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

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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.

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Acknowledgements

We gratefully acknowledge funding for the PERL Project: Urinary Incontinence Prevention: Reducing Birthing Risk (R01-NR4007) by the National Institute of Nursing Research and additional investigator support from the National Institute of Health through the Office of Research on Women’s Health SCOR on Sex and Gender Factors Affecting Women’s Health (P50 HD 44406).

Conflicts of interest

None.

Disclosures

John O.L. DeLancey: Kimberly Clark, Johnson and Johnson, American Medical Systems

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Authors and Affiliations

  1. School of Nursing and Department of Women’s Studies, University of Michigan, 400 North Ingalls Suite 3320, Ann Arbor, MI, 48109, USA

    Lisa Kane Low

  2. School of Nursing and Department of Obstetrics and Gynecology, University of Michigan, 400 North Ingalls Suite 3320, Ann Arbor, MI, 48109, USA

    Janis M. Miller

  3. School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA

    Ying Guo

  4. Mechanical Engineering and Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI, 48109, USA

    James A. Ashton-Miller

  5. Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, 1500 East Medical Center Dr. F4200, Ann Arbor, MI, 48109, USA

    John O. L. DeLancey

  6. School of Nursing, University of Michigan, 400 North Ingalls Suite 3320, Ann Arbor, MI, 48109, USA

    Carolyn M. Sampselle

Authors
  1. Lisa Kane Low
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  2. Janis M. Miller
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  3. Ying Guo
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  4. James A. Ashton-Miller
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  5. John O. L. DeLancey
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  6. Carolyn M. Sampselle
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Corresponding author

Correspondence to Lisa Kane Low.

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Low, L.K., Miller, J.M., Guo, Y. et al. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J 24, 453–460 (2013). https://doi.org/10.1007/s00192-012-1884-y

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  • DOI: https://doi.org/10.1007/s00192-012-1884-y

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