ICS 2018: The Role of the Nurse Midwife in Promoting Pelvic Floor Health During Childbirth

Philadelphia, PA (UroToday.com) Lisa K. Low, PhD has presented current studies related to childbirth and pelvic floor injuries, which can lead to urinary incontinence. The PERL randomized clinical trial investigated if pre-delivery bladder health class would decrease urge incontinence (UI) episodes postpartum compared to women who received a usual care. Total of 451 women have completed study protocol with 222 who received an education on pelvic floor muscle training, knack and bladder training. Data showed that bladder health class attendees had 24% lower odds of developing urge episodes at baseline and 38% lower odds at 38 weeks compared to participants who received standard care.

EMRLD study aimed to compare women with low risk vaginal births to women at risk for pelvic floor disorders after complicated delivery. Levator ani edema was one of the most significant injury outcomes in low risk group (see Figure 1).

Figure 1
Then researchers compared females with low risk vaginal births to women who never delivered vaginally, but received a C-section. Results demonstrate that all differences between 2 groups resolve overtime, but women in low risk vaginal group could develop pelvic floor injuries which women in a C-section don’t usually get (Figure 2).

Figure 2
In addition, Dr. Low presented a midwife perspective on reducing risk of urinary incontinence and trauma to the pelvic floor after birth. According to the presenter, these issues could potentially be addressed by changing birthing position from supine to sitting up to minimize pelvic constraints, performing self-directed pushing to avoid prolonged pushing, which can lead to urge incontinence in the future, and altering pushing time to reduce risk of tears.

Presented by: Lisa K Low, PhD, CNM, FACNM, FAAN, Associate Professor, School of Nursing, Women’s Studies, Dept. Obstetrics and Gynecology, University of Michigan

Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania, Twitter: @PennUrology at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA
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