Vaginal delivery and the pelvic floor.

Abstract

During the last several decades, the use of the term 'birth injury' has evolved to denote injury to the neonate. Previously the term was used to indicate maternal injury, i.e. the type of maternal injury that results in urogynecologic problems. In his landmark 1942 paper describing his suburethral sling technique, Albert Aldridge frequently referred to 'birth injury' and stated that 'the importance of birth injuries to the nervous mechanism which controls bladder function probably has not received the attention it deserves' [1]. More than 50 years later, this statement remains true and there are increasing social pressures affecting birth practices. Many of these pressures have highlighted the deficits in our scientific knowledge. There are striking geographical differences in birthing practices. The importance of obstetric fistulas in developing countries is familiar to readers of this journal. The magnitude of this human suffering and the devotion of involved physicians humbles all of us. Yet in other parts of the globe the liberal use of cesarean section is practiced with the hope of minimizing pelvic floor damage and preserving optimal sexual function. For many obstetricians, the route of delivery is increasingly influenced by patient preference and various administrative agencies. Individual patients and their physicians are left to wonder what is truly best best for today and best for tomorrow. Over the past decade, our literature has outlined anatomic and functional problems following vaginal delivery. Although some reports indicate a low incidence of these problems in women following cesarean section, vaginal delivery is clearly the major risk factor for stress incontinence, pelvic organ prolapse and fecal incon-