Effect of Childbirth on the Pelvic Floor

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 24th 2009

Neurological Compromise
Stretch and compression of the pudendal nerve occurs during labor as the baby’s head travels through the birth canal; this stretch can be as much as 20% of the total length of the nerve. This compromise to the pudendal nerve is most intense during pushing (the second stage of labor), through the completion of vaginal delivery.

Muscular Impairment
Extreme stretching of the pelvic floor tissues is inherent in the process of labor and vaginal delivery. The pelvic floor musculature may also be torn or incised during the birth process. An episiotomy is an incision made in the perineal body. It is automatically considered a second-degree laceration according to the following classification of perineal lacerations:

First degree-only skin

Second degree-includes underlying muscle

Third degree-extends to anal sphincter

Fourth degree-tears through the sphincter and into the rectum

Additional trauma can occur as a result of forceps use, necessitating suturing throughout the musculature and into the vaginal vault.

Episiotomy
Although episiotomy is common, occurring in 33% to 51% of vaginal deliveries (with some studies reporting a figure as high as 75%), there is no strong medical evidence supporting its use. In fact, outcomes with episiotomy are worse in some cases, including pain with intercourse and extension of the episiotomy into the sphincter or rectum. Pregnant women have many questions about labor in general and episiotomy in particular; the clinician is able to provide education and support for the patient as she explores her options.

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Tags: Effect, Episiotomy, Pelvic

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