Water birth in the parturients' estimation

OBJECTIVES: The purpose of the study was to characterise a group of women who decided for under water birth and to show an influence of warm water on their psychosomatic reactions. MATERIALS AND METHODS: The results of the inquiry conducted among 45 women bathed during first stage of normal labour and delivery under water were analysed. The demographic data, water birth knowledge and psychosomatic reactions were studied traditional. The age, education, obstetric history of the women was compared with a group of 45 women who gave birth in a way. RESULTS: The average age of women in labour under water was 25.6 years and no significant difference to control group (25 years) was found. The most common in our research group was secondary education (62%), after that elementary (20%) and university education (18%). Worse educated women were more rarely decided for water birth (20% in research group vs 41% in control; p < 0.05). A midwife was the most important source of information about warm tub bath during delivery, especially among worse educated women (67%). Concerning reactions after entering the pool, in 69% cases decrease of labour pain and in 64% decrease of spasm pains was observed. In 58% cases the time of delivery was advanced, only in 13% it lasted longer after going into the warm tub. Immersion in the pool was sensed in a positive way by all the parturients. The women described appeasement (78%), relaxation (67%), better opportunities for mid-spasm rest (67%). The water tub bath during delivery was estimated good by all of the women. 76% of the group gave 5 points in 1 to 5 scale. As many as 87% of women wish they born another baby in a water. CONCLUSIONS: A midwife has an essential role in information and making a decision of water birth. Entering the pool causes subjective decrease of labour pain and advance of delivery. Women very good estimate birth in water.     

Pregnancy outcome in women with heart disease undergoing induction of labour

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.     

Mobility and maternal position during childbirth in Tanzania: an exploratory study at four government hospitals

BACKGROUND: Emerging research evidence suggests a potential benefit in being upright in the first stage of labour and a systematic review of trials suggests both benefits and harmful effects associated with being upright in the second stage of labour. Implementing evidence-based obstetric care in African countries with scarce resources is particularly challenging, and requires an understanding of the cumulative nature of science and commitment to applying the most up to date evidence to clinical decisions. In this study, we documented current practice rates, explored the barriers and opportunities to implementing these procedures from the provider perspective, and documented women's preferences and satisfaction with care. METHODS: This was an exploratory study using quantitative and qualitative methods. Practice rates were determined by exit interviews with a consecutive sample of postnatal women. Provider views were explored using semi-structured interviews (with doctors and traditional birth attendants) and focus group discussions (with midwives). The study was conducted at four government hospitals, two in Dar es Salaam and two in the neighbouring Coast region, Tanzania. MAIN OUTCOME MEASURES: Practice rates for mobility during labour and delivery position; women's experiences, preferences and views about the care provided; and provider views of current practice and barriers and opportunities to evidence-based obstetric practice. RESULTS: Across all study sites more women were mobile at home (15.0%) than in the labour ward (2.9%), but movement was quite restricted at home before women were admitted to labour ward (51.6% chose to rest with little movement). Supine position for delivery was used routinely at all four hospitals; this was consistent with women's preferred choice of position, although very few women are aware of other positions. Qualitative findings suggest obstetricians and midwives favoured confining to bed during the first stage of labour, and supine position for delivery. CONCLUSIONS: The barriers to change appear to be complicated and require providers to want to change, and women to be informed of alternative positions during the first stage of labour and delivery. We believe that highlighting the gap between actual practice and current evidence provides a platform for dialogue with providers to evaluate the threats and opportunities for changing practice.     

Patient's preferences concerning the course of labor

OBJECTIVE: Much concern is being focused on the improvement of perinatal care standards in recent time. Not only the safety of woman and newborn, but also the comfort and individual preferences should to be considered. The aim of this study was to assess of expectations and requirements of the delivering women in relation to the course of labor and usage of the most common procedures in clinical practice. MATERIAL AND METHODS: 47 women who delivered in Obstetrical Word in Puck were questionnaire. Mean gestational age was 39 +/- 1.5 hbd. 47% of women were nulliparous, 53% were multiparous. The following variables were analyzed: the presence of medical staff and family at delivery, possibility of the delivery position choice, use of auxiliary devices, a friendly atmosphere during delivery, use of analgesia and labor induction, episiotomy and ante-partum preparation, cesarean section on request, attendance to labor school. Mann-Whitney, Pearson and Yule tests were used for statistical analysis. RESULTS: 25% of women, mainly younger gravidae, attended the labor school. The midwife was considered the most important person at delivery. The presence of family member(s) was important for highly-educated women. The possibility to choose the delivery position and to walk during the 1st stage of labor was important for 73% of respondents. The majority of women who had attended the labor school avoided the horizontal position. Over 60% of patients accepted the usage of labor induction. A vast majority of women were against antepartum perineal shaving and episiotomy. Better-educated women preferred water delivery. 69% of the studied women would like to listen to the music at the delivery room. Cesarean section on request was supported by 11% of women. CONCLUSIONS: The tendency to promote modern delivery methods and active participation in labor leading is noticed. The significant influence of labor school on women's knowledge and their preferences was found.     

Problems of obstetric care in Nigeria

The problems of obstetric care in Nigeria are multifactorial, enormous but represent inevitable evolutionary stages through which every community in the world must pass. In a population of around 90 million, there is one doctor for every 11,000 people and only 35% of the population is at present covered by any form of modern health care services. There are fewer than 500 doctors with specialist obstetric qualifications and many of them are concentrated in the large cities. A disquietingly small number (17%) of our women are delivered by personnel with modern obstetric knowledge; 83% are delivered by traditional birth attendants. The maternal mortality rate is around 8/1000, and the perinatal mortality is about 60/1000. Currently less than 20% of the population is educated. Only 3% of the national budget is devoted to health. A proper communication system so vital to the establishment of liaison between doctors and the community of patients is virtually non-existent. These problems are compounded by hostile environmental factors. A mixture of tribal, superstitious and religious practices permit marriages as early as 10 years of age and prevent women in labor from seeking medical attention in a timely fashion. Fortunately programmes for improved obstetric care are being expanded. Thus the present difficulty of working in an unfavorable and challenging situation may well be worthwhile.     

Midwife-led care unit for ‘low risk’ pregnant women in a Japanese hospital

Objectives.?To examine the obstetric outcomes of our ‘low risk’ pregnant women under the midwife-led delivery care compared with those under the obstetric shared care.

Methods.?A retrospective cohort study compared outcomes of labor under midwife ‘primary’ care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ‘low risk’ at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy.

Results.?There were 1031 pregnant women initially considered ‘low risk’ at admission. At admission, 878 of them (85%) requested to give birth under midwife care; however 364 of these women (42%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ‘primary’ care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥24?h). There were no significant differences in other obstetric or neonatal outcomes between the two groups.

Conclusions.?There was no evidence indicating that midwife ‘primary’ care is unsafe for ‘low risk’ pregnant women. Therefore, midwifery care is recommended for ‘low risk’ pregnant women.     

Fear of childbirth during pregnancy: a study of more than 8000 pregnant women

In today's modern obstetrics, perinatal morbidity and mortality of mother and neonate have become extremely rare. Despite these advances, are pregnant women still afraid of childbearing and, if so, what--and how intense--are their fears? Are these fears influenced by previous birthing experiences and by birth preparation classes? Data from more than 8000 expectant mothers (collated via a prenatal questionnaire distributed between November 1, 1991 and October 31, 1999) are evaluated. This study examines and discusses the answers concerning quantity and quality of childbirth-related fear among women of differing parity and its possible relation to attended birth preparation classes. The women delivered in a hospital setting that practices modern obstetrics combined with alternative delivery methods. The most frequent fears mentioned are fear for the child's health (50%) and fear of pain (40%). Fears dealing with medical intervention, such as operative delivery, anesthesia, nerve blockage and of being at the mercy of obstetrics all lie at around 12%. It is difficult to establish a clear-cut benefit of birth preparation classes in reducing childbirth fears.     

Women's experiences of continuity of midwifery care in a randomised controlled trial in Australia

OBJECTIVE: to compare the experiences of women who received a new model of continuity of midwifery care with those who received standard hospital care during pregnancy, labour, birth and the postnatal period. DESIGN: a randomised controlled trial was conducted. One thousand and eighty-nine women were randomly allocated to either the new model of care, the St George Outreach Maternity Project (STOMP), or standard care. Women completed a postal questionnaire eight to ten weeks after the birth. PARTICIPANTS: women in the trial were of mixed obstetric risk status and more than half the sample were born in a non-English speaking country. FINDINGS: questionnaires were returned from 69% of consenting women. STOMP women were significantly more likely to have talked with their midwives and doctors about their personal preferences for childbirth and more likely to report that they knew enough about aspects of labour and birth, particularly induction of labour, pain relief and caesarean section. Almost 80% of women in the STOMP group experienced continuity of care, that is, one of their team midwives was present, during labour and birth. STOMP women reported a significantly higher 'sense of control during labour and birth'. Sixty-three per cent of STOMP women reported that they 'knew' the midwife who cared for them during labour compared with 21% of control women. In a secondary analysis, women who had a midwife during labour who they felt that they knew, had a significantly higher sense of 'control' and a more positive birth experience compared with women who reported an unknown midwife. Postnatal care elicited the greatest number of negative comments from women in both the STOMP and the control group. CONCLUSION: The reorganisation of maternity services to enable women to receive continuity of care has benefits for women. The benefits of a known labour midwife needs further research.     

Knowledge and decision-making for labour analgesia of Australian primiparous women

OBJECTIVE: to assess and investigate knowledge of labour pain management options and decision-making among primiparous women. DESIGN: a semi-structured guide was used in focus groups to gather pregnant women's knowledge concerning labour analgesia. Attitudes to labour and pain relief, knowledge of pain relief, trustworthiness of knowledge sources, and plans and expectations for labour pain relief were investigated. SETTING: a major tertiary obstetric hospital in metropolitan Sydney, Australia. PARTICIPANTS: twenty five primiparous women, who were 25 weeks or more gestation, and planning a vaginal birth. FINDINGS: although women considered themselves knowledgeable, they were unable to describe labour analgesic risks or benefits. There was a large discrepancy between perception and actual knowledge. The main source of knowledge was anecdotal information. Late in pregnancy was considered the ideal time to be given information about labour analgesia. Women described their labour pain relief plans as flexible in relation to their labour circumstances; however, most women wanted to take an active role in decision-making. KEY CONCLUSIONS: the large discrepancy between perceived knowledge and actual knowledge of the likely consequences of labour analgesia suggests that women rely too heavily on anecdotal information. IMPLICATIONS FOR PRACTICE: clinicians should be aware that some women overestimate their knowledge and understanding of analgesic options, which is often based on anecdotal information. Standardised labour analgesia information at an appropriate time in their pregnancy may benefit some women and assist health-care providers and women to practice shared decision-making.     

Syrian Women's Preferences for Birth Attendant and Birth Place

Abstract: Background : Women's preferences for type of maternity caregiver and birth place have gained importance and have been documented in studies reported from the developed world. The purpose of our study was to identify Syrian women's preferences for birth attendant and place of delivery. Methods : Interviews with 500 women living in Damascus and its suburbs were conducted using a pretested structured questionnaire. Women were asked about their preferences for the birth attendant and place of delivery, and an open‐ended question asked them to give an explanation for their preferences. We analyzed preferences and their determinants, and also agreement between actual and preferred place of delivery and birth attendant. Results : Only a small minority of women (5–10%) had no preference. Most (65.8%) preferred to give birth at the hospital, and 60.4 percent preferred to be attended by doctors compared with midwives (21.2%). More than 85 percent of women preferred the obstetrician to be a female. The actual place of delivery and type of birth attendant did not match the preferred place of delivery and type of birth attendant. Women's reasons for preferences were a perception of safety and competence, and communication style of caregiver. Conclusions : Most women preferred to be delivered by female doctors at a hospital in this population sample in Syria. The findings suggest that proper understanding of women's preferences is needed, and steps should be taken to enable women to make good choices. Policies about maternity education and services should take into account women's preferences.     

Obstetric and perinatal complications in HIV-infected women. Analysis of a cohort of 167 pregnancies between 1997 and 2003

BACKGROUND: The unquestionable benefit of antiretroviral therapy in reducing the rate of mother-to-child transmission can be lessened by potential maternal or neonatal toxicity. OBJECTIVE: To analyze obstetric and perinatal complications in a cohort of HIV-infected pregnant women and their relationship with maternal antiretroviral therapy. POPULATION: One hundred and sixty-seven HIV-infected pregnant women who delivered at Hospital Universitario La Paz, Madrid, Spain between January 1997 and December 2003. METHODS: Data on the clinical and epidemiological characteristics of HIV-infected patients, previous and current antiretroviral therapy, gestational diabetes mellitus, length of pregnancy, mode of delivery, and weight of the newborn were collected. Pregnancy outcomes were compared with those of all the pregnant women attended at our hospital. MAIN OUTCOME MEASURES: Gestational diabetes mellitus, premature delivery, and low birth weight. RESULTS: Gestational diabetes mellitus was diagnosed in 8.9% of patients. All the cases of gestational diabetes were in the combined antiretroviral therapy group, and the majority were receiving triple antiretroviral therapy with a protease inhibitor. The risk of developing this pathology was greater among women receiving antiretroviral therapy prior to pregnancy. The premature delivery rate was 29% and the low birth weight rate was 28%. CONCLUSION: Gestational diabetes mellitus is more common in HIV-infected women than in the general population and is related to combined antiretroviral therapy, especially the use of protease inhibitors, which suggests the need for close follow-up during pregnancy in HIV-infected patients. Nevertheless, the adverse perinatal consequences observed were more related to maternal factors than to antiretroviral therapy.     

Differences in the Valuation of Birth Outcomes Among Pregnant Women,Mothers, and Obstetricians

Background: Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision. Methods: In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of birth combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum fetal heart rate monitoring. Results: Contrary to obstetricians, women valued permanent neurologic handicap significantly higher than neonatal death ( p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within-group consistency was significantly higher for pregnant women and mothers than for obstetricians ( p < 0.0001). However, application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives. Conclusions: Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.     

Maternal and fetal characteristics in an obstetric cohort in Mozambique

A sample of 908 Mozambican pregnant women with gestational age < or = 21 weeks (as measured by ultrasound) were followed fortnightly from their first antenatal clinic visit until the end of the perinatal period. All women attended two suburban/semirural antenatal clinics in Maputo. Only 9% were lost to follow-up. Pre-term delivery occurred in 15.4% of women and low birthweight (LBW) in 16.2%. Mean birthweight was 2.91 kg. Perinatal death occurred in 4.7%. This obstetric cohort provides valuable baseline data to be used as reference. With substantial efforts, the non-compliance with follow-up at birth could be kept at a low level.     

The fetal maturity and mode of delivery of a woman's first baby influences the characteristics of her next labour.

There are well documented differences between the characteristics of labour in primigravidae and multigravidae. The present study was undertaken to determine whether the gestational age and mode of delivery of a woman's first baby influences the characteristics of labour in her next pregnancy. Information regarding previous obstetric history and subsequent obstetric performance was derived from a database of 75,974 consecutive singleton births. As a group, women with a history of one preterm vaginal delivery had labour characteristics similar to those women whose one previous pregnancy had resulted in a vaginal delivery at term. When this group were analysed by the gestation at which the previous birth had occurred, a gestation-dependent effect was seen. Women whose first birth had been at less than 28 weeks gestation behaved in a similar manner to primiparous women. On the other hand, the characteristics of labour in women whose first birth had occurred between 33 and 36 weeks gestation were similar to those of women who had had a previous vaginal delivery at term. Women whose first delivery had been by caesarean section behaved in a similar manner to primiparae. The typical differences between the characteristics of first and second labours are the result of a gradual change which appears to be related to the gestation at which the first birth occurred.     

Accounts of severe acute obstetric complications in Rural Bangladesh

Background

Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour.

Methods

We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza.

Results

Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines.

Conclusions

This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate quality services during labour and delivery.     

Assisted labor among non European community pregnant women at the Gynecology and Obstetrics Clinic of the Verona University

BACKGROUND: The aim of this paper is to evaluate the role and the prevalence of the non-European Community pregnant women in our Institute during the period 1992-1998. The peculiarity of the female immigration in the world and particularly in Italy is stressed from the point of view of the different cultural, ethnic and religious problems of these women. METHODS: During the observed period 8972 women delivered; 434 of them came from non-European Community countries and their individual (age, country) and obstetric (parity, physiological or pathological evaluation of pregnancy, mode of delivery) data were observed. On the basis of the different countries of provenance these women have been subdivided into five groups (East Europe, North Africa and Middle East, Central Africa, Far East and Latin America). RESULTS: The percentages of preterm births (24.2% vs 23.1%), of < or = 1500 g newborns (6.9% vs 5.3%) and of caesarean sections (34.3% vs 27.7%) are higher in the non-European Community women that delivered in our Institute. In 222 (51.1%) cases the women delivered without induction of labour; while in 14.5% of cases it was induced. The length of labour and the genital conditions (episiotomy, tearing) were considered in all ethnic groups of women. CONCLUSIONS: On the basis of the literature and of the analysis of our data, some suggestions about the management of labour and delivery of non-European Community women in Italy are proposed. In particular, the problems of linguistic communication and of the hospital staff preparation in the assistance to labour and delivery are stressed.     

Interleukin 1beta in serum of women with preterm uterine contractions.

Preterm delivery is a major obstetric and public health problem, accounting for 50-70% of all perinatal deaths. An enzyme-linked immunoassay (ELISA) test was used to determine serum interleukin 1b (IL-1b) levels in 32 women with preterm contractions compared with 26 women in term labour and 11 normal preterm pregnant women. Women with preterm contractions (with or without treatment) had significantly lower mean serum levels of IL-1b (23.5 pgr/ml) compared with women in term labour (218 +/- 57 pgr/ml), but similar levels to pregnant women not in labour at the same weeks of gestation.     

The experience of pregnancy, labour and birth of Thai women in Australia.

OBJECTIVE: To identify the perceptions and experience of pregnancy care, labour and birth of Thai women in Melbourne, Australia. DESIGN: An ethnographic interview and participant observation with women in relation to pregnancy, labour and birth. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Melbourne. FINDINGS: Thai women saw antenatal care as an important aspect of their pregnancy and sought care as soon as they suspected they were pregnant. They were more concerned about the well-being of their babies than their own health, therefore they attended all antenatal appointments. In general, these women were satisfied with care during labour, but some also had negative experiences with their caregivers and hospital routine. When asked to compare maternity services between Thailand and Australia, most of the women believed that services in Australia were better. However, women who had had good experiences of childbirth in Thailand, tended to have negative feelings about the Australian experience. There was also evidence in this study that most of these Thai women did not receive adequate information about care. IMPLICATIONS FOR PRACTICE: Women's perceptions and experiences of antenatal care, labour and birth deserve attention, if appropriate and sensitive care is to be provided to women in Australia and elsewhere. It is only when women's voices are heard in all aspects of health-care delivery that we may see better and appropriate health services for women in childbirth.     

Childbirth Experience -Psychological,Cultural and Medical Associations

This study was carried out in Beer Sheva, Israel on 200 Jewish women. The women were interviewed twice; several weeks before delivery at the ‘antenatal care’ clinic, and within 48 h of delivery.

The questionnaire included socio-demographic information, past obstetric history, questions on previous births and expectations from the present birth. Anxiety was measured before and after delivery by the ‘State and Trait Anxiety Inventory’ compiled by Spielberger. The questionnaire used after delivery included obstetric data and questions concerning the woman's perception of the childbirth experience.

The findings of this study indicated that higher anxiety state and trait before birth associated significantly to a negative childbirth experience. Some factors like lack of explanation on childbirth and multiparity were shown to be associated with higher anxiety states before labour, while other factors that were found to have an important effect on the perception of childbirth as a negative experience were: (1) previous negative birth experience (P = 0.025); (2) abnormal deliveries (vacuum, forceps, cesarean section, P < 0.01); and (3) ethnic origin (P < 0.01).

According to our study, thorough explanation of what happens during pregnancy and labour which would be considered clear and satisfactory by the expectant mother, as well as more attention and support given to multiparous pregnant women, might positively influence the childbirth experience, directly or indirectly by reducing anxiety state.     

Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study

BACKGROUND: This study was carried out to identify risk factors associated with urinary incontinence in women three months after giving birth. METHODS: Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence. This prospective cohort study in 949 pregnant women in Quebec, Canada was nested within a randomised controlled trial of prenatal perineal massage. RESULTS: Postpartum urinary incontinence was increased with prepregnancy incontinence (adjusted odds ratio [adj0R] 6.44, 95% CI 4.15, 9.98), incontinence beginning during pregnancy (adjOR 1.93, 95% CI 1.32, 2.83), and higher prepregnancy body mass index (adjOR 1.07/unit of BMI, 95% CI 1.03,1.11). Caesarean section was highly protective (adjOR 0.27, 95% CI 0.14, 0.50). While there was a trend towards increasing incontinence with forceps delivery (adjOR 1.73, 95% CI 0.96, 3.13) this was not statistically significant. The weight of the baby, episiotomy, the length of the second stage of labour, and epidural analgesia were not predictive of urinary incontinence. Nor was prenatal perineal massage, the randomised controlled trial intervention. When the analysis was limited to women having their first vaginal birth, the same risk factors were important, with similar adjusted odds ratios. CONCLUSIONS: Urinary incontinence during pregnancy is extremely common, affecting over half of pregnant women. Urinary incontinence beginning during pregnancy roughly doubles the likelihood of urinary incontinence at 3 months postpartum, regardless whether delivery is vaginal or by Caesarean section.