Have you been been told that hyper mobility and having an increased risk of prolapse following a natural delivery?

I find it really interesting that OBs raise this issue yet do not raise the benefits of a natural birth nor all the risks associated with Caesarean Sections .


They also rarely mention that forceps deliveries increase all women’s risk of prolapse?

This issue has played on my mind and I decided to take a closer look.

If you Google “Hyper mobility  and pelvic organ prolapse” these are the most resent studies that come up:

This 2012 study  of 210 women did conclude that a collagen-associated disorder (I am still trying to find out if all cases of hyper mobility are due to a collagen- associated disorder) does increase the risk of Pelvic Organ Prolapse (POP). However all 210 women had had vaginal deliveries so how can we conclude that caesarean section would have been protective in these cases?

2. Joint hypermobility, obstetrical outcomes, and pelvic floor disorders

 This 2013 study of 587 woman concluded that:
“Benign joint hyper mobility syndrome (JHM) may facilitate spontaneous vaginal birth but does not appear to be a risk factor for pelvic floor disorders in the first decade after childbirth.”

I wonder which one OBs are more drawn to?

Or maybe they refer to this 2016 Review:

Association between joint hypermobility and pelvic organ prolapse in women: a systematic review and meta-analysis

This review  “retrieved 39” full texts however only 14 were used in the meta-analysis. And of these 14, “six  were at high risk of bias with frequent differences in sampling frames, limited validity for clinical assessments and failure to match for important prognostic variables”.

The review did conclude that there was strong association between POP and JHM, however they went on to state that:

“Our findings are limited by high heterogeneity and the potential for residual confounding factors. JHM is an important early indicator for POP risk, and future longitudinal studies should explore the shared aetiology.”

So not really conclusive!

I am not denying that vaginal childbirth is the leading cause of POP but we do have to look at the ‘compounding factors’ ie. other things that are now part and parcel of modern day vaginal birth.

Research does show that Forceps Delivery and Episiotomies are risk factors for POP.

I would also like to see research that controls for position of birth and active pushing (straining) in second stage. This is also called the Valsalva Manoeuvre which is not good for the pelvic floors.

However my biggest problem with this whole issue is the cherry picking of risks.

As I mentioned at the start I really  hope your OB also outlines the risk factors of a Caesarean Birth.

It really isn’t ok to draw attention to one possible risk factor of vaginal birth without also discussing all the risks of Caesarean Sections for mums and babies..

This is not informed consent.

And did your OB also mention that seeing a women’s health physio during pregnancy is a good idea for all pregnant women?

There are quite a few things we can all do to reduce our risk of POP.

This is an excellent resource: Pelvic Floor First

But the bottom line is “It is my body and my choice”.

As I approach 50 years of age I do have POP and the only thing I would do differently is to do more pelvic floor training when I was younger.

But, personally, I would never swap my 4 wonderful, empowering, vaginal births for a pert pelvic floor.

 

 

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