Urinary incontinence among mothers of multiples: The protective effect of cesarean delivery

Objective: The purpose of this study was to assess the impact of delivery mode on the risk of urinary incontinence among women with previous multiple childbirth. Study Design: A 77-item questionnaire was administered to 733 mothers of multiples. Multivariate regression was used to control for potentially confounding variables. Results: The mean rate of stress urinary incontinence among women who were delivered by cesarean-only delivery was 39.6%, which was significantly lower than the 60.4% among women who reported previous vaginal births (P = .005). Cesarean-only delivery was associated with a markedly reduced risk (odds ratio, 0.52; P = .002) after controlling for age, parity, and body mass index by multivariate regression. Weaker associations were found for age (odds ratio, 1.08), body mass index (odds ratio, 1.06), and parity (odds ratio, 1.46). Urge incontinence was associated with parity, body mass index, and age, but not delivery mode (P = .76). Conclusion: Vaginal delivery represents a major risk factor for stress incontinence among mothers of multiples. Delivery by cesarean delivery only confers an independent protective effect. (Am J Obstet Gynecol 2003;188:1447-53.)