Pelvic floor trauma in childbirth – Myth or reality?
Article first published online: 24 FEB 2005
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 45, Issue 1, pages 3–11, February 2005
How to Cite
DIETZ, H. P. and SCHIERLITZ, L. (2005), Pelvic floor trauma in childbirth – Myth or reality?. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45: 3–11. doi: 10.1111/j.1479-828X.2005.00363.x
- Issue published online: 24 FEB 2005
- Article first published online: 24 FEB 2005
- Received 16 August 2004; accepted 8 November 2004.
- birth trauma;
- levator muscle;
- magnetic resonance imaging;
- pelvic floor;
The issue of traumatic damage to the pelvic floor in childbirth is attracting more and more attention amongst obstetric caregivers and laypersons alike. This is partly due to the fact that elective Caesarean section, as a potentially preventative intervention, is increasingly available and perceived as safe. As there are a multitude of emotive issues involved, including health economics and the relative roles of healthcare providers, the discussion surrounding pelvic floor trauma in childbirth has not always been completely rational. However, after 25 years of urogynaecological research in this field it should be possible to determine whether pelvic floor trauma in childbirth is myth or reality. On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the caudal aspects of the levator ani muscle, fascial pelvic organ supports and the external and internal anal sphincter. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.