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[quote=Anonymous]Awhile back someone asked if I could suggest what I wish I did to avoid prolapse and levator avulsion.  Here is a top ten in no particular order -
1.  Have a coach or doula in the room who knew the method I chose for birthing (Bradley, hypnobirthing, whatever it is).  Be aware that the doula is often trained to encourage you to stick with your birth plan.  Talk to the doula beforehand about what she would do if you said “I really need to change the plan”  Will she support you?
2.  Listened to my instincts (hard to do when the birth is so intense and unknown) – a Dr who specialized in high risk birth told me to keep an open mind about a c-section after trying for 12 hours.  After 27 hours I asked for one, but the dr and midwife on duty told me I could make it on my own.  I believed them, even though I had doubts.  My body was desperately saying no, you can't do this.  Listen to your body.
3, Had an enema before I went to the hospital.  I wish I knew to ask the nurse to make sure the catheter I acquired at hour 28 when I got an epidural - was emptied.  This lack of space (my bladder was never emptied during labor) contributed to my injuries.  Many women with avulsion noted that they were also told after the birth that their bladders were full to the brim.  A big baby needs as much room as possible to slip out.  Further to this point, research the hell out of the quality/reputation of the nurses at the hospital where you plan to birth.   
4.  Maybe this is the most important one - not to push, under any circumstances, for more than two hours.  A prolonged pushing stage is highly correlated (along with over 40, large baby, etc) to prolapse.
5.  Seeing a pelvic floor physio for the entire 3rd trimester.
6.  Lifting nothing and doing nothing – as much as reasonably possible -  for 30 days after the birth.  This is common in China, and other parts of Asia.  The pelvic floor muscles are so weak.  Get everyone, everywhere to do stuff for you.  Lie flat whenever possible.  Your baby will love the extra snuggle time too.  Everything else can wait.  I realize if you have other small kids this may be impossible.  Or work committments  But try as much as you can.
7.  Asking the physio what pelvic floor exercises you can do as soon as the birth is over (or the next day) – the midwife told me to do them, the dr did not, and I did not know who to believe.
8.  Making sure you don't get constipated after the birth.  Hormones go bonkers and it can happen.  You can use stool softeners but they tend to stop working after awhile.  Drink tons of water with the nursing, and try all natural ways to keep things moving.  Buy a squatty potty from amazon to take pressure off your pelvic floor when you go.  No bearing down in this, or any other, activity.  I'd have that for the entire last trimester and 6 months after.
9.  Understand fully what the risks of ventouse, episiotomy and forceps are to your body so that if a birth plan does not go according to plan you know whether or not those choices are right for you, or whether a caesarian is best.  You don’t want to decide this after enduring 24 hours of labor.
10.  Have a full understanding and open communication  of how your husband/wife/partner/person supporting you in labor will advocate for you in the delivery space, and ensure they look out for preeclampsia signs, etc.  The best most calming thing about my birth was the mobile baby monitor - I almost always knew my son was ok.  My husband, on the other hand, was a well-meaning deer in the headlights.  He did, however, let me squeeze the bones of his hand together for 34 hours.
11.  I know I said 10 points, but frank discussions with the women in your family about their birth.  What does it mean when they say they had no prolapse?  Or did?  Episiotomies?  Forceps/  Etc?  Why?  How was menopause and their pelvic floor?
12.  Insist on a pessary, pelvic floor PT, a urogyno referral and IMAGING (either 3/4 d ultrasound or an MRI) if you feel prolapse, or you feel bone on one or either side when palpitating.  You deserve to know exactly what happened, just like any part of your body.  Ask the urogyno to assess your prolapse while you are standing up, since we dont go through life on our backs.
If this string helps one person - just one - I've done my work.  But I really hope it helps more, and that it bears witness to an understanding that respect for womens bodies includes how we birth, rather than just throwing up our hands and saying "it's a mystery!  there is no way to predict!  we're screwed no matter what!"  We need every muscle in our pelvic floor to support us for life.
13.  Know the risk factors for avulsion:  https://www.ncbi.nlm.nih.gov/pubmed/24593314 http://onlinelibrary.wiley.com/doi/10.1002/uog.9251/pdf
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