Aspects of Pelvic Floor Protection in Spontaneous Delivery – a Review

 

 Permissions and Reprints

Abstract

The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is “only” one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.

Publication History

Received: 29 January 2021

Accepted after revision: 17 May 2021

Article published online:
05 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References/Literatur

• 1 Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol 1996; 88: 470-478 DOI: 10.1016/0029-7844(96)00151-2.
  CrossrefPubMedGoogle Scholar
• 2 Jelovsek JE, Chagin K, Gyhagen M. et al. Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol 2018; 218: 222.e1-222.e19 DOI: 10.1016/j.ajog.2017.10.014.
  CrossrefPubMedGoogle Scholar
• 3 Delancey JO, Kane Low L, Miller JM. et al. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol 2008; 199: 610.e1-610.e5 DOI: 10.1016/j.ajog.2008.04.001.
  CrossrefPubMedGoogle Scholar
• 4 Huebner M, Brucker SY, Tunn R. et al. Intrapartal pelvic floor protection: a pragmatic and interdisciplinary approach between obstetrics and urogynecology. Arch Gynecol Obstet 2017; 295: 795-798 DOI: 10.1007/s00404-017-4316-x.
  CrossrefPubMedGoogle Scholar
• 5 Angelescu K. Inanspruchnahme von Leistungen der Hebammenhilfe durch GEK-versicherte Schwangere 2008 bis 2009. Eine explorative Analyse von Routinedaten einer gesetzlichen Krankenkasse. Universität Bremen 2012. Accessed November 15, 2020 at: http://nbn-resolving.de/urn:nbn:de:gbv:46-00102787-10
  PubMedGoogle Scholar
• 6 Sandall J, Soltani H, Gates S. et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; (04) CD004667 DOI: 10.1002/14651858.CD004667.pub5.
  CrossrefPubMedGoogle Scholar
• 7 Bihler J, Tunn R, Reisenauer C. et al. The preferred mode of delivery of medical professionals and non-medical professional mothers-to-be and the impact of additional information on their decision: an online questionnaire cohort study. Arch Gynecol Obstet 2019; 299: 371-384 DOI: 10.1007/s00404-018-4970-7.
  CrossrefPubMedGoogle Scholar
• 8 Borrelli SE, Walsh D, Spiby H. First-time mothersʼ expectations of the unknown territory of childbirth: Uncertainties, coping strategies and ‘going with the flow’. Midwifery 2018; 63: 39-45 DOI: 10.1016/j.midw.2018.04.022.
  CrossrefPubMedGoogle Scholar
• 9 Cerruto MA, DʼElia C, Aloisi A. et al. Prevalence, incidence and obstetric factorsʼ impact on female urinary incontinence in Europe: a systematic review. Urol Int 2013; 90: 1-9 DOI: 10.1159/000339929.
  CrossrefPubMedGoogle Scholar
• 10 Wesnes SL, Rortveit G, Bo K. et al. Urinary incontinence during pregnancy. Obstet Gynecol 2007; 109: 922-928 DOI: 10.1097/01.AOG.0000257120.23260.00.
  CrossrefPubMedGoogle Scholar
• 11 Metz M, Junginger B, Henrich W. et al. Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post Partum. Geburtshilfe Frauenheilkd 2017; 77: 358-365 DOI: 10.1055/s-0043-102693.
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 MacArthur C, Glazener C, Lancashire R. et al. ProLong study group. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG 2011; 118: 1001-1007 DOI: 10.1111/j.1471-0528.2011.02964.x.
  CrossrefPubMedGoogle Scholar
• 13 Oberwalder M, Connor J, Wexner SD. Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 2003; 90: 1333-1337 DOI: 10.1002/bjs.4369.
  CrossrefPubMedGoogle Scholar
• 14 Gyhagen M, Bullarbo M, Nielsen TF. et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2013; 120: 152-160 DOI: 10.1111/1471-0528.12020.
  CrossrefPubMedGoogle Scholar
• 15 Gyhagen M, Bullarbo M, Nielsen TF. et al. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2013; 120: 144-151 DOI: 10.1111/j.1471-0528.2012.03301.x.
  CrossrefPubMedGoogle Scholar
• 16 Siahkal SF, Iravani M, Mohaghegh Z. et al. Maternal, obstetrical and neonatal risk factorsʼ impact on female urinary incontinence: a systematic review. Int Urogynecol J 2020; DOI: 10.1007/s00192-020-04442-x.
  CrossrefPubMedGoogle Scholar
• 17 Solans-Domènech M, Sánchez E. Espuña-Pons M; Pelvic Floor Research Group (Grup de Recerca del Sòl Pelvià, GRESP). Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol 2010; 115: 618-628 DOI: 10.1097/AOG.0b013e3181d04dff.
  CrossrefPubMedGoogle Scholar
• 18 Blomquist JL, Munoz A, Carroll M. et al. Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA 2018; 320: 2438-2447 DOI: 10.1001/jama.2018.18315.
  CrossrefPubMedGoogle Scholar
• 19 Wilson D, Dornan J, Milsom I. et al. UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction?. Int Urogynecol J 2014; 25: 1449-1452 DOI: 10.1007/s00192-014-2376-z.
  CrossrefPubMedGoogle Scholar
• 20 Schreiner L, Crivelatti I, de Oliveira JM. et al. Systematic review of pelvic floor interventions during pregnancy. Int J Gynaecol Obstet 2018; 143: 10-18 DOI: 10.1002/ijgo.12513.
  CrossrefPubMedGoogle Scholar
• 21 Hill AM, McPhail SM, Wilson JM. et al. Pregnant womenʼs awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J 2017; 28: 1557-1565 DOI: 10.1007/s00192-017-3309-4.
  CrossrefPubMedGoogle Scholar
• 22 Franklin E. Beckenboden Power. München: Kösel; 2008
  Google Scholar
• 23 Heller A. Geburtsvorbereitung Menne-Heller Konzept. Stuttgart: Thieme; 1978
  Google Scholar
• 24 Chen I, Opiyo N, Tavender E. et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2018; (09) CD005528 DOI: 10.1002/14651858.CD005528.pub3.
  CrossrefPubMedGoogle Scholar
• 25 OʼKelly SM, Moore ZE. Antenatal maternal education for improving postnatal perineal healing for women who have birthed in a hospital setting. Cochrane Database Syst Rev 2017; (12) CD012258 DOI: 10.1002/14651858.CD012258.pub2.
  CrossrefPubMedGoogle Scholar
• 26 Daly D, Cusack C, Begley C. Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study. Int Urogynecol J 2019; 30: 965-975 DOI: 10.1007/s00192-018-3848-3.
  CrossrefPubMedGoogle Scholar
• 27 Ruckhaberle E, Jundt K, Bauerle M. et al. Prospective randomised multicentre trial with the birth trainer EPI-NO for the prevention of perineal trauma. Aust N Z J Obstet Gynaecol 2009; 49: 478-483 DOI: 10.1111/j.1479-828X.2009.01044.x.
  CrossrefPubMedGoogle Scholar
• 28 Kamisan Atan I, Shek KL, Langer S. et al. Does the Epi-No((R)) birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG 2016; 123: 995-1003 DOI: 10.1111/1471-0528.13924.
  CrossrefPubMedGoogle Scholar
• 29 Shek KL, Chantarasorn V, Langer S. et al. Does the Epi-No Birth Trainer reduce levator trauma? A randomised controlled trial. Int Urogynecol J 2011; 22: 1521-1528 DOI: 10.1007/s00192-011-1517-x.
  CrossrefPubMedGoogle Scholar
• 30 Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol 2000; 182 (1 Pt 1): 76-80 DOI: 10.1016/s0002-9378(00)70493-5.
  CrossrefPubMedGoogle Scholar
• 31 Eogan M, Daly L, OʼHerlihy C. The effect of regular antenatal perineal massage on postnatal pain and anal sphincter injury: a prospective observational study. J Matern Fetal Neonatal Med 2006; 19: 225-229 DOI: 10.1080/14767050600593155.
  CrossrefPubMedGoogle Scholar
• 32 Demirel G, Golbasi Z. Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet 2015; 131: 183-186 DOI: 10.1016/j.ijgo.2015.04.048.
  CrossrefPubMedGoogle Scholar
• 33 Mei-dan E, Walfisch A, Raz I. et al. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J 2008; 10: 499-502
  PubMedGoogle Scholar
• 34 Holst L, Haavik S, Nordeng H. Raspberry leaf–should it be recommended to pregnant women?. Complement Ther Clin Pract 2009; 15: 204-208 DOI: 10.1016/j.ctcp.2009.05.003.
  CrossrefPubMedGoogle Scholar
• 35 Beer AM, Adler M. Leitfaden Naturheilverfahren für die ärztliche Praxis. München: Urban & Fischer; 2012
  Google Scholar
• 36 Büthe K, Franke T, Hillen K. Geburtsvorbereitung des Perineums. Die Hebamme 2020; 33: 30-38
  Article in Thieme ConnectPubMedGoogle Scholar
• 37 Salvesen KA, Stafne SN, Eggebo TM. et al. Does regular exercise in pregnancy influence duration of labor? A secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand 2014; 93: 73-79 DOI: 10.1111/aogs.12260.
  CrossrefPubMedGoogle Scholar
• 38 Dias A, Assis L, Barbosa A, Santini A, Picelli-Dias F. Effectiveness of perineal exercises in controlling urinary incontinence and improving pelvic floor muscle function during pregnancy. Neurourology and Urodynamics 2011; 30: 968
  PubMedGoogle Scholar
• 39 Pelaez M, Gonzalez-Cerron S, Montejo R. et al. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Neurourol Urodyn 2014; 33: 67-71 DOI: 10.1002/nau.22381.
  CrossrefPubMedGoogle Scholar
• 40 Stafne SN, Salvesen KA, Romundstad PR. et al. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG 2012; 119: 1270-1280 DOI: 10.1111/j.1471-0528.2012.03426.x.
  CrossrefPubMedGoogle Scholar
• 41 Sut HK, Asci O, Topac N. Sleep Quality and Health-Related Quality of Life in Pregnancy. J Perinat Neonatal Nurs 2016; 34: 302-309 DOI: 10.1097/JPN.0000000000000181.
  CrossrefPubMedGoogle Scholar
• 42 Leon-Larios F, Corrales-Gutierrez I, Casado-Mejia R. et al. Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial. Midwifery 2017; 50: 72-77 DOI: 10.1016/j.midw.2017.03.015.
  CrossrefPubMedGoogle Scholar
• 43 Fritel X, de Tayrac R, Bader G. et al. Preventing Urinary Incontinence With Supervised Prenatal Pelvic Floor Exercises: A Randomized Controlled Trial. Obstet Gynecol 2015; 126: 370-377 DOI: 10.1097/AOG.0000000000000972.
  CrossrefPubMedGoogle Scholar
• 44 Mathe M, Valancogne G, Atallah A. et al. Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. Eur J Obstet Gynecol Reprod Biol 2016; 199: 201-206 DOI: 10.1016/j.ejogrb.2016.01.025.
  CrossrefPubMedGoogle Scholar
• 45 Jahdi F, Sheikhan F, Haghani H. et al. Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial). Complement Ther Clin Pract 2017; 27: 1-4 DOI: 10.1016/j.ctcp.2016.12.002.
  CrossrefPubMedGoogle Scholar
• 46 Barimani M, Forslund Frykedal K, Rosander M. et al. Childbirth and parenting preparation in antenatal classes. Midwifery 2018; 57: 1-7 DOI: 10.1016/j.midw.2017.10.021.
  CrossrefPubMedGoogle Scholar
• 47 Salvesen KA, Morkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 2004; 329: 378-380 DOI: 10.1136/bmj.38163.724306.3A.
  CrossrefPubMedGoogle Scholar
• 48 Boyle R, Hay-Smith EJ, Cody JD. et al. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review. Neurourol Urodyn 2014; 33: 269-276 DOI: 10.1002/nau.22402.
  CrossrefPubMedGoogle Scholar
• 49 Hay-Smith J, Morkved S, Fairbrother KA. et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2008; (04) CD007471 DOI: 10.1002/14651858.CD007471.
  CrossrefPubMedGoogle Scholar
• 50 Sobhgol SS, Smith CA, Dahlen HG. The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. Int Urogynecol J 2020; DOI: 10.1007/s00192-020-04298-1.
  CrossrefPubMedGoogle Scholar
• 51 Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med 2014; 48: 299-310 DOI: 10.1136/bjsports-2012-091758.
  CrossrefPubMedGoogle Scholar
• 52 Bo K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol 2009; 113: 1279-1284 DOI: 10.1097/AOG.0b013e3181a66f40.
  CrossrefPubMedGoogle Scholar
• 53 Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J 2013; 24: 889-899 DOI: 10.1007/s00192-012-2017-3.
  CrossrefPubMedGoogle Scholar
• 54 Glazener C, Elders A, MacArthur C. et al. ProLong Study Group. Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse. BJOG 2013; 120: 161-168 DOI: 10.1111/1471-0528.12075.
  CrossrefPubMedGoogle Scholar
• 55 Huebner M. Vitamin D: another piece of the puzzle in pelvic floor protection. BJOG 2020; DOI: 10.1111/1471-0528.16398.
  CrossrefPubMedGoogle Scholar
• 56 Stafne SN, Morkved S, Gustafsson MK. et al. Vitamin D and stress urinary incontinence in pregnancy: a cross-sectional study. BJOG 2020; DOI: 10.1111/1471-0528.16340.
  CrossrefPubMedGoogle Scholar
• 57 Huang J, Zang Y, Ren LH. et al. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci 2019; 6: 460-467 DOI: 10.1016/j.ijnss.2019.06.007.
  CrossrefPubMedGoogle Scholar
• 58 Mändle C, Opitz-Kreuter S. Lehrbuch der praktischen Geburtshilfe. Stuttgart: Schattauer; 2014
  Google Scholar
• 59 Aasheim V, Nilsen ABV, Reinar LM. et al. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2017; (06) CD006672 DOI: 10.1002/14651858.CD006672.pub3.
  CrossrefPubMedGoogle Scholar
• 60 Trochez R, Waterfield M, Freeman RM. Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS). Int Urogynecol J 2011; 22: 1279-1285 DOI: 10.1007/s00192-011-1454-8.
  CrossrefPubMedGoogle Scholar
• 61 Foroughipour A, Firuzeh F, Ghahiri A. et al. The effect of perineal control with hands-on and hand-poised methods on perineal trauma and delivery outcome. J Res Med Sci 2011; 16: 1040-1046
  PubMedGoogle Scholar
• 62 Mayerhofer K, Bodner-Adler B, Bodner K. et al. Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women. J Reprod Med 2002; 47: 477-482
  PubMedGoogle Scholar
• 63 Bulchandani S, Watts E, Sucharitha A. et al. Manual perineal support at the time of childbirth: a systematic review and meta-analysis. BJOG 2015; 122: 1157-1165 DOI: 10.1111/1471-0528.13431.
  CrossrefPubMedGoogle Scholar
• 64 Naidu M, Sultan AH, Thakar R. Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience. Int Urogynecol J 2017; 28: 381-389 DOI: 10.1007/s00192-016-3176-4.
  CrossrefPubMedGoogle Scholar
• 65 Ali-Masri H, Hassan S, Fosse E. et al. Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study. BMC Med Educ 2018; 18: 258 DOI: 10.1186/s12909-018-1363-3.
  CrossrefPubMedGoogle Scholar
• 66 Seehafer P. Warme Kompressen für den Damm: Evidenzbasiert, doch wenig angewendet. Deutsche Hebammenzeitschrift 09/2019.
  PubMedGoogle Scholar
• 67 Magoga G, Saccone G, Al-Kouatly HB. et al. Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 240: 93-98 DOI: 10.1016/j.ejogrb.2019.06.011.
  CrossrefPubMedGoogle Scholar
• 68 Akbarzadeh M, Vaziri F, Farahmand M. et al. The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in 2012–2013. Adv Skin Wound Care 2016; 29: 79-84 DOI: 10.1097/01.ASW.0000476073.96442.91.
  CrossrefPubMedGoogle Scholar
• 69 Dahlen HG, Homer CS, Cooke M. et al. Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial. Birth 2007; 34: 282-290 DOI: 10.1111/j.1523-536X.2007.00186.x.
  CrossrefPubMedGoogle Scholar
• 70 Essa R, Ismail N. Effect of second stage perineal warm compresses on perineal pain and outcome among primiparae. J Nurs Educ Pract 2015; 6: 48 DOI: 10.5430/jnep.v6n4p48.
  CrossrefPubMedGoogle Scholar
• 71 Gupta JK, Sood A, Hofmeyr GJ. et al. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017; (05) CD002006 DOI: 10.1002/14651858.CD002006.pub4.
  CrossrefPubMedGoogle Scholar
• 72 Thies-Lagergren L, Kvist LJ, Christensson K. et al. No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial. BMC Pregnancy Childbirth 2011; 11: 22 DOI: 10.1186/1471-2393-11-22.
  CrossrefPubMedGoogle Scholar
• 73 Nieuwenhuijze MJ, de Jonge A, Korstjens I. et al. Influence on birthing positions affects womenʼs sense of control in second stage of labour. Midwifery 2013; 29: e107-e114 DOI: 10.1016/j.midw.2012.12.007.
  CrossrefPubMedGoogle Scholar
• 74 Gareberg B, Magnusson B, Sultan B. et al. Birth in standing position: a high frequency of third degree tears. Acta Obstet Gynecol Scand 1994; 73: 630-633 DOI: 10.3109/00016349409013456.
  CrossrefPubMedGoogle Scholar
• 75 Edqvist M, Hildingsson I, Mollberg M. et al. Midwivesʼ Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study. Birth 2017; 44: 86-94 DOI: 10.1111/birt.12267.
  CrossrefPubMedGoogle Scholar
• 76 Olson R, Olson C, Cox NS. Maternal birthing positions and perineal injury. J Fam Pract 1990; 30: 553-557
  PubMedGoogle Scholar
• 77 Altman D, Ragnar I, Ekstrom A. et al. Anal sphincter lacerations and upright delivery postures–a risk analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 141-146 DOI: 10.1007/s00192-006-0123-9.
  CrossrefPubMedGoogle Scholar
• 78 WHO. WHO recommendations: intrapartum care for a positive childbirth experience. 2018 Accessed October 26, 2020 at: https://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/
  PubMedGoogle Scholar
• 79 Jesacher K. Kritik an strikter Anleitung zu forciertem Pressen und Rückenlage der Gebärenden. Die Hebamme 2016; 29: 160-165
  Article in Thieme ConnectPubMedGoogle Scholar
• 80 Caughey AB. Is there an upper time limit for the management of the second stage of labor?. Am J Obstet Gynecol 2009; 201: 337-338 DOI: 10.1016/j.ajog.2009.08.001.
  CrossrefPubMedGoogle Scholar
• 81 American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine. Caughey AB, Cahill AG, Guise JM. et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210: 179-193 DOI: 10.1016/j.ajog.2014.01.026.
  CrossrefPubMedGoogle Scholar
• 82 Gimovsky AC, Berghella V. Randomized controlled trial of prolonged second stage: extending the time limit vs. usual guidelines. Am J Obstet Gynecol 2016; 214: 361.e1-361.e6 DOI: 10.1016/j.ajog.2015.12.042.
  CrossrefPubMedGoogle Scholar
• 83 Rouse DJ, Owen J, Savage KG. et al. Active phase labor arrest: revisiting the 2-hour minimum. Obstet Gynecol 2001; 98: 550-554 DOI: 10.1016/s0029-7844(01)01516-2.
  CrossrefPubMedGoogle Scholar
• 84 Henry DE, Cheng YW, Shaffer BL. et al. Perinatal outcomes in the setting of active phase arrest of labor. Obstet Gynecol 2008; 112: 1109-1115 DOI: 10.1097/AOG.0b013e31818b46a2.
  CrossrefPubMedGoogle Scholar
• 85 Zipori Y, Grunwald O, Ginsberg Y. et al. The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes. Am J Obstet Gynecol 2019; 220: 191.e1-191.e7 DOI: 10.1016/j.ajog.2018.10.028.
  CrossrefPubMedGoogle Scholar
• 86 Marsoosi V, Jamal A, Eslamian L. et al. Prolonged second stage of labor and levator ani muscle injuries. Glob J Health Sci 2014; 7: 267-273 DOI: 10.5539/gjhs.v7n1p267.
  CrossrefPubMedGoogle Scholar
• 87 Pardo E, Rotem R, Glinter H. et al. Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor. Arch Gynecol Obstet 2019; 300: 127-133 DOI: 10.1007/s00404-019-05173-1.
  CrossrefPubMedGoogle Scholar
• 88 Low LK, Zielinski R, Tao Y. et al. Predicting Birth-Related Levator Ani Tear Severity in Primiparous Women: Evaluating Maternal Recovery from Labor and Delivery (EMRLD Study). Open J Obstet Gynecol 2014; 4: 266-278 DOI: 10.4236/ojog.2014.46043.
  CrossrefPubMedGoogle Scholar
• 89 Lal M, Pattison HM, Allan TF. et al. Postcesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity. J Reprod Med 2009; 54: 53-60
  PubMedGoogle Scholar
• 90 Schwarz C. Die Erlaubnis zum Nichtstun. Deutsche Hebammenzeitschrift 09/2014.
  PubMedGoogle Scholar
• 91 Bader W, Aigmueller T. Leitlinie zum Management von Dammrissen III. und IV. Grades nach vaginaler Geburt. AWMF 015/079. 2020. Accessed October 20, 2020 at: http://www.awmf.org/leitlininen/detail/II/015-079.html
  PubMedGoogle Scholar
• 92 Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (01) CD000081 DOI: 10.1002/14651858.CD000081.pub2.
  CrossrefPubMedGoogle Scholar
• 93 Jiang H, Qian X, Carroli G. et al. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017; (02) CD000081 DOI: 10.1002/14651858.CD000081.pub3.
  CrossrefPubMedGoogle Scholar
• 94 Fodstad K, Staff AC, Laine K. Effect of different episiotomy techniques on perineal pain and sexual activity 3 months after delivery. Int Urogynecol J 2014; 25: 1629-1637 DOI: 10.1007/s00192-014-2401-2.
  CrossrefPubMedGoogle Scholar
• 95 Sultan AH, Thakar R, Ismail KM. et al. The role of mediolateral episiotomy during operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol 2019; 240: 192-196 DOI: 10.1016/j.ejogrb.2019.07.005.
  CrossrefPubMedGoogle Scholar
• 96 DeLancey JO. Episiotomy: whatʼs the angle?. Int J Gynaecol Obstet 2008; 103: 3-4 DOI: 10.1016/j.ijgo.2008.06.004.
  CrossrefPubMedGoogle Scholar
• 97 Eogan M, Daly L, OʼConnell PR. et al. Does the angle of episiotomy affect the incidence of anal sphincter injury?. BJOG 2006; 113: 190-194 DOI: 10.1111/j.1471-0528.2005.00835.x.
  CrossrefPubMedGoogle Scholar
• 98 Harvey MA, Pierce M, Alter JE. et al. Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol Can 2015; 37: 1131-1148 DOI: 10.1016/s1701-2163(16)30081-0.
  CrossrefPubMedGoogle Scholar
• 99 Kapoor DS, Thakar R, Sultan AH. Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions. Int Urogynecol J 2015; 26: 1725-1734 DOI: 10.1007/s00192-015-2747-0.
  CrossrefPubMedGoogle Scholar
• 100 Jango H, Langhoff-Roos J, Rosthoj S. et al. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol 2014; 210: 59.e1-59.e6 DOI: 10.1016/j.ajog.2013.08.043.
  CrossrefPubMedGoogle Scholar
• 101 Laycock J, Jerwood D. Pelvic Floor Muscle Assessment: The PERFECT Scheme. Physiotherapy 2001; 87: 631-642 DOI: 10.1016/S0031-9406(05)61108-X.
  CrossrefPubMedGoogle Scholar
• 102 Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can 2003; 25: 487-498 DOI: 10.1016/s1701-2163(16)30310-3.
  CrossrefPubMedGoogle Scholar
• 103 Klinger H. Verbessert sich die Funktion des Beckenbodens durch Rückbildungsgymnastik?. Die Hebamme 2007; 20: 251-255
  Article in Thieme ConnectPubMedGoogle Scholar
• 104 Meyer S, Hohlfeld P, Achtari C. et al. Pelvic floor education after vaginal delivery. Obstet Gynecol 2001; 97 (5 Pt 1): 673-677 DOI: 10.1016/s0029-7844(00)01101-7.
  CrossrefPubMedGoogle Scholar
• 105 Morkved S, Bo K. The effect of post-natal exercises to strengthen the pelvic floor muscles. Acta Obstet Gynecol Scand 1996; 75: 382-385 DOI: 10.3109/00016349609033336.
  CrossrefPubMedGoogle Scholar
• 106 Sacomori C, Zomkowski K, Dos Passos Porto I. et al. Adherence and effectiveness of a single instruction of pelvic floor exercises: a randomized clinical trial. Int Urogynecol J 2020; 31: 951-959 DOI: 10.1007/s00192-019-04032-6.
  CrossrefPubMedGoogle Scholar
• 107 Benjamin DR, Frawley HC, Shields N. et al. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019; 105: 24-34 DOI: 10.1016/j.physio.2018.07.002.
  CrossrefPubMedGoogle Scholar
• 108 Pascoal AG, Dionisio S, Cordeiro F. et al. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy 2014; 100: 344-348 DOI: 10.1016/j.physio.2013.11.006.
  CrossrefPubMedGoogle Scholar
• 109 Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 2014; 100: 1-8 DOI: 10.1016/j.physio.2013.08.005.
  CrossrefPubMedGoogle Scholar
• 110 Eggenschwiler R. Clinical Assessment von Hebammen. Die Hebamme 2015; 28: 57-59
  Article in Thieme ConnectPubMedGoogle Scholar
• 111 Franz A. PT und Hebamme: Konkurrenten?. Physiopraxis 2004; 2: 10-11
  Article in Thieme ConnectPubMedGoogle Scholar
• 112 Baessler K, Heihoff-Klose A, Boelke S. et al. Does an early postpartum pessary treatment lead to remission of pelvic organ prolapse after vaginal birth? A pilot study. AUGS/IUGA Scientific Meeting. Int Urogynecol J 2019; 30: 219-380 DOI: 10.1007/s00192-019-04116-3.
  CrossrefPubMedGoogle Scholar
• 113 Beilecke K, Tunn R. Ein neues Konzept in der postpartalen Pessartherapie. gynäkologie + geburtshilfe 2017; 22: 30-32
  CrossrefPubMedGoogle Scholar