The Long-Term Pelvic Floor Health Outcomes of Women After Childbirth: The Influence of Labour in the First Pregnancy.
OBJECTIVE
To estimate the influence of labour and pregnancy factors on long-term pelvic floor health outcomes.


METHODS
This population-based cohort study was conducted using linkage between the Nova Scotia Atlee Perinatal Database, the Medical Services Insurance Database, and the Canadian Institute for Health Information's Discharge Abstract Database from 1988 to 2006; this allowed for the evaluation of patient utilization of care providers for pelvic floor disorders and captured conservative and surgical interventions. We compared rates of urinary and anal incontinence, pelvic organ prolapse, and fistula disorders in women undergoing Caesarean section (CS) without labour and women undergoing labour with any method of delivery. Multivariate logistic regression and survival (time-to-event) analyses were performed.


RESULTS
Absolute risks for the selected pelvic floor health outcomes were low, regardless of whether labour was experienced in the first pregnancy. Women with one or more deliveries who had a CS without labour in their first pregnancy had reduced risks for all pelvic floor health outcomes, except fistula formation, and they were also less likely to develop these outcomes during the study period.


CONCLUSIONS
Women undergoing obstetrically indicated CS without labour in their first delivery may have reduced risks of pelvic floor health disorders, even after multiple deliveries. These findings contribute important information for health care providers when counselling women and their families who are weighing the risk of long-term pelvic floor disorders against the benefits of spontaneous vaginal delivery.
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.
Baharak
B
Amir
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; Department of Community Health and Epidemiology, Dalhousie University, Halifax NS.
Victoria M
VM
Allen
Department of Community Health and Epidemiology, Dalhousie University, Halifax NS.
Susan
S
Kirkland
Department of Community Health and Epidemiology, Dalhousie University, Halifax NS.
Kathleen
K
MacPherson
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.
Scott
S
Farrell
Caesarean section; incontinence; labour; prolapse