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.