Have you been told that your hypermobility and having an increased risk of prolapse following a natural delivery?

I find it really interesting that OBs are raising this issue yet do not raise the benefits of a natural birth nor all the risks associated with Caesarean Sections.

If you Google “Hyper mobility  and pelvic organ prolapse” these are the most resent studies that come up:

This 2012 study of 210 women did conclude that a collagen-associated disorder (I am still trying to find out if all cases of hypermobility are due to a collagen- associated disorder) does increase the risk of Pelvic Organ Prolapse (POP). However, all 210 women had had vaginal deliveries so how can we conclude that caesarean section would have been protective in these cases?

2. Joint hypermobility, obstetrical outcomes, and pelvic floor disorders

 This 2013 study of 587 women concluded that:
“Benign joint hyper mobility syndrome (JHM) may facilitate spontaneous vaginal birth but does not appear to be a risk factor for pelvic floor disorders in the first decade after childbirth.”

I wonder which one OBs are more drawn to?

Or maybe they refer to this 2016 Review:

Association between joint hypermobility and pelvic organ prolapse in women: a systematic review and meta-analysis

This review  “retrieved 39” full texts however only 14 were used in the meta-analysis. And of these 14, “six were at high risk of bias with frequent differences in sampling frames, limited validity for clinical assessments and failure to match for important prognostic variables”.

The review did conclude that there was a strong association between POP and JHM, however, they went on to state that:

“Our findings are limited by high heterogeneity and the potential for residual confounding factors. JHM is an important early indicator  for POP risk, and future longitudinal studies should explore the shared aetiology.”

So not really conclusive!


Even if you haven’t got hypermobility some OBs still like to scare women with the risk of POP from vaginal birth

I am not denying that vaginal childbirth is one of the leading cause of POP but we do have to look at the ‘compounding factors’ ie. other things that are now part and parcel of modern-day vaginal birth.

Childbirth Connection has a great article on the risks and benefits of caesarean section and they looked at the evidence into whether it is protective against sexual, bowel and urinary problems. 

This is what they concluded:

“The best available research has found no difference between women with vaginal and cesarean birth for:

  • Anal incontinence (leakage of stool or gas)
  • Urge urinary incontinence (leakage of urine with a sense of “got to go”)
  • Any severe urine leakage

However, in the short and long term, best research finds that women with vaginal birth are more likely to experience stress urinary incontinence (leakage with exertion). Current studies cannot clarify whether this is due to vaginal birth itself or to practices that are common with vaginal birth. Concerning practices include:

  • Lying on your back or with legs in stirrups when pushing and giving birth (women with epidurals)
  • Assisted vaginal birth (with vacuum or forceps)
  • Common interventions that increase the likelihood of assisted vaginal birth (epidural analgesia, continuous electronic fetal monitoring)
  • Staff pushing on your upper belly to move the baby out (fundal pressure)
  • Episiotomy (a cut just before birth to enlarge the opening of the vagina)

It would be wise to avoid these practices when possible and to follow other practices (such as having a healthy weight and not smoking) that help avoid problems in your pelvic floor.”

I would also like to see research that controls for position of birth and active pushing (straining) in the second stage. This is also called the Valsalva Manoeuvre which is not good for the pelvic floors.

However, my biggest problem with this whole issue is the cherry-picking of risks.

As I mentioned at the start I really hope your OB has also outlined the risk factors of a Caesarean Birth.

It really isn’t ok to draw attention to one possible risk factor of vaginal birth without also discussing all the risks of Caesarean Sections for mums and babies…

This is not informed consent.

You might like to read these articles:

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

And the research that shows Forceps Delivery and Episiotomies are risk factors for POP. OBs rarely mention this before doing them.

Again #notinformedconsent

And did your OB also mention that seeing a women’s health physio during pregnancy is a good idea for all pregnant women?

There are quite a few things we can all do to reduce our risk of POP.

This is an excellent resource: Pelvic Floor First

But the bottom line for me is: “It is my body and my choice”.

As I approach 50 years of age I do have trouble with POP but the only thing I would do differently is to do more pelvic floor training when I was younger.

Personally, I would never swap my 4 wonderful, empowering, vaginal births for a pert pelvic floor.



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