There's screaming, blood, and
enough cursing to make a sailor blush. No, we're not talking
about the latest Vin Diesel flick, but about that beautiful
and joyous event, known as natural childbirth. Of course,
for most North American women, childbirth, may be somewhat
less than completely 'natural' given the employment of
painkillers, complex breathing patterns and coaches who
tell you when and how hard to push. The latter may not
necessarily be a good thing, according to a presentation
at the late July joint meeting of the American Urogynecologic
Society and the Society of Gynecologic Surgeons in San
Diego. The study showed that pushing when it feels natural
to do so may spare the pelvic floor from damage that occurs
when a woman is instructed to push.
"We wanted to study the effects
of coached pushing because some of the midwifery literature
had suggested some benefits to delayed pushing," lead
investigator Dr Joseph Schaffer told Medscape. Dr Schaffer
is director of the division of urogynecology and reconstructive
surgery at the University of Texas Southwestern Medical
Center in Dallas.
The study was done using 325 women
(94% Hispanic, 4% Black and 2% White, but otherwise
similar in their demographics) who were carrying their
first child and weren't scheduled for induced labour.
The women who were randomly assigned to receive coached
pushing were directed to take a deep breath, hold it
and push hard for as long as they could. While all births
occurred vaginally, none of the women had to endure
abnormally long labour, nor had they received pain relief
during the initial stage.
The influence of coached pushing
on pelvic functions was assessed in the 128 women (67
coached and 61 uncoached) who returned for a followup
exam three months after giving birth. During the exam,
maximum urethral closure pressure was checked as reduced
pressure is an indication of pelvic floor damage. The
test gauges how much liquid is needed to open the closed
urethra. A significant difference was evident in this
measure between the coached group (83cm water) and the
uncoached group (90cm water). As well, those in coached
group were significantly more likely to experience involuntary
muscle contractions while their bladders were being
filled. They were also more likely to suffer from incontinence.
The researchers feel that these
results may be because coached pushing puts more force
on the floor of the pelvis, thus causing more damage.
"Everyone uses coached pushing, but it has no known
maternal or fetal benefits, and we found that it was
associated with negative effects. Our findings suggest
that physicians may want to reconsider routine coached
pushing," said Dr Schaffer.
Unfortunately, some women aren't
able to follow a natural inclination to push. "In the
last few decades epidurals have become the labour medication
of choice and because the mother's vagina and perineum
are without sensation as a result of the epidural drug,
she is once again in the unhappy position of needing
a lot of assistance with second stage," said Louise
McDonald, a Nova Scotian midwife.
|
