This literature review examines midwives' and certified nurse midwives' knowledge and practice regarding bladder incontinence in pregnant and postnatal women. Drawing on empirical research studies, the review identifies genital and perineal trauma during childbirth as the primary predictor of postpartum urinary incontinence, and evaluates evidence-based interventions including pelvic floor muscle exercises and perineal warm packs. The review also highlights a significant gap between established best practices and the awareness levels found among practicing midwives, and emphasizes the role of one-on-one counseling and communication in improving patient outcomes. Recommendations from the Joanna Briggs Institute and findings from multiple clinical trials are discussed alongside calls for more consistent and unified research methodologies in this area.
Many complicating factors of pregnancy can develop and exhibit symptoms both during the pregnancy and following childbirth, some of which can persist for months. As midwives and certified nurse midwives are often the primary source of advice, care, and communication for women during pregnancy and the postpartum period, it is incumbent upon these professionals to be well versed in the knowledge and practices required to recognize potential conditions and to provide appropriate information and care to their patients. One such condition that has received a fair amount of attention in the literature — but of which knowledge and proper practices may not be as widespread in the midwife community as desired — is bladder control.
Bladder incontinence during and following pregnancy is not uncommon, due to both hormonal factors and physical pressure on the bladder resulting from the changing physiology of the pregnant and postnatal woman. Although absorbent materials and devices can help manage this condition, they do not constitute an adequate or comprehensive treatment. Understanding of the causes of bladder incontinence during and following pregnancy has continued to develop over the years, as have perspectives in nursing and midwifery on methods for addressing the issue.
This paper presents a literature review on the topic, seeking to ascertain the current level of midwife knowledge and practice in the provision of care for bladder incontinence in pregnant and postnatal women. The purpose of the review is to establish identified best practices and appropriate knowledge levels for the provision of care and information to patients with bladder incontinence, and to identify any gaps between the recommendations of current research and the perceived provision of care by midwives and certified nurse midwives. A variety of perspectives and conclusions are incorporated into this review, providing a comprehensive examination of the issue from medical, nursing, midwifery, and patient perspectives. This holistic approach is intended to increase the validity of the findings and to provide greater resources for the development of practical guidelines.
In addition to simple bladder pressure and hormonal factors, bladder incontinence before and following pregnancy can result from stress and damage to the perineal muscles during both the pregnancy and the birthing process. Muscle tearing in the perineum not only results in greater pain and other complications during pregnancy and birth, but can also lead to an increased likelihood of urinary incontinence following birth and for longer periods during the postnatal period. This understanding has contributed significantly to the clinical context of bladder incontinence in pregnant and postnatal women.
Midwifery practice has long included both medical and non-medical approaches to developing an understanding of patient issues and to providing treatment and care once those issues are identified. Medical and empirical investigations of certain midwife practices have confirmed that many of these practices are directly beneficial not only to the provision of care, but to the overall health and well-being of the patient. Currently, however, medical understandings of bladder incontinence have dominated the research in this area, with midwifery practice only recently gaining recognition within the medical community as offering effective means to address this issue during pregnancy and the postnatal period. By the same token, medical approaches to providing preventative care and treatment for pregnant and postnatal women with bladder incontinence have only relatively recently begun to permeate midwife knowledge and practice. This literature review is set against this background of differing knowledge pools and varying perspectives, seeking to develop a broader and more comprehensive understanding of the issue.
The literature reviewed below consists primarily of empirical research studies conducted among nursing and midwifery staff and pregnant and postnatal patients. The findings are not always identical, but they do not directly contradict one another, reinforcing the validity of each independent article and the collective worth of this body of literature.
"Evidence on trauma, exercises, warm packs, and care gaps"
"Consolidated key findings across reviewed studies"
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 postnatal women within the midwifery and nursing communities. Effective means for preventing and treating bladder incontinence — as well as for preventing certain traumas during childbirth that are seen as causal of postnatal 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.
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