'Coaching' in Labour Makes Little Difference

Turned up with or without a coach?
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Dr. Steven Bloom and his colleagues from UT Southwestern found that "coaching" a mother to push during labour makes little difference in the birth. A previous study has shown that coaching may actually cause damage to the bladder and pelvic floor. "Oftentimes, it's best for the patient to do what's more comfortable for her," said Bloom.

In the study, UT Southwestern researchers focused on second-stage labour - the time in which the cervix is fully dilated and the baby begins to descend. This report follows an earlier one that found a rise in pelvic-floor problems among coached women.

The new study involved 320 women at Parkland Memorial Hospital who were giving birth for the first time, had uncomplicated pregnancies and did not receive epidural anaesthesia. They were randomly assigned, with both groups tended by nurse-midwives. Of the two groups, 163 were coached to push for 10 seconds during a contraction, and 157 told to "do what comes naturally."

For women who were randomly assigned to the coaching group, the second stage of labour was shortened by 13 minutes, from 59 to 46 minutes. "There were no other findings to show that coaching or not coaching was advantageous or harmful," Dr. Bloom said.

The earlier study, reported in the May issue of Obstetrics and Gynecology, involved the same group of women. In it, researchers investigated whether coaching causes long-term problems to the mother's pelvic region.

Of the 320 women in the study, 128 returned for testing three months later. The coached women, researchers reported, had smaller bladder capacity and a decreased "first urge to void". However, over time, the bladder function can return to normal.

"Whether or not these functional changes have long-term consequences, I'm not ready to say," said Dr. Kenneth Leveno, professor of obstetrics and gynaecology. "We don't want to alarm patients about this."

MEDICA.de; Source: UT Southwestern Medical Center