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Coaching In Labor Could Increase Bladder Problems

A recent research conducted by researchers at the UT Southwestern Medical Center has found that there is actually increased risk damage to the urinary bladder if a woman is coached during labor to push during contractions. // Furthermore, the presence of a coach does not seem to provide any visible clinical benefit in terms of shortening labor.

The study is the first of its kind done to explore the relationship between the presence of a coach during labor and the clinical outcome. The researchers specifically looked at second stage labor, when there is maximal dilatation of the cervix and the descent of the baby through the birth canal.

Reports of increased chances of pelvic floor problems amongst women coached during labor is believed to have initiated the current trial. Nearly 320 women who presented at the Parkland Memorial Hospital for a delivery (first delivery) were taken up for the study. Care was taken to ensure that only women with uncomplicated pregnancy and negative history of epidural anesthesia administration were included in the study.

They were assigned to two different groups, both comprising of nurse-midwives in a random fashion. Members of one group (163) were coached to push for 10 seconds during a uterine contraction while members of the other group (157) were instructed to “do what comes naturally”.

At the end of the study, it was found that in women allowed to respond naturally, the labor period was shortened from 59 to 46 minutes, yielding a 13-minute reduction.

A follow up study was conducted to investigate the long-term effects of coaching, with respect to the pelvic floor. Surprisingly, women who were coached during labor were found to have a reduced bladder capacity and a decreased sensation to urinate (first urge to void).

"There were no other findings to show that coaching or not coaching was advantageous or harmful. Oftentimes, it's best for the patient to do what's more comfortable for her, Whether or not these functional changes have long-term consequences; I'm not ready to say, " said Dr. Bloom, senior researcher of the team.

Results of this interesting research appear in the January issue of the American Journal of Obstetrics and Gynecology. More studies are clearly indicated to accurately estimate the long-term effects of coaching during labor as effects such as these stated above can return to normal over a period of time.


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