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Overdistension and defects of the levator ani muscle observed after vaginal delivery are associated with the pathogenesis of pelvic organ prolapse. Cesarean delivery has been suggested as an alternative, but it does adequately protect against symptomatic pelvic organ prolapse. To explain why delivering by cesarean fails to protect the pelvic floor, it has been suggested that pregnancy itself weakens the support system. Few studies have studied the pelvic floor support system during pregnancy.

Pelvic floor dysfunction and weakening of the pelvic floor muscles (PFMs) during vaginal delivery play a major role in postpartum incontinence. It is believed that vaginal childbirth may result in reduced vaginal resting pressure (VRP) and reduced PFM strength and endurance, whereas cesarean section (CS) may protect the PFM. Several studies have assessed change in PFM strength from pregnancy to shortly after childbirth in relation to mode of delivery; the results were conflicting. Moreover, most such studies were small, few were prospective, and none addressed change in VRP when comparing modes of delivery.