Vaginal birth and pelvic floor dysfunction revisited: Can cesarean delivery be protective?

Excerpt

In 1985, the World Health Organization (WHO) published a seminal report about the ideal rates for caesarean delivery and concluded with the following statement: “There is no justification for any region to have a rate higher than 10–15 %” [1]. As a direct result, several governments have expressed concern about the progressively increasing rates of cesarean births, with potentially negative consequences on maternal and infant health and escalating health-care costs related to this trend. Different factors can explain this increasing rate of caesarean sections (CS). In particular, many women who fear childbirth or possible pelvic floor dysfunctions can request an elective CS; moreover, medicolegal issues influence gynecologist decisions. In many South American countries, the proportion of CS have reached 40 % of all births. In 2006, the CS rate in the USA was 31.1 %. Recent data from European countries also shows rates >30 %. In Italy, >38 % of births are CS deliveries [2]. In the last 30 years, therefore, CS has progressively become the bete noire in obstetric practice. …