Prenatal and Postpartum Experience, Knowledge and Engagement with Kegels: A Longitudinal, Prospective, Multisite Study.

Introduction: Urinary incontinence (UI) increases during pregnancy and continues into the postpartum period. Continued UI impacts women's comfort and affects aspects of their everyday lives. Kegel exercises have been found to decrease the incidence and severity of UI. The purpose of this study was to describe severity of UI, how women gained knowledge about Kegels, influences impacting Kegel exercises during pregnancy and postpartum, and characterize women's performance of Kegels. Methods: A longitudinal, prospective, multistate study was undertaken at four sites across the United States. Postpartum women completed the Pelvic Floor Control Questionnaire that incorporated the Sandvik Severity Index. At 3 and 6 months postpartum the women's UI, performance of Kegels, and affect on life was reviewed through seven questions. Institutional Review Board (IRB) approval was obtained. Results: Participants were 368 predominately multiparous, white women. Approximately 20% of women reported prepregnancy UI. Multiparous women reported similar incidence rate of UI regardless of birth history. Among one-fifth of the participants, persistent UI was reported as 45.2% at 3 months and 44.1% at 6 months postpartum. Only 25% of these women sought care. Women learned about Kegel exercises from written information or their provider. Women performed an average 16 Kegels twice daily. Kegel performance increased at 3 months postbirth but dropped by 6 months. UI was associated with age >35 and parity. Discussion: Prevalence of UI before and during pregnancy and postpartum is high, yet consistent Kegel performance postpartum is low. Screening for UI is necessary and high-quality referrals for treatment are needed. Consistent education is needed for all women. Education and support should be individualized. Future research is needed to identify techniques that motivate women to routinely perform Kegel exercises.

Use of an Early Labor Lounge to Promote Admission in Active Labor.

Professional maternity care organizations within the United States are aligned in the goal to prevent the first cesarean birth in nulliparous women with a term, singleton, vertex fetus. Currently, one in 3 women are at risk for having a cesarean birth. The most common reason for cesarean in the United States is labor dystocia. The evidence supports delaying admission to the birthing unit until active labor is established, thereby minimizing the inadvertent diagnosis of labor dystocia. Providers are familiar with the rationale supporting delayed admission to the birthing unit until active labor is established; however, there is very little evidence on how to effectively promote this delay. Provider apprehension and the lack of early labor support are challenges to sending women home to await the onset of active labor. Maternal anxiety, fear, pain, and unpreparedness also play a part in this reluctance. To address these obstacles, South Shore Hospital created an early labor lounge with stations aimed at instilling confidence in the birth team, promoting teamwork, facilitating relaxation, and reducing anxiety for laboring women. A literature review focusing on women's perceptions of promoting admission in active labor, maternal anxiety, and nonpharmacologic strategies for managing early labor are discussed within the context of the creation, implementation, and evaluation of an early labor lounge.

Primary Prevention of Urinary Incontinence: A Case Study of Prenatal and Intrapartum Interventions.

A wealth of information is available regarding the diagnosis and treatment of urinary incontinence. However, there is a dearth of quality information and clinical practice guidelines regarding the primary prevention of urinary incontinence. Given the high prevalence of this concern and the often cited correlation between pregnancy, childbirth, and urinary incontinence, women's health care providers should be aware of risk factors and primary prevention strategies for stress urinary incontinence (SUI) in order to reduce associated physical and emotional suffering. This case report describes several common risk factors for SUI and missed opportunities for primary prevention of postpartum urinary incontinence. The most effective methods for preventing urinary incontinence include correct teaching of pelvic floor muscle training (PFMT; specifically Kegel exercises), moderate combined physical exercise regimens, counseling and support for weight loss, counseling against smoking, appropriate treatment for asthma and constipation, and appropriate labor management to prevent pelvic organ prolapse, urethral injury, and pelvic floor muscle damage.

The pharmacology of prostaglandins for induction of labor.

Prostaglandin medications are frequently used in the process of induction of labor. Understanding the history and research that supports prostaglandin use for induction of labor is crucial for safe practice. Dinoprostone has been the standard of care for cervical ripening in term pregnancies. Misoprostol administration via various routes has been shown to be efficacious. Oral misoprostol in particular is effective and associated with reassuring maternal and fetal outcomes. In addition, cost has become a variable in decision making regarding best practice. More research is necessary to determine the safest medication, route, dose, and interval of administration. This article reviews cervical physiology and endogenous prostaglandin activity in relation to labor, and the pharmacologic profiles of synthetic prostaglandins currently used for induction of labor.

The Impact of Pelvic Floor Disorders and Pelvic Surgery on Women's Sexual Satisfaction and Function.

Pelvic floor disorders have a significant impact on women's daily lives. Sexual health, which includes sexual satisfaction and function, can be altered by pelvic floor disorders and pelvic surgery. This article reviews common pelvic floor disorders (pelvic organ prolapse, urinary and fecal incontinence) and the effect they have on sexual satisfaction and function. Associations between sexual function and pelvic floor disorders are described, as are the relationships between sexual function and pelvic surgery. Women of all ages need to know their options and understand the impact pelvic surgery can have on sexual satisfaction, function, and activity.

Contraception and antiepileptic drugs.

Epilepsy is a neurologic condition that affects women and women's choices in many areas of their lives. Some antiepileptic drugs (AEDs) used in the treatment of epilepsy can interact with hormonal contraceptives. The result can be decreased effectiveness in the contraceptive with the possibility of unintended pregnancy, or decreased effectiveness of the AED that can result in seizure activity. This article provides information about concurrent AED and contraceptive use to assist health care providers in guiding women with epilepsy to make the best contraceptive choices based on their reproductive life plans.

Oral health and oral health care practices among low-income pregnant women.

INTRODUCTION: Access to dental care is a problem in California as in many parts of the United States. Many women, including half of those having dental problems, do not see a dentist during pregnancy. The objective of this study was to describe the oral health status and oral health practices of low-income pregnant women in San Diego, California, and to determine the needs for oral health care education in this population. METHODS: This descriptive, retrospective, correlational study examined oral health and oral health care practices by age, ethnicity, and gravidity by using medical records from a convenience sample of 380 low-income pregnant women. RESULTS: Most participants were primigravida, aged between 19 and 29 years, of Hispanic ethnicity, and insured by the state (Medi-Cal). All women received education on oral health. The majority (84%) were encouraged to get a dental examination. It had been more than 1 year since the last dental visit for most women (55%). Hispanic women were in need of dental care more than Filipina women or women of other ethnicities. A broken tooth was the primary reason for immediate dental referrals. Regularity of flossing and brushing teeth differed significantly (P= .015, P < .001) across ethnic groups, with Filipina women reporting better oral care practices. DISCUSSION: The results provide information for the future planning of effective dental health promotion programs. Findings suggest that low-income pregnant women have some healthy oral health care practices but are in need of dental services and oral health education. An oral health history, oral health education, dental screening, and dental referral, if needed, should be a routine part of prenatal care and annual examinations.

A selective review of maternal sleep characteristics in the postpartum period.

OBJECTIVE: To determine the current knowledge of postpartum women's sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. DATA SOURCES: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. STUDY SELECTION: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum women's sleep and implications for health care providers. DATA EXTRACTION: Literature was reviewed and organized into groups with similar characteristics. DATA SYNTHESIS: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. CONCLUSIONS: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.