Thursday, January 22, 2009

Pelvic organ prolapse risk with vaginal delivery - are women made aware of it?

A new American study, Relation between vaginal birth and pelvic organ prolapse (by Eddie H. M. Sze and Gerry Hobbs), set out to "evaluate the relation between vaginal birth and pelvic organ prolapse quantification (POPQ) stages III and IV prolapse and whether each additional vaginal birth is associated with an increase in pelvic support defects."

Study conclusions

The researchers conclude that "Vaginal birth is not associated with POPQ stages III and IV prolapse, but it is associated with an increase in POPQ stage II defect."

Birth risk/benefit analysis
This study demonstrates that there IS a link between vaginal delivery and subsequent pelvic organ prolapse (POP), and is in fact one of a number of studies to do so. Unfortunately, women planning vaginal deliveries are not always advised of this risk. In fact, in the U.S. December 2006 'Pelvic Organ Prolapse Topline Summary by ICR', an Ethicon Women's Health & Urology survey found that among the total female population age 21 and older, only 1 in 5 (19%) are even aware that such a female condition exists.

Furthermore, 2 out of 3 (68%) women diagnosed with POP were not aware of its existence before experiencing symptoms, and the majority (81%) of women who have given birth did not receive education about the relationship between a vaginal delivery and possible pelvic organ prolapse from their OB/GYN.

Are we truly informing women of the risks associated with vaginal delivery?
"Only 15% of women who have given birth report that their OB/GYN educated them about the relationship between a vaginal delivery and the condition [yet the] greatest risk factor for pelvic organ prolapse is a vaginal delivery, at any age."

Study results
Sze and Hobbs analyzed 458 nulliparas (first-time mothers) and 892 multiparas, including 272 with one, 299 with two and 321 with at least three term vaginal deliveries, and found that the "prevalence of POPQ stage II defect among nulliparas and multiparas that had one, two, and at least three term vaginal deliveries was 25% (119/458), 50% (137/272), 66% (198/299), and 69% (220/321), respectively (p<0.001), p="0.618)." style="font-weight: bold; color: rgb(0, 0, 102);">

1 comment:

Anonymous said...

Thanks for this website - I've just discovered it. I had 2 c-sections, the second by pre-arranged choice (no way was I going for a VBAC), but the first one only because my son started experiencing heartbeat decelerations early during labor (at 2cm dilation) and my doctor thought proceeding through to the end would put him was at risk. This made it easy for me to choose a non-emergency c-section, despite all the pro-vaginal-delivery propaganda of the time (early 2000's). Iow, as I see it now, I had my first c-section only out of dumb luck.

My ob, who is female and considers herself a women's rights advocate, never told me a *thing* about any of the risks of vaginal delivery, including pelvic organ prolapse. When I asked her about tearing, she pooh-poohed my concerns, saying something meant to be soothing but actually condescending and dishonest, like, "Most tears are small and heal just fine on their own."

I'm sure she felt she was avoiding a danger she imagined of raising "hysterical fears" many women have about vaginal delivery. In fact, she was being paternalistic in a way that undermined the rights and dignity of her female patients.

Thanks again -- I'll be reading further when I have more time.