The Long-term Pelvic Floor Health Outcomes of Women after Childbirth: The Influence of Labour in the First Pregnancy

Abstract

Introduction: Labour and/or vaginal delivery may have long-term pelvic floor health consequences. The purpose of this study was to estimate the influence of type of labour and pregnancy factors on these outcomes. Methods: This population-based cohort study used linkage between the Nova Scotia Atlee Perinatal Database (NSAPD), the Medical Services Insurance (MSI) Database and the Canadian Institute for Health Information (CIHI) Discharge Abstract Database from 1988 to 2006. Urinary and anal incontinence, pelvic organ prolapse and fistula disorders were compared for women undergoing Caesarean section without labour to women undergoing labour and any method of delivery. Multivariate logistic analyses and time-to-event analyses were performed. Results: Absolute risks for the selected pelvic floor health outcomes were small (regardless of type of labour in the first pregnancy). Women with one or more deliveries who had no labour in their first pregnancy had reduced risks for all pelvic floor health outcomes except fistula formation, although these finding were dependent on the outcome codes used in the analysis; they were also less likely to develop these outcomes during the study period. Conclusion: Women undergoing obstetrically indicated caesarean section without labour in their first delivery had reduced risks of important pelvic floor health disorders, even after multiple deliveries. These findings contribute important information for health care providers when counseling women and their families who are weighing the risk of long-term pelvic floor disorders against the benefits of spontaneous vaginal delivery.