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We thank Drs Yagel et al for their comment and appreciate that they have not been able to confirm an association between maternal age and obstetric anal sphincter injuries in their own obstetric service. In fact, this association did not reach significance in our own study (P = .13). However, there is evidence in the literature that, at least in some populations, sphincter trauma may indeed be more prevalent in older women having their first child,1Fitzgerald M.P. Weber A.M. Howden N. Cundiff G.W. Brown M.B. Risk factors for anal sphincter tear during vaginal delivery.Obstet Gynecol. 2007; 109: 29-34Crossref PubMed Scopus (101) Google Scholar, 2Elvander C. Ahlberg A. Thies-Lagergren L. Cnattingius S. Stephansson O. Birth position and obstetric anal sphincter injury: a population-based study of 113,000 spontaneous births.BMC Pregnancy Childbirth. 2015; 15: 252Crossref PubMed Scopus (49) Google Scholar, 3Gurol-Urganci I. Cromwell D. Edozien L. et al.Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.Br J Obstet Gynaecol. 2013; 120: 1516-1525Crossref Scopus (262) Google Scholar and this also seems to be the case for levator trauma.4Kearney R. Miller J. Ashton-Miller J. Delancey J. Obstetric factors associated with levator ani muscle injury after vaginal birth.Obstet Gynecol. 2006; 107: 144-149Crossref PubMed Scopus (359) Google Scholar, 5Dietz H.P. Simpson J.M. Does delayed child-bearing increase the risk of levator injury in labor?.Aust N Z J Obstet Gynaecol. 2007; 47: 491-495Crossref PubMed Scopus (65) Google Scholar, 6Rahmanou P. Caudwell-Hall J. Kamisan Atan I. Dietz H.P. The association between maternal age at first delivery and risk of obstetric trauma.Am J Obstet Gynecol. 2016; 215: 451.e1-451.e7Abstract Full Text Full Text PDF Scopus (33) Google Scholar Hence, we would like to reiterate the main conclusion of our article: advancing maternal age increases the risks of multiple negative birth outcomes, including pelvic floor trauma, and such increased risk should be disclosed antenatally. The risk profile of vaginal vs cesarean birth clearly varies from one individual to the next, and one of the main variables is maternal age. The older someone is at the time of her first birth, the greater the potential benefit of avoiding vaginal birth. Pelvic floor trauma and maternal ageAmerican Journal of Obstetrics & GynecologyVol. 217Issue 3PreviewWe read with interest the recent publication by Rahmanou et al1 that found risk of pelvic floor trauma increased with maternal age. We reviewed our database of >126,000 births in the years 2003 through 2015 and found that was not the case in our population. There were 25,942 primiparae with spontaneous or instrumental vaginal deliveries; among them, there were 262 cases of third- to fourth-degree tears (1.0%). We examined the rate of obstetric anal sphincter injuries in successive cohorts of maternal age at delivery from 16-45 years. Full-Text PDF