Midwife Bladder Midwives' Knowledge and 'Literature Review' chapter

Excerpt from 'Literature Review' chapter :

2007). Bladder management issues were also described as under-discussed and under-treated during the pregnancy, despite the observed commonality of these occurrences among pregnant women (Butterfield et al. 2007). This indicates a definite lack of discussion regarding the issue between midwives and their patients, which is a situation that itself must be resolved in order to address the problem of bladder incontinence in pregnant and post-natal women. Without developing a greater awareness of the issue in the midwife community, the seeking out of best practices and interventions for addressing the issue cannot be accomplished; greater assessment for bladder incontinence is definitely needed in order for successful and widespread applications of these strategies in both midwife and nursing practice to be accomplished (Butterfield et al. 2007).

At the same time, research itself must become better defined and more unified in regards to this issue, with clear ethical and empirical guidelines established that will assist in the maintenance of valid, objective and consist research. One major review of literature in the area found that measurements of first-year incidence of urinary incontinence following childbirth ranged from as low as less than three percent to as much as seventy-seven percent, largely depending on the research methodology employed in the particular studies (Birch et al. 2009).

This comprehensive review of existing data on the existence and proper treatments of the problem reinforces the finding that trauma to the genital region during childbirth is a highly predictive factor for the development of urinary incontinence in the post-natal period, with the only non-controversial risk factors for incontinence outside of trauma being a heightened body mass index, vaginal delivery (which is itself causal of trauma), and instrumental delivery (which is also a factor primarily due to its creation of greater trauma during the birthing process) (Birch et al. 2009). Other risk factors have been identified by individual studies, but these have far less certainty and validity in the scientific community; trauma during childbirth remains the primary indicator of urinary incontinence following pregnancy, and the prevention of such trauma as well as muscle training and strengthening exercises (which may also lead to reduced trauma) is the best preventative measure.


The general consensus among the available literature is that genital trauma experienced during childbirth, especially to the perineal muscle tissue, is primarily responsible for a heightened incidence of bladder incontinence in women during the post-natal period. A commonly cited, well-researched, and clearly established practice for preventing and limiting bladder incontinence during pregnancy and in the post-natal period is the use of pelvic floor exercises, when properly guided and trained and when implemented at the correct time. Perineal warm packs during labor can also reduce trauma, thereby lessening the likelihood of bladder incontinence.

Midwife practice, though forming a large part of the foundational practice upon which the current research has been built, has largely failed to maintain consistently up-to-date in regards to the assessment and treatment of bladder incontinence in pregnant and post-natal women. Though effective practices have been developed, they have not been employed in a widespread manner; a low awareness of the issue in the midwife community in general is seen as an inhibitive force in the progression and dissemination of the established best practices and midwife knowledge that has been generated on the issue. Developing fuller one-on-one counseling relationships that facilitate full communication in both directions will increase the likelihood that women will be properly assessed for bladder incontinence during and following childbirth, and that proper care measure and best practices knowledge will be sought by midwives and nurse midwives.


It is the hope of the author that this literature review will assist in the growing knowledge and awareness of bladder incontinence issues in pregnant and post-natal women in the midwife and nursing communities. Effective means for preventing and caring for bladder incontinence issues, as well preventing certain traumas during childbirth that are seen as causal of post-natal bladder incontinence clearly exist, they simply need to become better-known. As more attention is brought to this subject, more effective care can be provided.


Birch, L.; Doyle, P.; Ellis, R. & Hogard, E. (2009). Failure to void in labour: postnatal urinary and anal incontinence." British Journal of Midwifery 17(9), pp. 562-6.

Butterfield, Y.; O'Connel, B. & Phillips, D. (2007). "Peripartum urinary incontinence: A study of midwives' knowledge and practices." Women and birth 20, pp. 65-9.

Dahlen, H.; Homer, C.; Cooke, M.; Upton, A.; Nunn, R. & Brodick, B. (2007). "Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Trial." Birth 3(4), pp. 282-90

Dannecker, C; Wolf, V.; Raab, R.; Hepp, H. & Anthuber, C. (2005). "EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients." Archives of gynecology and obstetrics 273(2), pp. 93-7.

Haddow, G.; Watts, R. & Robertson, J. (2005). "Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth." International journal of evidence-based healthcare 3(5), pp.103-46.

Joanna Briggs Institute. (2006). "A pelvic floor muscle exercise programme for urinary incontinence following childbirth." Nursing Standard 20(33), pp. 46-50.

Rogers, R.; Leeman, L.; Kleyboecker, S.; Pukite, M.; Manocchio, R. & Albers, L. (2007). "Is anterior genital tract trauma associated with complaints of postpartum urinary incontinence?" International urogynecology journal and pelvic floor dysfunction 18(12), pp. 1417-22.

Schmeid, V.; Cooke, M.; Gutwein, R.; Steinein, E. & Homer,…

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