It is the first birth that does the damage: a cross-sectional study 20 years after delivery.
Ixora Kamisan AtanSylvia LinHans Peter DietzPeter HerbisonPeter Donald Wilsonnull nullPublished in: International urogynecology journal (2018)
Most LAM avulsions and EAS defects seem to be caused by the first vaginal birth. Subsequent vaginal deliveries after the first were unlikely to cause further LAM trauma.