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Objective. To determine the impact of urinary incontinence (UI) on the quality of life of the elderly in the general population and to identify factors with the greatest effect. Design. Qualitative and quantitative analyses of interview data. Setting . Patients from the nine family practices of the Nijmegen University Research Network. Subjects. Independently living patients aged 60 and over. Main outcome measures. All independently living patients aged 60 and over with uncomplicated UI were interviewed at home using the Incontinence Impact Questionnaire and open-ended questions. Results. In total, 56 men and 314 women were interviewed. A majority do not have such an impact. In the Incontinence Impact Questionnaire (IIQ) emotional well-being was most affected. Half to one-third of the patients felt nervous, embarrassed, or frustrated because of their incontinence. In the social domain ''clothing'' and ''fear of odour'' scored the highest impact. The most affected practical consequence in the IIQ was ''going to places where you are not sure about the availability of a toilet'' followed by ''travelling longer than 20 minutes'' and ''entertainment''. Men reported higher impact scores than women, despite the fact that incontinence was less severe in men. The most important effect of incontinence reported in men was ''being out of control'' while most women considered ''feeling impelled to take several precautions'' to be the most important consequence of UI. Conclusion. UI affects nearly half of patients, particularly as regards their emotional wellbeing and in public activities. Men experienced more impact compared with women and experienced loss of control more often than women.

The routine use of the supine position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish whether the continuation of this intervention is justified. Nine randomized controlled trials and one cohort study were included. A meta-analysis indicated a higher rate of instrumental deliveries and episiotomies in the supine position. A lower estimated blood loss and lower rate of postpartum hemorrhage were found in the supine position, however it is not clear whether this is a real or only an observed difference. Heterogenous, non-pooled data showed that women experienced more severe pain in the supine position and had a preference for other birthing positions. Many methodological problems were identified in the studies and the appropriateness of a randomized controlled trial to study this subject is called into question. A cohort study is recommended as a more appropriate methodology, supplemented by a qualitative method to study women's experiences. Objective laboratory measurements are advised to examine the difference in blood loss. In conclusion, the results do not justify the continuation of the routine use of the supine position during the second stage of labor.

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