Issue link: https://www.massageandbodyworkdigital.com/i/1315831
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 59 regard to pelvic organ prolapse; as the participants aged, the amplitude of these differences grew. Examples of prevalence after 15 years from the first delivery noted that a grade three prolapse, defined as organ tissue distending beyond the vaginal opening, was seen in 9 percent of women who delivered by cesarean, 30 percent of those who underwent one or more vaginal deliveries, and 45 percent of women who had at least one operative delivery, defined as medically assisted vaginal delivery with the use of forceps or suction. The study also noted that within the first five years after delivery, there was a considerable increase in new cases of urinary bowel incontinence, while pelvic organ prolapses generally seemed to develop many years after childbirth. "A third discovery was that the genital hiatus size is significantly associated with all pelvic floor disorders but most significantly with pelvic organ prolapse. This suggests that the genital hiatus size is a marker that might identify women at high risk of developing pelvic floor disorders with aging," researchers noted. • Hans Peter Dietz, a urogynecologist from Australia who studies maternal childbirth injury, noted that according to the Centers for Disease Control and Prevention, from 2000 to 2014, the average age of women giving birth to their first child rose from just under 25 to 26.3, and the number of first-time moms over age 35, jumped up 23 percent. 13 This is notable because as a mother of a group of people that have the same characteristics within the same time period) of at least one pelvic floor disorder was 23.7 percent, with 15.7 percent of the women experiencing urinary incontinence, 9 percent experiencing fecal incontinence, and 2.9 percent experiencing pelvic organ prolapse. The study noted that the proportion of women reporting at least one disorder increased incrementally with age—ranging from 9.7 percent in women between ages 20 and 39 years and increasing to 49.7 percent in those aged 80 years or older. A significant correlation between number of births and the prevalence of PFD was reported: 12.8 percent in women who never had children, 18.4 percent in women with one delivery, 24.6 percent in women with two deliveries, and 32.4 percent in women with three or more deliveries. • A research project led by John Hopkins and the Greater Baltimore Medical Center studied 1,528 women enrolled within five to 10 years of their first birth and followed them annually for the next nine years. Of the participants, "778 delivered all of their children via cesarean birth, 565 had at least one spontaneous vaginal delivery, and 185 had at least one delivery involving forceps or vacuum assistance, also called operative vaginal delivery." 12 The research team collected data, such as maternal age at the time of delivery, date of delivery, body mass index, signs of prolapse, and the distance between the urethrae and posterior hymen (genital hiatus), at the start of the study and at each subsequent annual visit. Some of the participants already had pelvic floor disorders when the study began, while others developed conditions over the duration of the study. It was noted that cesarean deliveries reduced the risk of PFD considerably, while assisted vaginal birth using forceps increased the probability of PFD, especially in Scope of Practice Working with the pelvis via intravaginal methods is outside the scope of practice of most massage therapists and bodyworkers. A few states, including Oregon, allow such work with very specialized training. Check with your state board or regulatory agency to confirm intravaginal massage falls within your scope of practice. Also, check to see if this technique is covered by your professional liability insurance provider, as most do not have coverage for this type of work within customary massage and bodywork settings.