Midwives Knowledge and Practice of Bladder Care During Labour and After Birth Literature Review

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Midwife Bladder

Midwives' Knowledge and Practice of Bladder Control Care in Pregnant and Postnatal Patients: A Literature Review

There are many complicating factors of pregnancy that can develop and exhibit symptoms both during the pregnancy and following giving birth, some of which can persist for months in some cases. As midwives and certified nurse midwives are often the primary source of advice, care, and communication for the woman during her pregnancy and following the birthing, it is incumbent upon these individuals to be well versed in the knowledge and practices of recognizing the potential and the existence of these various conditions, and of providing appropriate information and care to the patients they are assisting during this life event and stage. One such condition that has received a fair amount of attention in the literature, but of which knowledge and proper practices are perhaps not as widespread in the midwife community as would be desired, is that of bladder control.

Bladder incontinence during and following pregnancy is not uncommon, due to both hormonal issues and physical pressures on the bladder due the changing physiology of the pregnant and/or post-natal woman. Though absorptive materials and devices can be employed to assist in the handling of this incontinence issue, this is not really an adequate or comprehensive treatment. Understandings of the causes of bladder incontinence during and following a pregnancy have continued to develop over the years, as have perspectives in nursing and among midwives in their methods of handling of this issue.Buy full Download Microsoft Word File paper
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Literature Review on Midwives Knowledge and Practice of Bladder Care During Labour and After Birth Assignment

This paper consists of a literature review on the topic, attempting to ascertain the current level of midwife knowledge and practice in the provision of care for bladder incontinence in pregnant and post-natal women. The purpose of the review is to establish the identified best practices and appropriate knowledge levels for the provision of care and information to patients with bladder incontinence, and to identify any gaps in the recommendations of current research on the subject and the perceived provision of care by midwives and certified nurse midwives. A variety of different perspectives and conclusions are incorporated into this literature review, providing a comprehensive and detailed examination of the issue from medical, nursing, midwife, and patient perspectives. This holistic approach is expected to increase the validity of the findings of the literature review and to provide greater resources for the development of practical guidelines.


In addition to simple bladder pressure and hormonal issues, bladder incontinence before and following pregnancy can be the result of stress and damage to the perineum muscles both during the pregnancy and as a result of the birthing process. Muscle tearing in the perineum not only results in greater pain and other complications during both pregnancy and birthing, but can also lead to an increased likelihood of urinary incontinence following birth, and for greater periods of time in the post-natal period. This understanding has contributed significantly to the context of bladder incontinence in pregnant and post-natal women.

Midwife practice itself has long included both medical and non-medical approaches to developing an understanding and awareness of patient issues, and to providing the treatment and care for these issues once identified. Medical and empirical investigations of certain midwife practices have confirmed that many of these practices are directly beneficial not only in the provision of care, but in the overall health and medical well-being of the patient as well. Currently, however, medical understandings of bladder incontinence have dominated the research and understandings in this area, with midwife practice only recently gaining recognition within the medical community and the wider research as having effective means to deal with this issue during pregnancy and the post-natal period. By the same token, medical understandings and approaches to providing preventative care and treatment for pregnant and post-natal women exhibiting bladder incontinence have only relatively recently begun to permeate midwife knowledge and practice. This literature review is starkly set against this background of differing pools of knowledge and varying perspectives, attempting to develop a broader and more comprehensive understanding of the issue.

Literature Review

The literature reviewed below consists primarily of empirical research studies conducted among nursing and/or midwife staff and pregnant and postnatal patients. The findings are not always similar, but avoid direct mutual exclusions, reinforcing the validity of each of the independent published articles and the collective worth of this literature as a whole.

In post-natal bladder incontinence, genital trauma during the birthing process has been identified as a primary cause of the issue. A study that collected birthing trauma data from informed midwifery patients and collected incontinence data three months following their giving birth found that while eighty percent of the women in the study suffered genital trauma during the birthing process, over a third of these women experienced only anterior (periuretheral, clitoral, or labial) trauma (Rogers et al. 2007). A slightly larger percentage suffered both anterior and perineal trauma or only perineal trauma, and these women were far more likely to suffer from bladder incontinence -- as defined by any self-reported unintended urine leakage -- than those suffering only anterior trauma (Rogers et al. 207).

One method for combating bladder incontinence in pregnant and post-natal females, as well as other women suffering from bladder stress and/or bladder incontinence, is the training in specific floor-exercises for isolated pelvic muscles (Dannecker et al. 2005). Proper training in these exercises reduced incidences of bladder incontinence in a self-reported ninety-five percent of the nearly four hundred women who participated in the study, suggesting a profound ability to improve balder incontinence through muscle training and conditioning (Dannecker et al. 2005). Results might be skewed for post-natal women as a specific population, however, as symptoms of bladder incontinence are often reduced over time often even to the point of disappearance in women experiencing urine leakage following genital trauma and other physiological effects of pregnancy.

Earlier studies that actually examined the effectiveness of similar pelvic exercises specifically in women who had recently given birth and found that such exercises were indeed effective at controlling bladder incontinence in this population in both the short- and long-terms during the post-natal period (Haddow et al. 2005). In their review of multiple clinical trials and long-range studies, Haddow et al. (2005) found that the performance of these exercises for the month prior to the survey and testing administered as a part of the trial eliminated instances of bladder incontinence in most women, and the regular exercising in the prescribed manner was effective at long-term reduction in bladder incontinence. This has direct implications for midwife and nursing practice, as for many women these exercises can be practiced during pregnancy and can help reduce the likelihood of bladder incontinence developing during pregnancy and in the post-natal period.

The various studies of the efficacy of pelvic floor exercises in reducing balder incontinence specifically in women following childbirth has led to the publication of certain best practices standards b the Joanna Briggs Institute (2007). The published recommendations include beginning the exercises during the pregnancy prior to giving birth, in most cases, and discuss the proper timing of introducing the program, a specific discussion of the exercises, and the implications that these recommendations have specifically for nursing practice (Briggs 2007). Implications for midwife practice are equally apparent, though not stated as such, and suggest higher interactive care and preparation.

In order to directly combat the effects of perineal trauma during the birthing process, as well as stress and even possible trauma to the perineal muscles during pregnancy, pernieal warmer packs have often been employed by midwives in an effort to increase comfort and reduce trauma to the area. An empirical evaluation of this practice and its effects both directly on perineal trauma, as well as it relationship to post-natal bladder incontinence, shows that while there was not a significant reduction in the number of women experiencing some degree of trauma and requiring sutures following giving birth, fewer women had third- and fourth-degree tears in the perineal muscles, and women that had received perineal warming packs also reported a significantly lower rate of bladder incontinence at three months (Dahlen et al. 2007).

A broader study found that general health problems in pregnant and post-natal women, and especially the provision of adequate post-natal care, was highly dependent on the level of communication that existed between the patient and the nurse/midwife (Schmied et al. 2009). One-on-one question and answer sessions, as well as the provision of preparatory information to the patient on potential symptoms, discomforts, and disorders by of the midwife greatly increases the likelihood that post-natal women will seek effective treatment for what may be perceived as minor problems, such as many cases of minimal bladder incontinence (Schmied et al. 2009). Providing more personalized and more comprehensive counseling and information, then, is a key feature of midwife practice in the assessment and effective care of pregnancy and post-natal conditions.

Despite all of these research findings, a majority of midwives are unaware of the best practices for effectively dealing with bladder incontinence, and even exhibit a lack… [END OF PREVIEW] . . . READ MORE

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