Actuary Greta Thurgood, 29,
is nervously expecting her first child in February. Her
apartment is already childproof and she's taken just about
every course she can think of, from Lamaze to time management
for working mothers. However, she's undecided about whether
to undergo a pelvic training program that strengthens
the pelvic floor muscles and helps prevent urinary incontinence,
one of the commonest complications of pregnancy. The flip
side to pelvic training is the widely held belief that
stronger pelvic muscles are a disadvantage once labour
begins, making it harder for the cervix to dilate sufficiently.
Research in the August 14 issue of the British Medical
Journal (BMJ) proving this theory wrong will undoubtedly
make Greta's decision easier.
Dr Kjell Å Salvesen, obstetrician
at Trondheim University Hospital in Norway, and his
physiotherapist colleague Siv Mørkved said their
results showed that women with strong pelvic floor muscles
are in a win-win situation. It's proven that they're
less likely to suffer incontinence both before and after
pregnancy. They're also less likely to experience a
breech presentation, require an episiotomy, or spend
more than an hour in second-stage labour � the active
pushing phase.
The researchers split 301 healthy
pregnant women carrying their first child into a pelvic
training group and a control group. The training group
took part in an intensive pelvic floor muscle training
program that began in the 20th week of pregnancy and
ended in the 36th, a week before a typical term delivery.
Only the 224 women who gave birth to a baby whose head
was facing down in the womb were included in the final
analysis.
Women who had been randomized into
the training group were less likely to experience more
than one hour of active pushing during the second stage
of labour. Only 22% of women with trained pelvic muscles
fell into this group, compared to 37% of those in the
untrained group.
Shorter labour times should translate
into fewer interventions but that wasn't always the
case. The training group underwent fewer episiotomies,
although at 51% � vs 64% in the control group � the
use of this partly discredited procedure seemed far
too frequent in both populations. But there was no significant
difference between the groups in the rates of Cesarean
in the first stage of labour, vaginal operative delivery
in the second stage, epidural analgesia or oxytocin
augmentation. All of these treatment decisions were
made by people blinded to the randomization process.
The overall average time of second-stage
labour was 40 minutes in the trained group and 45 minutes
in the control group, a finding that just missed statistical
significance. It's possible that this time disparity
was due to yet another difference between the groups.
The women with trained pelvic floor muscles gave birth
an average of three days earlier than those in the control
group. The inevitable result was lighter babies with
smaller heads. Babies born to the control group were
3% heavier with a 1.6% greater head circumference than
those born to the trained group. It might be argued
that the greater head size could have independently
contributed to longer labour in the control group.
Overall the researchers described
the improvements associated with pelvic floor training
as "borderline." But that's not the point, they argued,
since the main purpose of pelvic floor training is to
prevent incontinence, not to facilitate labour. If it
can do that without adverse effects on delivery, it
should be encouraged.
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