Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial

Abstract

Introduction and hypothesis The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management. Methods This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage. Results No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value=0.57) or in combination with prenatal perineal massage (P value=0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected. Conclusions Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups.

Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: a multicentre randomised trial—the EOLE study protocol

“…15 The intervention studied varied between studies: although the control groups always used directed Valsalva pushing, the open-glottis breathing in the intervention group was sometimes spontaneous7–10 12 13 and sometimes directed 56 11 The meta-analysis by Prins et al 14 compared self-directed spontaneous pushing with directed Valsalva pushing (n=425) and concluded that closed-glottis pushing had a negative effect on urodynamic prognosis, consistent with the findings by Schaffer et al 9.…”

Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?

“…Two meta-analyses [5,6] and seven single-centre, randomised trials reported in nine articles were identified [7][8][9][10][11][12][13][14][15]. Neither participants nor personnel can be blinded to the intervention we consider here.…”

“…Lemos pushing [6]. The authors included seven studies [9][10][11][12][13][14][15][16][17], all of which involved potential bias.…”

“…pushing, the open-glottis breathing in the intervention group was sometimes spontaneous (not coached) [9][10][11][12]14,15] and sometimes coached [7,8,13] (Table 1). Study inclusion criteria included a gestational age of at least 36 weeks' gestation or more, cephalic presentation, and a singleton pregnancy.…”

The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labor

“…The study methods for the larger project are reported in detail elsewhere. 26 As an additional component of the parent project, a subset of the participants agreed to allow audio recording of the conversations during the second stage of labor. The audio recordings were intended to serve as a validation of the pushing method used by women during the second stage of labor.…”