title: Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial.
abstract: OBJECTIVE
  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.
authors: School of Nursing and Department of Women's Studies, University of Michigan, 400 North Ingalls Suite 3320, Ann Arbor, MI 48109, USA. kanelow@umich.edu
authors: Lisa Kane
authors: LK
authors: Low
authors: Janis M
authors: JM
authors: Miller
authors: Ying
authors: Y
authors: Guo
authors: James A
authors: JA
authors: Ashton-Miller
authors: John O L
authors: JO
authors: DeLancey
authors: Carolyn M
authors: CM
authors: Sampselle
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007748:Labor Stage, Second / Q000502:physiology*; D008405:Massage / Q000379:methods; D036801:Parturition / Q000502:physiology*; D010502:Perineum / Q000502:physiology; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*