic floor relaxation and urethral hypermobility that have only had c-sections, or have never been pregnant. On the flip side, not everyone who has a vaginal delivery will have stress urinary incontinence.

I think that this subject is very controversial, but is a valid topic of discussion between you and your obstetrician when you are pregnant if this is something you are concerned about. The decision is very personal, and there is currently no right answer, and I am not sure there ever will be. The most important thing is to have an open line of communication between you and your doctor if you are thinking about this.