title: Effect of mode of delivery on the incidence of urinary incontinence in primiparous women.
abstract: OBJECTIVE
  To estimate the effect of mode of delivery on the incidence of urinary incontinence in primiparous women.
  
  
  METHODS
  A population-based survey was mailed to all Oregon women who delivered a liveborn neonate in a 1-year period. Data were collected on urinary incontinence, childbirth experience, and other risk factors for incontinence at 3-6 months postpartum. Univariable analyses were conducted using t tests and Wilcoxon rank-sum tests for continuous variables and chi tests for categorical variables. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals for demographic and clinical risk factors.
  
  
  RESULTS
  A total of 15,787 women completed the survey, for a response rate of 39%. Of these women, 5,599 were primiparous, completed the survey in the desired timeframe, submitted information on their urinary continence, and did not have incontinence before pregnancy. A total of 955 (17.1%) reported leakage of urine. Women who had vaginal deliveries were more likely to have urinary incontinence than women who had cesarean deliveries (odds ratio 4.96 [95% confidence interval 3.82-6.44], P<.001). This risk increased with assisted delivery and perineal laceration. No statistical difference in the incidence of urinary incontinence was found among women who had elective cesarean deliveries (6.1%), women who had cesarean deliveries after laboring (5.7%), and women who had cesarean deliveries after laboring and pushing (6.4%).
  
  
  CONCLUSIONS
  Urinary incontinence is common in the immediate postpartum period after a woman's first pregnancy. Although vaginal delivery increases the risk of urinary incontinence, labor and pushing alone without vaginal delivery do not appear to increase this risk significantly.
  
  
  METHODS
  II.
authors.affiliation: From the Providence Women and Children's Health Research Center, Providence Health and Services, Portland, Oregon; and the Department of Public Health and Preventive Medicine, the Department of Obstetrics and Gynecology, and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Sarah Hamilton
authors.initials: SH
authors.lastname: Boyles
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Tomi
authors.initials: T
authors.lastname: Mori
authors.forename: Patricia
authors.initials: P
authors.lastname: Osterweil
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D010298:Parity; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D014549:Urinary Incontinence / Q000209:etiology*; D055815:Young Adult