Wednesday, October 29, 2008

Cesarean delivery protects against fecal incontinence

The latest study into whether cesarean delivery protects against fecal incontinence (FI) has reached the same conclusions as many others before it. Researchers in the U.S. (Guise et al) surveyed all women delivering between 2002 and 2003 in Oregon, and found that "vaginal delivery was associated with a greater risk of FI compared to cesarean".

The survey details
A total of 6,152 primiparous women completed the survey 3–6 months postpartum with 2,482 reporting a new onset of FI after childbirth. That's a 40% prevalence.

Although vaginal delivery was associated with a greater risk compared to cesarean, the researchers do point out that vaginal delivery without laceration or instrument assistance did not increase the risk of FI over cesarean. In addition, they report that being overweight, pushing for longer than 2 hours, and constipation were independently associated with postpartum FI regardless of route of delivery.

What the study tells us
The researchers conclude that this study "provides important data to inform counseling and management of primiparous women", and I agree. Obviously, I don't think it means that all pregnant women will or should switch their delivery plans to a cesarean, but I do think that it further supports the argument that cesarean delivery has benefits over planned vaginal delivery - and that a woman's decision to choose a cesarean is a legitimate one.

One last point. While the researchers state that vaginal delivery without laceration or instrumental assistance does not increase the risk of FI, as always, it is important to understand that these risk factors are entirely unpredictable. A spontaneous vaginal delivery without laceration or assistance cannot be guaranteed for any woman, and therefore any assessment of 'planned vaginal delivery' risks must include morbidity associated with all its potential outcomes.


Christine Fiscer, Birthkeeper said...

Actually, it IS entirely PREDICTABLE.

The more women avoid unnecessary intervention ( mainly induction, epidural, and episiotomy ), the less they will see issues with FI.

But that's too easy!

Let's perform major abdominal surgery where the woman risks major infection, a baby ending up in the NICU, possible long term avoid the possibility of fecal incontinence.

That's SO much better than avoiding an epidural.

Anonymous said...

I read the first few articles on this blog with interest. I always try to figure out the mindset behind choosing an elective procedure which will affect both the future of the mother and child. The fact that you aren't comparing good care to surgery, instead you are comparing our current shoddy state of care with an optional major surgery really reveals the truth of this. Obstetrical care has become a heinous torture that damages women so much they prefer the controlled damage of a cesarean. Sad that women are resulting to that rather than standing up and refusing to be treated badly. ACOG's President once said that they could shift the balance if they could get cesareans to 50% because the only vaginal births that would be occurring would be so bad that women would choose cesareans, freeing OB's to do only them. I guess they were right. Torture women long enough and they will agree to anything.

cesarean debate said...

Anonymous - My risk-benefit comparison takes into account the available research on ACTUAL birth outcomes in hospitals since this is where 90-99% of births take place.

If the care is 'shoddy' (your word), this doesn't change the facts. A woman cannot make her birth plan decision based on an ideal scenario of care that does not actually exist. She can only make her decision based on evidence of the reality she will experience.

Christine Fiscer, Birthkeeper said...

Silly women. Why should we demand better care, when we can sign up for elective surgery!

Are you of the camp that women who get raped, "ask for it"?

Because essentially, that's what you're saying. ;)

cesarean debate said...

birthkeeper - Following your 'rape' comment/question, I am going to politely bow out of further discourse on this subject with you.

My apologies for any inconvenience but you have allowed what I hoped might be a tolerant and respectful debate on the subject of PCD to deteriorate into one of insult and ignorance.