title: A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function.
abstract: OBJECTIVE
  The purpose of this study was to determine if refraining from coached pushing during the second stage of labor affects postpartum urogynecologic measures of pelvic floor structure and function.
  
  
  METHODS
  Nulliparous women at term were randomized to coached (n = 67) vs uncoached (n = 61) pushing. At 3 months' postpartum women underwent urodynamic testing, pelvic organ prolapse examination (POPQ), and pelvic floor neuromuscular assessment.
  
  
  RESULTS
  Urodynamic testing revealed decreased bladder capacity (427 mL vs 482 mL, P = .051) and decreased first urge to void (160 mL vs 202 mL, P = .025) in the coached group. Detrusor overactivity increased 2-fold in the coached group (16% vs 8%), although this difference was not statistically significant (P = .17). Urodynamic stress incontinence was diagnosed in the coached group in 11/67 (16%) vs 7/61 (12%) in the uncoached group (P = .42).
  
  
  CONCLUSIONS
  Coached pushing in the second stage of labor significantly affected urodynamic indices, and was associated with a trend towards increased detrusor overactivity.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Schaffer
authors.forename: S L
authors.initials: SL
authors.lastname: Bloom
authors.forename: B M
authors.initials: BM
authors.lastname: Casey
authors.forename: D D
authors.initials: DD
authors.lastname: McIntire
authors.forename: M A
authors.initials: MA
authors.lastname: Nihira
authors.forename: K J
authors.initials: KJ
authors.lastname: Leveno
mesh_terms: D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007748:Labor Stage, Second; D008880:Midwifery / Q000379:methods*; D009321:Natural Childbirth; D017773:Pelvic Floor / Q000473:pathology* / Q000503:physiopathology*; D010808:Physical Examination; D049590:Postpartum Period; D011247:Pregnancy; D016037:Single-Blind Method; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000209:etiology; D014563:Urodynamics