Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders

Background:

• Postpartum urinary incontinence is a common complication following childbirth.
• The incidence of urinary incontinence increases with parity, affecting women after pregnancy and childbirth significantly more than nulliparous individuals.

Purpose of the Study:

• To test if spontaneous pushing alone or with perineal massage reduces de novo postpartum urinary incontinence in primiparous women.
• To compare these methods against traditional directed pushing for second-stage labor management.

Main Methods:

• A prospective clinical trial randomized 249 women into four groups: routine care with directed pushing, spontaneous pushing, prenatal perineal massage, or a combination of spontaneous pushing and massage.
• Incontinence was assessed at 12 months postpartum using the Leakage Index in 145 women.

Main Results:

• No statistically significant difference in the incidence of de novo postpartum incontinence was observed between the spontaneous pushing and directed pushing groups (P=0.57).
• The addition of prenatal perineal massage to spontaneous pushing also did not significantly alter incontinence rates (P=0.57).
• High crossover between treatment groups was noted during fidelity assessments.

Conclusions:

• Spontaneous pushing, with or without perineal massage, did not demonstrate a reduction in postpartum urinary incontinence one year after a first birth.
• High crossover rates between randomization groups limited the ability to detect potential treatment effects.