Handa VL, et al. - Focusing on the impact of vaginal vs cesarean delivery, authors here investigated the longitudinal, quantitative changes in pelvic organ support after childbirth. In this work, vaginal birth was related to a worse support 5 years from first delivery and to more rapid deterioration in support at the apex. The size of the genital hiatus, above and beyond the impact of vaginal birth, could be an independent marker for those at greatest risk of prolapse progression.