I couldn't agree more with Sally!  "Purple pushing," done by many
women who've had epidurals, is VERY different from the reflexive
pushing a laboring woman does when she is unmedicated and fully in
control.  Making matters worse, this "purple pushing" is often done
in a semi-supine position, which is unphysiologic for birth.

It just doesn't make sense that natural, physiologically normal
childbirth and breastfeeding would routinely contribute to urinary
incontinence.  I'm inclined to think that birth practices and other
variables are inadequately defined and/or accounted for in these
studies.

Women who birth vaginally in the US and probably most westernized
societies are under pressure to "bounce back" very quickly, while
women who have cesareans get a bit more slack.  Moms are proud of how
soon they are running errands, doing housework, resuming exercise,
etc after birth.  The lay midwife (20+ years of experience) who
attended the homebirth of my second child believes that resting (as
in *bed* rest) and healing up for two weeks postpartum is important
for the pelvic floor.  Vaginal childbirth is certainly stressful for
the pelvic floor muscles, and it seems only reasonable to allow time
for rest & recovery, for optimal healing.

Now how would breastfeeding by itself would have an effect on
incontinence?  The odds ratio in the one study Barb Strange cited
(Burgio et al. 2003) was only 1.169, which is low, with a P-value of
0.023.  The P-value indicates that the finding, while statistically
significant, is not highly so -- there's about a 1 in 40 chance that
it occured randomly.  We don't know from the abstract how many women
breastfed (the full-text article is viewable by subscribers only).
It is entirely possible that this study's finding regarding
breastfeeding and incontinence was a fluke, due to insufficient
numbers or inadequate definitions or . . . ?

Margaret
Longmont, CO


Sally Myer writes:
>They also need to separate directed pushing ("hold your breath to
>count of ten and don't make noise " for 2-3 hours pushing) from
>spontaneous pushing (the pushing a woman does on her own when she
>has the urge-open glottis, more gentle) or laboring down (with an
>epidural, rest and let the uterus push the baby down until crowning
>and mom assists with pushing her baby out then or when she has the
>urge and only as her urge tells her).    Also, did they separate
>episiotomy from no episiotomy and instrument assisted from not?  I
>suspect that the widespread medical control of second stage has
>caused many of the problems with the pelvic floor that are so common
>now.

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