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30th December 2005 Women in labour should 'do what comes naturally' The traditional midwife role of urging the mother to push at the end of labour could actually be causing future health problems. Research by the University of Texas found that 'coaching' a woman did little to shorten the length of the labour and increased the risk of bladder problems after the birth. Scientists suggest letting a woman follow her own instincts and do what comes naturally. The researchers from the University of Texas Southwestern Medical Center studied 320 women who were giving birth for the first time, had uncomplicated pregnancies and did not need epidural anaesthesia when they gave birth. Half the women were randomly assigned to be coached to push for 10 seconds during a contraction, while the rest were told to do what comes naturally. The results showed that the second stage of labour - from full dilation of cervix to delivery - was an average 46 minutes in the 'coached' mums, compared to 59 minutes in the second group. Of the 320 women in the study, 128 returned for testing three months later and it was found that those who had been coached during labour had a decreased bladder capacity and needed to pass urine at a lower bladder volume. The research, which follows an earlier study that found a rise in pelvic-floor problems among coached women, concluded that "coached pushing could potentially increase the amount of pressure on the pelvic floor with subsequent deleterious effects". They said more research is needed to work out if these effects on the bladder are permanent. Professor Kenneth Leveno, who worked on the study, said, "Whether or not these functional changes have long-term consequences, I'm not ready to say. "We don't want to alarm patients about this." Midwife Mary Newburn said that in the past UK midwives had told women when and how to push. But they never used such strict coaching as the Americans and it was an approach from which most midwives were increasingly moving away. "If a woman is told to push before her body is ready then she can become tired and worry that things are not progressing as they should," she warned. "Holding her breath and bearing down hard before she is ready could also deprive the baby of oxygen. "Women should be at the centre of what is going on and receive support and encouragement from the people around her. "A partner can help the woman to try to relax or massage her, but definitely should not be taking control." Where to next?
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