I recently read some research (BMJ Open 2013:3:e002789) looking at the Caesarean rate in public and private hospitals in Western Australia. It looked at births to nulliparous women during 1996-2008 (155646). The study looked at the Caesar rate depending on the source of funding (private versus public hospital) and found 29% ( 45903) in total were performed. 24803 were performed in-labour meaning that because of foetal or maternal distress, and 21100 were performed pre-labour, meaning they were planned C section. The study concluded that an increase in the pre-labour caesarean delivery rate for private patients has been driving the increase in C section rate for nulliparous women since 1996.
Now the point of this blog is not to draw attention to the many pelvic floors that are not undergoing the potential damage that pushing a baby out may cause ie the Caesar rate, but rather to reiterate the importance of all women undergoing any gynaecological surgery including Caesareans, to be minding their bladders. You can have a very strong pelvic floor and still leak with the urge to go if you have not been aware of the fact that the bladder capacity with each void should be 350-500 mls.
Yes, as an adult, every time you go to the loo you should be aiming to hold onto around this much. If you go too often then your bladder forgets how to store and starts to want to empty at smaller and smaller capacities. This leads the smooth muscle pump of the bladder, the detrusor, to fire off earlier and gives you urgency, frequency and urge incontinence. This is known as the overactive bladder. So here we have women who have potentially a Grade 5 out of 5 pelvic floor muscle,but can actually leak like a sieve.
So regardless of how you have your baby, always follow the good bladder habits:
- Drink 2 litres of fluid including mostly water, decaffeinated drinks and milk. More if you exercise.
- Be careful, over-drinking can be a problem.
- Go with a bouncy full bladder (350-500 mls).
- Know what your bladder capacity is by doing a bladder diary – measure all your wees out and all your drinks in for 24-48 hours.
- Avoid where possible the just in case visits to the toilet, but you should go before bed.
- Always sit properly to void (wee) and never hover or strain to void.
- All you life have good bowel function- never strain to pass a motion and sit using the good bowel posture.
And remember we are very lucky in Australia – we have good access to excellent conservative management of bladder and bowel problems. The Continence Foundation of Australia has a helpline- the wonderful people manning the phones can answer many of your questions and point you to the nearest Continence and Women’s Health Physiotherapist or Continence Clinic that may have Continence Nurse Advisors to help you.
And I promise you they will never do this…….