The birth canal as a determinant of vaginal birth outcomes: physiological adaptation, trauma prevention, and recovery strategies

Abstract

Perineal trauma complicates up to 70–85% of vaginal births and represents a major contributor to long-term pelvic floor dysfunction. Obstetric anal sphincter injuries (OASI) occur in approximately 3–11% of vaginal deliveries and are associated with chronic pain, urinary and fecal incontinence, pelvic organ prolapse, dyspareunia, and impaired quality of life. Contemporary obstetrics increasingly focuses on preserving pelvic floor integrity as an essential component of safe vaginal birth. Objective. To evaluate current evidence regarding the adaptive capacity of the birth canal and evidence-based strategies for the prevention and rehabilitation of OASI.