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Elective cesarean delivery: the pelvic perspective.

Anne M Weber1

  • 1Pelvic Floor Disorders Program, Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA. webera@mail.nih.gov

Clinical Obstetrics and Gynecology
|May 22, 2007
PubMed
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Elective cesarean delivery shows weak evidence for improving urinary incontinence compared to vaginal birth, with unclear long-term effects. Pelvic floor function outcomes like prolapse and sexual function showed no difference between delivery methods.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Pelvic Floor Disorders

Background:

  • Elective cesarean delivery on maternal request is a growing consideration in obstetric practice.
  • Concerns exist regarding potential impacts of delivery mode on maternal pelvic floor function.
  • The National Institutes of Health convened a State-of-the-Science Conference to address these issues.

Purpose of the Study:

  • To evaluate the evidence comparing elective cesarean delivery with planned vaginal delivery for maternal outcomes.
  • To specifically assess effects on urinary incontinence and other pelvic floor functions.
  • To provide evidence-based guidance on delivery route selection for maternal request.

Main Methods:

  • Comprehensive literature review was conducted.

Related Experiment Videos

  • Expert speakers presented findings at a State-of-the-Science Conference.
  • Panelists synthesized evidence to draw conclusions.

    • Main Results:

    • Weak-quality evidence suggests elective cesarean delivery may be favored over planned vaginal delivery for urinary incontinence.
    • The duration of any potential benefit for urinary incontinence is unclear.
    • Weak-quality evidence did not favor either delivery route for pelvic organ prolapse, fecal incontinence, anorectal symptoms, or sexual function.

    Conclusions:

    • Current evidence supporting elective cesarean delivery for maternal request, particularly for urinary incontinence, is of low quality.
    • There is insufficient evidence to recommend elective cesarean delivery over vaginal delivery for most pelvic floor-related maternal outcomes.
    • Further high-quality research is needed to clarify the long-term effects of delivery mode on maternal health.