Women who have given birth are twice as likely to experience urinary incontinence later in life, compared with women who have never been pregnant. Some practitioners have suggested that spontaneous pushing during labor, rather than the more traditional directed pushing, might reduce postpartum urinary incontinence. Directed pushing means a caregiver directs a woman in labor when to push. Although it can reduce the time spent in labor, it can also increase the risk of a perineal tear and reduce the amount of oxygen available for both the woman and her baby. Spontaneous pushing is the self-directed effort a woman makes as she feels the urge to push. This type of pushing is generally easier for a woman and reduces the risk of a tear because it allows the perineum to stretch naturally. Prenatal perineal massage may also reduce genital tract trauma by making the perineum more flexible for the birthing process.
Working with scientists in the Pregnancy Research Branch within the Division of Intramural Research, researchers evaluated whether women’s risk for urinary incontinence could be reduced by spontaneous pushing, with or without perineal massage, instead of directed pushing.
They analyzed data on 145 women in four groups:
- Routine care with directed pushing
- Spontaneous pushing
- Prenatal perineal massage
- Combination prenatal perineal massage and spontaneous pushing
The researchers found that neither spontaneous pushing nor prenatal perineal massage reduced the risk of birth-related urinary incontinence at 12 months after the birth (PMID: 22839349).