Five Myths and Facts About Childbirth and Uterine Prolapse

1/4 of US adult women report at least 1 pelvic floor disorder

Childbirth awards us with the incredible gift of children, but changes to your body can linger long after your little one has grown up. One of the most important casualties is damage to your pelvic floor muscles.

This group of muscles, ligaments and tissues do the hard work of supporting your uterus, bladder and rectum. But keep in mind that these are muscles. With enough wear and tear, they can get weak.

When these muscles weaken, things start to drop, like your uterus bulging down into your vagina, which is called prolapse.

Pamela Levin, MD, urogynecologist and Assistant Professor of Obstetrics and Gynecology with Penn Medicine, dispels five myths about what role childbirth really plays in how your pelvic floor muscles fare.

Myth 1: Long or difficult labor is usually the culprit

Although difficult labor that involves breach births, extended pushing, and deliveries that require forceps or vacuum pumps prove stressful for pelvic floor structures, prolapse can start long before delivery with pregnancy itself.

“Simply carrying a pregnancy does put a lot of strain on the support structures of the vagina and the pelvic floor that sets the stage for prolapse in the future,” says Dr. Levin. “And that’s prolapse of any wall of the vagina.”

Your pelvic floor muscles have a bowl shape that cradles your bladder, uterus and rectum. If the prolapse occurs:

  • In the front wall, then the bladder can sag
  • In the wall supporting the top of the vagina, then the uterus sags
  • In the back wall of the vagina, then the rectum can sag

“And the end result is that it creates a bulge in the vagina,” adds Dr. Levin.

Myth 2: C-sections prevent pelvic floor disorders

Having a C-section doesn’t protect you from prolapse or urinary incontinence. You’re at the mercy of many other factors as well.

“It’s the carrying of the baby, your genetics and bad luck at play,” says Dr. Levin. That’s because genes can determine muscle and tissue strength. Women born with weaker tissues are at greater risk for prolapse, reports the American Urogynecologic Society.

Dr. Levin warns women not to “make any quick judgments about how functional your pelvic floor muscles are until you’ve had plenty of time to recover after pregnancy.”

Myth 3: It will worsen with each birth

Not so, says Dr. Levin.

“We don’t have a direct correlation that says if you have a certain number of babies, you’re going to have a certain extent of prolapse,” she says.

Studies have shown that women who have never had babies have prolapse alongside women who have had multiple babies with minimal to no prolapse.

“Certainly, have as many babies as makes sense for you, your family and your life, but not so much based on your pelvic floor,” she says. “You may end up with or without it regardless of what you do.”

Myth 4: Prolapse repair surgery is fine between births

No. This is largely non-negotiable.

Dr. Levin quote

“With very few exceptions, we don’t repair prolapse until women are 100% done having children,” says Dr. Levin. “If we repair your prolapse and then you carry another pregnancy, we may be right back where we started.”

Not to mention what could happen later: “Each time we go back and do more surgery, you’re at higher risk for injuries and complications,” she says.

Myth 5: What happens to pelvic floor muscles during pregnancy remains after delivery

Thankfully, pregnancy is finite. That also rings true for the conditions that can occur during pregnancy.

“The way you are in pregnancy isn’t necessarily indicative of how you’ll be after pregnancy,” says Dr. Levin.

For example, “If you have incontinence during pregnancy, it doesn’t necessarily guarantee that you’ll have it after delivery,” she explains.

Just because pelvic floor muscles are unpredictable doesn’t mean you have to suffer.

“Prolapse may be a fact of life, unfortunately,” adds Dr. Levin. “But there are lots of things we can do to manage it, so it doesn’t have to be a permanent fact of life.”

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