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Ficha bibliográfica (sin autores) :
| A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. American Journal of Obstetrics & Gynecology. 192(5):1692-1696, May.
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Autores :
| Schaffer, J.I.; Bloom, S.L.; Casey, B.M.; McIntire, D.D.; Nihira, M.A.; Leveno, K.J.
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Résumé (français)
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| Résumé d’Aline Périault, "Le coaching de la mère pendant l’accouchement ne serait pas utile", le 30/12/05. LJS.com
[…]
L’équipe du Dr Steven Bloom, professeur d’obstétrique et de gynécologie au Southwestern Medical Center de l’université du Texas à Dallas, a étudié les effets du « coaching » de la mère pendant la deuxième phase de l’accouchement sur la durée du travail. Bilan : les « poussez » répétés ne changent pas grand-chose.
L’étude, publiée dans l’American Journal of Obstetric and Gynecology, a porté sur 320 femmes enceintes de leur premier enfant. Toutes avaient vécu une grossesse sans problème et ont accouché sans péridurale. Parmi elles, 163 futures mamans ont été encouragées par une sage-femme à pousser 10 secondes pendant les contractions. Aux 157 autres, il a été recommandé de faire absolument comme elles le voulaient et de pousser naturellement quand elles sentaient que c’était nécessaire.
Dans le groupe « Poussez », bébé n’est arrivé que 13 minutes plus tôt que dans le groupe dépourvu de coach. Ces dernières ont accouché en moyenne en 59 minutes, contre 46 avec un coach. Ce qui fait dire au Dr Steven Bloom que « la plupart du temps, il vaut mieux laisser faire les patientes de la façon la plus confortable pour elles. »
L’étude a par ailleurs soulevé un autre argument en défaveur du « poussez » autoritaire : les mamans coachées ont eu plus de problèmes urinaires par la suite. Les auteurs de l’étude les ont revues 3 mois plus tard et ont constaté que leur vessie avait une capacité plus faible. Les mamans devaient donc uriner beaucoup plus souvent. Ces désagréments sont cependant rapidement rentrés dans l’ordre. « On ne sait pas si ce changement passager peut avoir des conséquences à long terme, explique le Dr Kenneth Leveno, co-auteur de l’étude. Ça ne sert donc a rien d’inquiéter les futures mamans ».
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Abstract (English)
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| “Coaching Barely Shortens Labor”
by Miranda Hitti, WebMD Medical News <http://www.webmd.com/content/article/116/112330>
Dec. 30, 2005 -- 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 Shorter 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.
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