Give It A Rest, Coach?

When a woman gives birth, her labor isn't shortened much by being coached about when to push, a new study shows.

The report, published in the American Journal of Obstetrics and Gynecology, shows labor was 13 minutes shorter for women who were coached compared with those who were told to do what came naturally.

"Withholding such coaching is not harmful," write the researchers. They included Steven Bloom, MD, of the obstetrics and gynecology department at University of Texas Southwestern Medical Center.

"Oftentimes, it's best for the patient to do what's more comfortable for her," Bloom says in a news release.

Checking on Coaching

The study included 320 women who were in labor with their first child at term.

The women's pregnancies were uncomplicated. They didn't get epidurals during labor. All gave birth at Parkland Memorial Hospital in Dallas.

The women were split into two groups. Certified nurse-midwives tended to women in both groups.

The nurse-midwives coached the women in the first group to push at certain times during labor. The nurse-midwives told women in the second group to "do what comes naturally," without telling them when to push.

Slightly Shortens Labor

Labor was 13 minutes shorter for the women who had been coached about when and how to push.

They spent an average of 46 minutes in labor's second stage, compared to 59 minutes for those who weren't coached to push at specific times.

That's a "slight" difference, the researchers write.

No other benefits to mother or child were reported with labor coaching. "There were no other findings to show that coaching or not coaching was advantageous or harmful," Bloom says. The rates of episiotomy (cutting of the skin between the vagina and anus to ease delivery) and tears in the same area were similar between the two groups of women.

In an earlier study published in the journal's May edition, the researchers found that three months after giving birth vaginally, a smaller group of the women who had been coached during labor were more likely to have smaller bladder capacity than those who hadn't been coached.

However, those bladder problems can be temporary, and women who give birth vaginally without coaching can also experience changes in their urinary function.

It would take a much bigger study to see if labor coaching really made a difference, the researchers write.

"Whether or not these functional changes have long-term consequences, I'm not ready to say," says Kenneth Leveno, MD, in the news release. "We don't want to alarm patients about this."

Leveno, a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center, worked on both studies with Bloom and the other researchers.

SOURCES: Bloom, S. American Journal of Obstetrics and Gynecology, January 2006; vol 193. Schaffer, J. American Journal of Obstetrics and Gynecology, May 2005; vol 192: pp 1692-1696. News release, University of Texas Southwestern Medical Center.

By Miranda Hitti
Reviewed by Louise Chang, MD
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