What delivery mode do the women want?: A multicentre observational cohort study

What delivery mode do the women want?: A multicentre observational cohort study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 22 September 2025 V1 Latest version Share on What delivery mode do the women want?: A multicentre observational cohort study Authors : Jan Dvorak , Tomas Fucik , Jaromir Masata , Zdenek Rusavy 0000-0001-7125-9819 , Michal Kozerovsky , Marian Rybar , and Kamil Svabik 0000-0003-1778-2101 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175856235.50359380/v1 187 views 131 downloads Contents Abstract Abstract: Funding: Introduction Methods Results Conclusion: Declaration of generative AI and AI-assisted technologies in the writing process. Tables References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To identify factors associated with the preferred mode of delivery among women with a prior vaginal birth after caesarean section (VBAC). Design: Secondary analysis of a multicentre observational cohort. Setting : Two tertiary care centres in the Czech Republic Population : Women who had a term VBAC as their second delivery Methods: Participants completed validated questionnaires PFDI-20, PISQ-IR, and ICIQ-SF and underwent 4D transperineal ultrasound to assess levator ani muscle avulsion. Preferred mode of delivery under full autonomy was recorded. Statistical tests were used to identify independent predictors of a preference for caesarean birth. Main Outcome Measures: Self-reported preferred mode of delivery (vaginal vs caesarean). Results: Of 164 women, 64.2% preferred vaginal delivery, 13.9% preferred caesarean, and 21.8% were undecided. On multivariable analysis, obstetric anal sphincter injury (OASI) (OR 8.38, 95% CI 1.20-58.30; p=.031) and episiotomy (OR 3.07, 95% CI 0.98-9.59; p=.047) were associated with a preference for caesarean delivery. Postpartum sexual inactivity was associated with caesarean preference in univariable analyses but was not an independent predictor after adjustment. Conclusions: Most women with prior VBAC preferred future vaginal birth; however, previous perineal trauma, particularly OASI and episiotomy, was associated with a preference for caesarean delivery. These findings support trauma-informed counselling that addresses pelvic floor outcomes and sexual health in shared decision-making. What delivery mode do the women want?: A multicentre observational cohort study Authors: Jan Dvořák 1 , Tomáš Fučík 1 , Jaromír Mašata 1 , Zdeněk Rušavý 2 , Michal Kozerovský 2 , Marian Rybář 3 , Kamil Švabík 1 1) Department of Gynecology, Obstetrics and Neonatology, General University Hospital in Prague and First Faculty of Medicine, Charles University, Czech Republic 2) Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic. 3) Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic Corresponding author: Kamil Švabík Email: [email protected] Adress: Apolinářská 18, Praha 2, 128 00, Czech republic Author’s contribution: Jan Dvořák – manuscript author, ultrasound evaluation Tomáš Fučík – data collection Jaromír Mašata – ultrasound evaluation Zdeněk Rušavý – data collection supervisor Michal Kozerovský – data collection Marian Rybář – data analysis Kamil Švabík – head of project Abstract: Objective: To identify factors associated with the preferred mode of delivery among women with a prior vaginal birth after caesarean section (VBAC). Design: Secondary analysis of a multicentre observational cohort. Setting : Two tertiary care centres in the Czech Republic Population : Women who had a term VBAC as their second delivery Methods: Participants completed validated questionnaires PFDI-20, PISQ-IR, and ICIQ-SF and underwent 4D transperineal ultrasound to assess levator ani muscle avulsion. Preferred mode of delivery under full autonomy was recorded. Statistical tests were used to identify independent predictors of a preference for caesarean birth. Main Outcome Measures: Self-reported preferred mode of delivery (vaginal vs caesarean). Results: Of 164 women, 64.2% preferred vaginal delivery, 13.9% preferred caesarean, and 21.8% were undecided. On multivariable analysis, obstetric anal sphincter injury (OASI) (OR 8.38, 95% CI 1.20-58.30; p=.031) and episiotomy (OR 3.07, 95% CI 0.98-9.59; p=.047) were associated with a preference for caesarean delivery. Postpartum sexual inactivity was associated with caesarean preference in univariable analyses but was not an independent predictor after adjustment. Conclusions: Most women with prior VBAC preferred future vaginal birth; however, previous perineal trauma, particularly OASI and episiotomy, was associated with a preference for caesarean delivery. These findings support trauma-informed counselling that addresses pelvic floor outcomes and sexual health in shared decision-making. Keywords: VBAC, caesarean delivery, delivery preference, pelvic floor, episiotomy, OASI, sexual function Funding: Charles University in Prague ’[UNCE/24/MED/018]’, the Charles University Research program ’[Cooperatio – Maternal and Childhood Care; Neonatology]’ and by The General University Hospital in Prague ’[CZ-DRO-VFN64165]’. Funding: This work was supported by grant from Charles University in Prague ’[UNCE/24/MED/018]’, the Charles University Research program ’[Cooperatio – Maternal and Childhood Care; Neonatology]’ and by an institutional grant from The General University Hospital in Prague ’[CZ-DRO-VFN64165]’. Conflict of interest: The authors declare that they have no conflict of interest. Introduction An editorial by The Lancet stated there is a false dichotomy in modern obstetrics - overmedicalisation of birth, shaped by the paternalistic approach of medical staff, and on the other hand, uncritical promotion of natural birth without intervention.[1] This raises an important question: Can pregnant women reject vaginal delivery by informed choice, and what might be the implications of truly autonomous delivery decision-making? Elective caesarean delivery, requested by women without medical indications, is increasingly common. Despite growing demand, the topic remains controversial among obstetricians. The International Federation of Gynecology and Obstetrics (FIGO) discourages caesarean deliveries performed for non-medical reasons.[2] In Sweden, elective caesarean sections are tightly restricted, and this policy has been subject to ethical debate in the media. [3] There are many reasons why women would prefer a caesarean section - among these would be fear of pain and fear of pelvic organ prolapse or urinary incontinence.[4] While vaginal delivery carries some risks, repeat caesarean deliveries also present serious complications, including placenta accreta spectrum, impaired foetal growth, adhesions, and chronic pelvic pain.[5] Some argue that the risks of vaginal birth are underreported and that vaginal delivery is too readily idealized in public discussion.[6] Furthermore, caesarean delivery may impact the neonatal microbiome, with potential long-term health implications for the child. [7] A unique population is women who have undergone vaginal birth after caesarean (VBAC). These women face higher risks of uterine rupture, levator ani muscle injury, and assisted vaginal deliveries, particularly with forceps. [8] Having experienced both delivery modes, their perspectives can provide valuable insights into childbirth preferences. In this context, our study focused on women with a history of VBAC. We aimed to explore their preferences for delivery if given full autonomy and to identify the clinical, pelvic floor, and sexual health factors associated with a preference for caesarean delivery over repeat vaginal birth. Methods This secondary analysis of a multicentre observational cohort study identifies all women who had a term VBAC for their second delivery at the Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, and the Department of Gynaecology, Obstetrics and Neonatology, 1st Faculty of Medicine, Prague, Charles University between 2012 and 2016. Women having a repeat VBAC, preterm birth, or stillbirth were excluded from the study. Local ethics committees of both units approved the study (Ethics committee of the University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University - number 92/2017, date of approval 2.3.2017, and Ethics committee of the General University Hospital, Prague – number 100/17, date of approval 19.10.2017). Before enrolment, all women provided a signed informed consent. The study was registered on clinicaltrials.gov (NCT03420001) before its commencement. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The hospital electronic clinical database in participating units was used to identify eligible women, and their health records were used for data collection (age, BMI, gestational age, birthweight, duration of the first and the second stage of labour, perineal trauma, episiotomy, vaginal laceration, operative vaginal delivery, obstetric anal sphincter injury - OASI). Women were contacted and invited to participate in the study. Women were assessed in the supine position after bladder emptying using a 4D pelvic ultrasound (GE Voluson E8 - GE Kretz Medizintechnik, Zipf, Austria) with 8–4 MHz curved array volume transducer (acquisition angle 85°). Volume acquisition was performed on maximum pelvic floor muscle contraction to diagnose levator ani avulsion. The acquired volumes were analysed off-line on a desktop PC using the proprietary software 4D View version 18.0 (GE Medical Ultrasound Kretz GmbH, Zipf, Austria). Assessors who undertook the ultrasound analyses were blind to all patients’ data. Tomographic ultrasound imaging (TUI) was used for the diagnosis of levator ani muscle (LAM) avulsion, with slices obtained at the axial plane at 2.5-mm slice intervals, from the plane of minimal hiatal dimensions and the two slices immediately above that plane. LAM avulsion was diagnosed if the distance between the centre of the urethra and the LAM insertion (levator–urethra gap) was ≥25mm in all three central slices. Standardized questionnaires evaluated pelvic floor dysfunction. All women were asked to fill out the PISQ-IR questionnaire for evaluation of sexual dysfunction - the single summary score was used as a result. The PFDI-20 summary score was used for the evaluation of pelvic floor dysfunction [9]. For urinary incontinence evaluation, the ICIQ-SF summary score was used[10]. All women were asked a question: How would you prefer to deliver if you could choose it by yourself? The statistics were calculated using the Software R (Version 4.3.1, R Core Team, Vienna University). Continuous variables were reported as means with standard deviation (SD) or medians with interquartile range IQR and two-sample t-test or Mann-Whitney U test were used for a simple comparison of groups in univariable analysis. Categorical variables were reported as proportions, and Pearson’s chi-squared test was used to compare groups in univariable analysis. To assess the dependency of the type of delivery chosen on various variables, a multivariate logistic regression model was used. Variables with p < .25 from univariate analyses were entered into a multivariable logistic regression analysis to determine the adjusted influence of variables on outcome. A backward stepwise variable elimination procedure with the variables of interest with p less than .05 was then used in the final model. The results of multivariate analyses were expressed as odds ratios (OR) with 95% confidence intervals and p-values. Results We identified 356 women with a history of VBAC during the study period who met the inclusion and exclusion criteria. 164 (46%) women were recruited to our study. The mean age was 32 years, the mean BMI was 29, and the mean newborn weight was 3342g. Additional descriptive data are presented in Table 1. In our study group, 46% of women underwent an episiotomy, 4.26% experienced an OASI, and 3.65% had an assisted vaginal delivery. The rate of levator ani muscle avulsion was 29.34%. At the time of the study, 94% of participants had resumed sexual activity since giving birth. Preferred mode of delivery: Out of the total, 106 women (64.24%) preferred vaginal delivery over caesarean, 23 women (13.94%) preferred caesarean over vaginal delivery, and 36 women (21.82%) were undecided. Table 2 demonstrates factors possibly influencing the preferred mode of delivery. Episiotomy, OASI, and assisted vaginal delivery were significantly associated with caesarean preference, as well as the absence of sexual activity. Women preferring caesarean also scored statistically significantly higher on the PFID-20 questionnaire. Avulsion of LAM or duration of labour were not statistically significant factors for choosing the caesarean section. Neither age, BMI, nor newborn weight represented a statistically significant factor. To simplify the analysis, we conducted a subgroup comparison by dividing participants into two categories: those who preferred a caesarean section and those who did not. The presence of episiotomy, assisted vaginal delivery, OASI, and lack of sexual activity remained statistically significant factors associated with a preference for caesarean delivery. While the PFDI-20 score did not show a statistically significant difference between the groups, the PISQ-IR single summary score was significantly lower among women who preferred caesarean section. Detailed results are presented in Table 3. Table 4 presents the results of multivariate analysis and the calculated odds ratios (OR) for the preference of caesarean section. Statistically significant associations were found for a history of OASI, with an OR of 8.38, and for episiotomy, with an OR of 3.07. Main Findings Our study offers novel insights into the delivery preferences of women who have experienced both caesarean and vaginal birth. Most women in our cohort preferred vaginal delivery for future births. However, our findings underscore the significant impact of specific birth-related complications - particularly OASI, episiotomy, and assisted vaginal delivery - on the likelihood of preferring caesarean section. An important factor for preference of caesarean section is lack of sexual activity, but in multivariate analysis, this was not statistically significant. Strengths and Limitations Our multicentre study group is unique as all women are already after VBAC and therefore have had an experience of vaginal delivery and a caesarean section. Another strength of our study is the multicentre design and use of validated questionnaires. A limitation of our study is that the preferences and questionnaire data were collected at a single postpartum time point, limiting the ability to assess how delivery preferences evolve. Interpretation Women preferring a caesarean section were significantly associated with not being sexually active. This can originate from the common belief that a caesarean section protects sexual function. Contrary to the belief that caesarean section protects sexual health, a study from the UK suggests no protective effect.[11] Also, women with episiotomy were more likely to choose caesarean section, which can be related to the fact that women with episiotomy resume sexual activity later than those with second-degree tears.[12] This contrasts with findings by Bertozzi et al., which suggest that women with selective episiotomy have a better quality of life. [13] A prospective study conducted in Turkey assessed sexual satisfaction among women who had either a vaginal delivery or a planned caesarean section using a validated questionnaire, the study found no significant difference in sexual satisfaction between the two groups. [14] Higher preference for caesarean section was more common in our study group in women with some form of “complication”, be it assisted vaginal delivery or OASI. The OASI is a serious trauma that often leads to avoiding the next pregnancy. [15]Also, as one of the reasons for preferring caesarean section could be a reason, there is an increased risk of recurrent OASI in the second delivery for women with a previous OASI, compared to women without a previous OASI.[15] The preference for caesarean section could be because assisted vaginal delivery was associated with decreased quality of life measured by PFDI-20 in comparison to caesarean section. [16] In our study group, a higher PFDI-20 score was associated with a greater preference for caesarean section. VBAC is associated with a significantly higher rate of LAM avulsion than vaginal birth in nulliparous women. [17] A well-established factor is that LAM avulsion severely impacts quality of life. The LAM avulsion is a well-known factor associated with pelvic floor dysfunction.[18] Interestingly, in our study group, there was no significant difference between preferring caesarean section or vaginal delivery in women with LAM avulsion. This could be because the forceps rate in our study group is low. It is established that forceps-assisted vaginal delivery increases the risk of a LAM avulsion, and vacuum extraction does not increase this risk. [19] LAM avulsion is associated with a more advanced pelvic organ prolapse and higher impact on the quality of life; however, LAM avulsion was not an independent factor influencing the quality of life of affected women.[20] This could be because pelvic organ prolapse syndromes develop with time. VBAC is desired by women who undergo caesarean section often because they find themselves wanting the feeling of vaginal birth, and in the USA 45% of women after a caesarean section wished to deliver their next baby vaginally. [21] Therefore, our study brings important information for many specialists who educate women about the possibility and risks of VBAC. Conclusion: In this multicentre cohort of women with VBAC, the majority expressed a preference for vaginal delivery in future pregnancies despite having experienced both delivery modes. Even though the complication rate in our study population is higher than in the standard population, only 14% women preferred caesarean section over vaginal delivery. However, our findings highlight that specific birth-related complications (OASI, episiotomy, and assisted vaginal delivery) are significantly associated with a preference for caesarean section. Notably, the absence of sexual activity postpartum emerged as the strongest individual predictor of caesarean preference, underscoring the potential role of sexual well-being in delivery decision-making. The question remains whether this preference for caesarean section or vaginal delivery would be the same in a longer follow-up. Further longitudinal research is needed to assess how these preferences evolve and to explore interventions that mitigate the long-term impact of vaginal delivery-related injuries. While OASI or assisted vaginal delivery cannot be completely prevented in vaginal delivery, based on our data, the reduction of OASI or assisted vaginal delivery rates would likely increase preference for vaginal delivery over caesarean section. These results suggest that improving obstetric practices to minimize pelvic floor trauma, as well as integrating sexual health into postpartum counselling, may enhance the acceptability of vaginal birth and support truly informed maternal choice. Declaration of generative AI and AI-assisted technologies in the writing process. Statement: The authors did not use generative AI while preparing this manuscript. Tables Table – Basic descriptive data Age (years) 32.00 3.10 20 - 40 BMI 29.00 3.37 22 - 34.20 Newborn weight (g) 3342.00 341 2110 - 4450 Table - factors influencing the preferred mode of delivery Factor Vaginal Caesarean Undecided p-value n 106 23 36 Levator ani avulsion n (%) No 75 (70.8) 15 (65.2) 27 (75.0) .721 Yes 31 (29.2) 8 (34.8) 9 (25.0) Episiotomy n (%) No 60 (57.1) 6 (26.1) 21 (61.8) .015 Yes 45 (42.9) 17 (73.9) 13 (38.2) Assisted vaginal delivery n (%) No 103 (98.1) 20 (87.0) 33 (97.1) .036 Yes 2 (1.9) 3 (13.0) 1 (2.9) OASI n (%) No 102 (97.1) 19 (82.6) 34 (100.0) .003 Yes 3 (2.9) 4 (17.4) 0 (0.0) Sexually active n (%) No 2 (1.9) 5 (21.7) 3 (8.3) .001 Yes 104 (98.1) 18 (78.3) 33 (91.7) 1st stage of labour duration - minutes mean (SD) 291.56 (155.96) 264.09 (101.71) 281.21 (139.17) .712 2nd stage of labour duration - minutes mean (SD) 21.97 (18.15) 31.48 (23.33) 30.94 (35.19) .061 ICIQ-SF score mean (SD) 2.32 (3.48) 3.48 (4.19) 3.08 (4.21) .301 PFDI-20 score mean (SD) 20.55 (24.63) 33.47 (29.49) 29.92 (31.32) .045 PISQ-IR single summary score mean (SD) 3.96 (0.99) 3.67 (0.76) 4.06 (0.76) .109 Newborn weight - g mean (SD) 3352.00 (389.36) 3490.87 (477.70) 3208.82 (503.92) .050 Age - years mean (SD) 32.50 (3.63) 32.30 (3.52) 31.94 (5.16) .772 BMI mean (SD) 28.65 (4.30) 29.68 (4.35) 29.76 (5.36) .463 Table factors influencing the preferred mode of delivery -- simplified analysis Factor vaginal caesarean p-value n 142 23 Levator ani avulsion n (%) No 102 (71.8) 15 (65.2) .621 Yes 40 (28.2) 8 (34.8) Episiotomy n (%) No 81 (58.3) 6 (26.1) .006 Yes 58 (41.7) 17 (73.9) Assisted vaginal delivery n (%) No 136 (97.8) 20 (87.0) .038 Yes 3 (2.2) 3 (13.0) OASI n (%) No 136 (97.8) 19 (82.6) .008 Yes 3 (2.2) 4 (17.4) Sexually active n (%) No 5 (3.5) 5 (21.7) .005 Yes 137 (96.5) 18 (78.3) 1st stage of labour duration - minutes mean (SD) 289.03 (151.60) 264.09 (101.71) .458 2nd stage of labour duration - minutes mean (SD) 24.17 (23.65 31.48 (23.33) .171 ICIQ-SF score mean (SD) 2.51 (3.68) 3.48 .254 PFDI-20 score mean (SD) 22.92 (26.68) 33.47 .085 PISQ-IR single summary score mean (SD) 4.04 (.83) 3.67 (.76) .045 Newborn weight - g mean (SD) 3316.98 (422.83) 3490.87 (477.70) .075 Age years mean (SD) 32.37 (4.05) 32.30 (3.52) .944 BMI mean (SD) 29.01 (4.67) 29.68 (4.35) .580 Table - multivariate analysis and odds ratios for the preference of caesarean section Episiotomy 3.07 .982 9.59 .047 Assisted vaginal delivery .98 .104 9.42 .992 OASI 8.38 1.200 58.30 .031 Sexually active .24 .050 1.20 .082 2nd stage of labour duration 1.01 .989 1.03 .406 PFDI-20 1.00 .988 1.02 .588 PISQ-IR .995 .969 1.02 .728 References 1. [1] The Lancet. Empowering women during childbirth. The Lancet 2025;406:1. https://doi.org/10.1016/S0140-6736(25)01382-0. [2] Barnea ER, Inversetti A, Di Simone N. FIGO good practice recommendations for cesarean delivery: Prep-for-Labor triage to minimize risks and maximize favorable outcomes. International Journal of Gynecology & Obstetrics 2023;163:57–67. https://doi.org/10.1002/IJGO.15115. [3] Fredriksson M, Mattebo M. The struggle over caesarean section on maternal request: an ethical principles approach to Swedish media portrayal. Reproductive Health 2025;22:1–12. https://doi.org/10.1186/S12978-025-02057-3/TABLES/2. [4] Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine 2020;33:3867–72. https://doi.org/10.1080/14767058.2019.1587407. [5] Clark EAS, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011;205:S2. https://doi.org/10.1016/J.AJOG.2011.09.028. [6] Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, et al. Factors influencing decision-making for caesarean section in Sweden - A qualitative study. BMC Pregnancy Childbirth 2018;18:1–8. https://doi.org/10.1186/S12884-018-2007-7/FIGURES/1. [7] Hoang DM, Levy EI, Vandenplas Y. The impact of Caesarean section on the infant gut microbiome. Acta Paediatr 2021;110:60–7. https://doi.org/10.1111/APA.15501. [8] Dietz HP, Campbell S. Toward normal birth–but at what cost? Am J Obstet Gynecol 2016;215:439–44. https://doi.org/10.1016/J.AJOG.2016.04.021. [9] Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 2005;193:103–13. https://doi.org/10.1016/j.ajog.2004.12.025. [10] Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004;23:322–30. https://doi.org/10.1002/NAU.20041. [11] Martin FZ, Madley-Dowd P, Ahlqvist VH, Jónsson-Bachmann E, Fraser A, Forbes H. Mode of delivery and maternal sexual wellbeing: A longitudinal study. BJOG 2022;129:2010–8. https://doi.org/10.1111/1471-0528.17262. [12] Fernández-Fernández MJ, de Medina-Moragas AJ. Comparative study of postpartum sexual function: Second-degree tears versus episiotomy outcomes. Arch Gynecol Obstet 2024;309:2761. https://doi.org/10.1007/S00404-024-07494-2. [13] Bertozzi S, Londero AP, Fruscalzo A, Driul L, Delneri C, Calcagno A, et al. Impact of episiotomy on pelvic floor disorders and their influence on women’s wellness after the sixth month postpartum: A retrospective study. BMC Womens Health 2011;11:1–7. https://doi.org/10.1186/1472-6874-11-12/TABLES/4. [14] Kahramanoglu I, Baktiroglu M, Hamzaoglu K, Kahramanoglu O, Verit FF, Yucel O. The impact of mode of delivery on the sexual function of primiparous women: a prospective study. Arch Gynecol Obstet 2017;295:907–16. https://doi.org/10.1007/S00404-017-4299-7/FIGURES/2. [15] Mørch EJ, Perslev K, Wrønding T, Aabakke A, Jangö ·Hanna. Counseling women with obstetric anal sphincter injury – Risk of recurrence and the influence of mode of second delivery on subsequent anal incontinence – A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2025;309:14–22. https://doi.org/10.1016/J.EJOGRB.2025.03.018. [16] Crane AK, Geller EJ, Bane H, Ju R, Myers E, Matthews CA. Evaluation of Pelvic Floor Symptoms and Sexual Function in Primiparous Women Who Underwent Operative Vaginal Delivery Versus Cesarean Delivery for Second-Stage Arrest. Female Pelvic Med Reconstr Surg 2013;19:13. https://doi.org/10.1097/SPV.0B013E31827BFD7B. [17] Paymova L, Svabik K, Neumann A, Kalis V, Ismail KM, Rusavy Z. Vaginal birth after Cesarean section and levator ani avulsion: a case–control study. Ultrasound in Obstetrics & Gynecology 2021;58:303–8. https://doi.org/10.1002/UOG.23629. [18] Van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG 2014;121:1164–72. https://doi.org/10.1111/1471-0528.12666. [19] Dvorak J, Poncova R, Fucik T, Dietz HP, Masata J, Martan A, et al. Impact of the type of vaginal assisted delivery on the pelvic floor and OASI – Ultrasound study. European Journal of Obstetrics & Gynecology and Reproductive Biology 2025;305:142–6. https://doi.org/10.1016/J.EJOGRB.2024.12.023. [20] Yu CH, Chan SSC, Cheung RYK, Chung TKH. Prevalence of levator ani muscle avulsion and effect on quality of life in women with pelvic organ prolapse. Int Urogynecol J 2018;29:729–33. https://doi.org/10.1007/S00192-017-3454-9. [21] Attanasio LB, Kozhimannil KB, Kjerulff KH. Women’s preference for vaginal birth after a first delivery by cesarean. Birth 2019;46:51–60. https://doi.org/10.1111/BIRT.12386. Crossref Google Scholar Information & Authors Information Version history V1 Version 1 22 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords delivery: birth trauma delivery: caesarean section general obstetrics Authors Affiliations Jan Dvorak Univerzita Karlova 1 lekarska fakulta View all articles by this author Tomas Fucik Univerzita Karlova 1 lekarska fakulta View all articles by this author Jaromir Masata Univerzita Karlova 1 lekarska fakulta View all articles by this author Zdenek Rusavy 0000-0001-7125-9819 Univerzita Karlova Lekarska fakulta v Plzni View all articles by this author Michal Kozerovsky Univerzita Karlova Lekarska fakulta v Plzni View all articles by this author Marian Rybar Ceske vysoke uceni technicke v Praze Fakulta biomedicinskeho inzenyrstvi View all articles by this author Kamil Svabik 0000-0003-1778-2101 [email protected] Univerzita Karlova 1 lekarska fakulta View all articles by this author Metrics & Citations Metrics Article Usage 187 views 131 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Jan Dvorak, Tomas Fucik, Jaromir Masata, et al. 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