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.
Summary
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...
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