Complementary interventions for childbirth
Introduction
Part of an alternative approach to childbirth is an inquiring attitude about common childbirth practices. A number of conventional medical and other means have been used to bring on labour.
| Healthcare condition | Intervention | About the findings |
|---|---|---|
| Incontinence | Pelvic floor muscle training | 16 trials |
| Low resource areas | Training traditional birth attendants in clinical facilities | 4 trials |
We present some of the evidence from Cochrane systematic reviews about care related to pregnancy and childbirth. This evidence comes from carefully researched reviews of information about clinical trials done to evaluate medical treatments. Studies are only included in these reviews if they meet pre-defined criteria.
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Pelvic floor muscle training to prevent and treat incontinence - before and after giving birth
The pelvic floor muscles form the muscular base of the abdomen. They support the pelvic organs (bladder, some reproductive organs and the rectum) and contribute to the closure of the urethral sphincter, where the urethra is joined to the bladder, to prevent leakage of urine. The pelvic floor muscles also surround the external anal sphincter.
Stress incontinence is the term used to describe involuntary urine leakage that occurs with physical exertion or coughing. Urge incontinence involves involuntary leakage associated that results from a sudden compelling need to void.
Pregnant women often leak urine during pregnancy. After childbirth, up to a third of women leak urine and one in ten leak faeces, which can be distressing both physically and mentally (psychologically). Women who are potentially at the greatest risk of postnatal incontinence are those with large babies or who have a forceps delivery, giving birth vaginally.
The most common type of urinary incontinence associated with childbirth is stress incontinence although many women have both urge and stress incontinence.
What is known
A wide range of treatments are offered, including medications and surgery. Physical therapies (pelvic muscle floor training), lifestyle interventions, behavioural training, and anti-incontinence products (for example pads), are most often used both during pregnancy and after giving birth.
Pelvic floor muscle training involves exercises that increase the strength, endurance and coordination of the pelvic floor muscles. It is used both to prevent incontinence from occurring in the first place and to help control leakage.
What the synthesised research says
Controlled clinical trials show that pelvic floor muscle training does prevent urinary incontinence during pregnancy and after birth for women having their first baby. Intensive antenatal pelvic floor muscle training meant that women were around half as likely to report urinary incontinence in late pregnancy and at 12 weeks after giving birth. They were about 30% less likely to report incontinence six months after giving birth than women who had received usual antenatal care without the training.
Women receiving the training were also about half as likely to report faecal incontinence 6 to 12 months after giving birth.
If women had persistent urinary incontinence three months after giving birth and then undertook pelvic floor muscle training, they were 21% less likely to report continued urinary incontinence at 6 to 12 months. The benefit appeared to be greater when the program was more intensive.
How it was tested
The researchers made a thorough search of the medical literature and found 16 controlled trials that met the criteria for the review. The results of 15, involving 6181 women, were pooled.
The women receiving pelvic floor muscle training were generally taught the exercise techniques by a physiotherapist. They attended daily sessions over a period of weeks. The women receiving usual care often received information on pelvic floor muscle training, for example in a routine pamphlet.
Side effects and general cautions
There was not enough information about long-term effects for either urinary or faecal incontinence.
It is unavoidable that the women and treatment providers could not be blinded to the exercise-based interventions.
Source
Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007471. DOI: 10.1002/14651858.CD007471.
Providing training of traditional birth attendants in clinical facilities
Each year many child-bearing women (approximately 529,000) die, 80% giving birth. Some 4 million infants are stillborn and an equal number die within their first month of life. The majority of these deaths, birth-related illness and disabilities occur in the developing world.
What is known
Many women give birth at home in some parts of the world. They are assisted by family or traditional birth attendants. A traditional birth attendant gains her skills through delivering babies or initially works as an apprentice with an experienced attendant. Their tasks include bathing and massaging the mother carrying out domestic chores, and providing care after the birth.
The World Health Organisation promotes training of the traditional birth attendants as a public health strategy to reduce deaths around the time of giving birth. Training usually involves a short course in a modern health facility as a way of upgrading their skills, connecting communities to health facilities, and to encourage the use of traditional birth attendants. The courses vary a lot in their content and how they are delivered. They include advice on hygiene, prevention of bleeding (haemorrhage), screening for potential problems and referral to a health facility when required. Yet traditional birth attendants often practice in places where access to emergency obstetric care and health facilities are limited.
What the synthesised research says
Traditional birth attendant training in a modern health facility has the potential to reduce deaths during child birth.
One large controlled trial randomly assigned pregnant women to traditional birth attendants with and without extra training according to the areas in which they lived (cluster-randomised trials). The areas where the attendants received the extra training reported clearly lower numbers of stillbirths (adjusted OR 0.7), deaths around the time of birth and newborn deaths (all adjusted odds ratios of 0.7). Maternal deaths also tended to be less and referrals to health facilities for obstetric complications were clearly increased (adjusted OR 1.50, range 1.2 to 1.9) (increased by some 50%).
How it was tested
The researchers made a thorough search of the medical literature and found four trials including over 2000 traditional birth attendants and nearly 27,000 mothers.
Two studies looked at the benefits of educational instruction in the management of normal delivery, timely detection and referral of women with obstetric complications and linking women to essential care services. In one controlled before and after study, women in both communities had access to the same improved health facility with or without training of the attendants and so perinatal deaths were reduced for all.
One trial successfully encouraged early exclusive breastfeeding and the introduction of weaning foods. The intervention in another trial emphasized initiation of early suckling before placental delivery to reduce blood loss after giving birth without a clear difference for health service trained and untrained attendants.
The duration of training for traditional birth attendants was two to three days for all studies.
Side effects and general cautions
In three of the studies, the majority of traditional birth attendants had received some form of special training before the study.
Source
Sibley LM, Sipe TA, Brown CM, Diallo MM, McNatt K, Habarta N. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005460. DOI: 10.1002/14651858.CD005460.pub2.
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