Jennie Larsudd-Kåverud: Vaginal delivery increases the risk of incontinence and genital prolapse

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JENNIE LARSUDD-KÅVERUD
Dissertation defense: 5 December 2025 (click for details)
Doctoral thesis: Pelvic floor trauma after childbirth – Risk factors, surgical treatment and prevention
Research area: Obstetrics and gynecology
Sahlgrenska Academy, The Institute of Clinical Sciences

Pelvic floor dysfunction in women is a major global health issue. Many women experience urinary leakage, difficulties with bowel control, or genital prolapse after childbirth. In some cases, the symptoms become so distressing and severe that surgery is required. It is estimated that one in five women will undergo reconstructive pelvic floor surgery before the age of 80.

“The purpose of the thesis was to examine how different factors during childbirth—such as mode of delivery, number of deliveries, and the baby’s birth weight—affect the mother’s long-term pelvic floor health,” says Jennie Larsudd-Kåverud, obstetrician at Sahlgrenska University hospital, Östra, in Gothenburg and a doctoral student at the Institute of Clinical Sciences. In her work, she follows women throughout pregnancy, childbirth, and the early postpartum period. Her clinical work includes both specialist maternity care and labor wards.

The thesis is based on data from more than 600,000 Swedish women gathered from several national registers. The project also developed a web-based model (the OASI calculator*) to predict childbirth outcomes—a digital tool that estimates an individual’s risk of obstetric anal sphincter injury.

“The model can be used by midwives and obstetricians as a decision-support tool to identify women at higher risk of injury and to plan their delivery more safely together with the expectant mother.”

Illustration from thesis: Infant birth weight and the distribution of all modes of delivery. Black bars at the top indicate the distribution of individuals across 100-g birth weight categories. The dotted lines illustrate the estimated percentages from logistic regression, with third-grade polynomials across 100g infant birth weight categories.

Heavier babies increase the risk of birth injuries

The findings show that vaginal delivery increases the long-term risk of requiring surgery for urinary incontinence and prolapse, while cesarean section largely eliminates this risk.

“The thesis also shows that the baby’s birth weight has a major impact. The heavier the baby, the higher the risk of emergency cesarean section, vacuum extraction, and complications for both mother and child. A high birth weight may also contribute to a more negative birth experience.”

An important conclusion is that a more accurate estimation of fetal weight at the end of pregnancy could reduce the risk of serious pelvic floor injuries—particularly anal sphincter tears. This is because it allows healthcare providers to identify women at increased risk and plan the birth in a way that increases the safety of the pregnant woman.

Contributing new knowledge to improve women’s health

What has been the most rewarding and challenging part of the doctoral project?
“The most rewarding part has been contributing new knowledge that can improve women’s health after childbirth. It has been especially exciting to see how research findings can be translated into practice and support more individualized and safer maternity care. The most educational aspect has been working with very large datasets and translating complex statistical models into clinically useful knowledge. But that challenge has also been one of the most rewarding parts of the work.”

Text: Susanne Lj Westergren