Studying Damage Control

Recent reports about incontinence


A couple of interesting studies made it into the American Journal of Obstetrics and Gynecology recently. Both of them have to do with bladder control and incontinence. Fun, right? I know. They both offer good news though. Having a baby vaginally doesn't appear to increase your chances for urinary incontinence (that's medical-speak for wetting your pants). We don't often talk about that but it's a fear a lot of women have and for good reason. Sometimes, some women leak a little for a few months after birth. The pelvic floor (the muscles that support the uterus and bladder) get kind of roughed up during delivery and sometimes they need a little time to heal. The vast majority of women are just fine within a few months of delivery. Those that aren't, well that's what gynecologists and urologists specialize in. Fixing you up. There have been multiple studies about late-in-life leaking. The conventional wisdom lately has been that women who had vaginal births were more at risk for post-menopausal urinary incontinence. Apparently, not so much.

One study that appeared in the January issue said that women who are "coached" while pushing might have a slightly higher risk of having post partum bladder issues than those who just do what comes naturally. Coaching meant that someone (a nurse, doctor, midwife or partner) told them to bear down for 10 seconds during contractions. The study was done at UT Southwestern Medical Center where 320 women, all first time mothers without epidurals were studied. Apparently, coaching made very little difference in the amount of time it took to push the baby out and may actually have some adverse affects on the bladder during the first few months following delivery.

The other study done at University of Rochester Medical Center and published in the December issue, looked at 143 pairs of biological, postmenopausal sisters. Of these pairs, one sister had delivered a baby and the other never had. Turns out they had equal numbers of complaints or lack of complaints about urinary incontinence. That's a heck of a lot of information for sisters to divulge and I thank them for that. Nobody wants to get to the point where they finally get to ditch the tampons and pads just to trade them in for Depends. The study says that genetics have more to do with whether you're going to leak when you giggle than birthing. There was another study done quite a while back that's been nicknamed, "The Nun Study." A bunch of postmenopausal nuns who'd never had babies and hadn't had much sex either had the same amount of bladder trouble as women who'd had lots of sex and babies. It's a gene thing. Or an age thing. It just doesn't appear to be a birth thing.

Some of the arguments for increased elective cesarean sections have been to prevent postmenopausal incontinence. There's been a school of thought for a while that they were a good idea for saving the pelvic floor. This study says, maybe not so much. And how about that coaching? Granted, this study was done on women without epidurals when the urge to push is mighty strong. They don't need much guidance. They generally do whatever Mother Nature (that bossy girl) tells them to do. Women with epidurals oft-times need coaching because they can't feel their contractions. The study wasn't prepared to say if there were any long-term affects from coaching.

The thing about studies is, they'll probably come up with another one next month that says something else entirely. I kind of like these two though. One says, quit screaming "PUSH" at a woman who's going to do it anyway, whether or not you tell her to. It's the same thing as when people tell poor laboring women to "remember to breathe." That one always makes me giggle silently to myself. Yeah, labor hurts but you're not likely to forget to inhale, exhale, inhale, exhale. Really, we've got that one nailed. The other study just has so much common sense to it. Don't worry so much about leaking later on. If you do, you do. Medical science will have a darn good way to fix you up down the road if it comes to that. Having that kind of surgery makes more sense to me than an elective cesarean in the name of "what if."

Lately, all I seem to be writing about is simplicity. Most of the time, childbirth just doesn't need to be as complicated as we've made it. Certainly sometimes, it's very complicated and dangerous and thank God we've got all those tools in the tool box to solve some damn-scary situations. But most of the time,I really think we could dial down the drama and dial up the common sense.

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