Perineal massage in labour and prevention of perineal trauma: randomised controlled trial

Abstract

Objective To determine the effects of perineal massage in the second stage of labour on perineal outcomes. Design Randomised controlled trial. Participants At 36 weeks' gestation, women expecting normal birth of a singleton were asked to join the study. Women became eligible to be randomised in labour if they progressed to full dilatation of the cervix or 8 cm or more if nulliparous or 5 cm or more if multiparous. 1340 were randomised into the trial. Intervention Massage and stretching of the perineum during the second stage of labour with a water soluble lubricant. Main outcome measures Primary outcomes: rates of intact perineum, episiotomies, and first, second, third, and fourth degree tears. Secondary outcomes: pain at three and 10 days postpartum and pain, dyspareunia, resumption of sexual intercourse, and urinary and faecal incontinence and urgency three months postpartum. Results Rates of intact perineums, first and second degree tears, and episiotomies were similar in the massage and the control groups. There were fewer third degree tears in the massage group (12 (1.7%) v 23 (3.6%); absolute risk 2.11, relative risk 0.45; 95% confidence interval 0.23 to 0.93, P < 0.04), though the trial was underpowered to measure this rarer outcome. Groups did not differ in any of the secondary outcomes at the three assessment points. Conclusions The practice of perineal massage in labour does not increase the likelihood of an intact perineum or reduce the risk of pain, dyspareunia, or urinary and faecal problems.

Effect of perineal massage on the incidence of episiotomy and perineal laceration

“…Both groups needed identical episiotomy, tears repair and rate of 1st grade tears repair, frontal perineal tears was same in two groups. Studies of Stamp (2001) demonstrated that perineal massage in labor 2th stage didn't affect on frequency of intact perineal, its damage prevention, pain, incontinence of urine and feces as well as sexual intercourse [12]. Alberts (2005) studied reducing method of vaginal tract trauma during delivery on 3 groups including: perineal hot compress, massage with lubricant, and non-intervention till groaning, there were not significant differences in 1st and 2nd grade tears, episiotomy, and tear repair [5].…”

“…Women with intact perineal childbirth reported that they had felt less pain promptly after giving birth to the child, and they could have better intercourse too [3,11]. Supportive evidence of systematic randomized clinical trials confirms limited episiotomy [12]. Since 1980, proportion of childbirth episiotomy has fallen from 64% to 30%, while perineal tear has risen from 11% to 40% [11,12].…”

“…Supportive evidence of systematic randomized clinical trials confirms limited episiotomy [12]. Since 1980, proportion of childbirth episiotomy has fallen from 64% to 30%, while perineal tear has risen from 11% to 40% [11,12]. Postpartum hemorrhage is due to large incision, tear and delayed repair of episiotomy endangers mother's life.…”

“…Perineal massage with lubricant is a potential therapeutic approach implemented at the second stage of delivery. Its mechanism of action is vasodilatation, increasing muscle relaxation, more blood supply, as well as creating a pleasant feeling for mother [12][13][14]. In a clinical study in Canada on Nullipara women, the investigators thought that perineal massage would increase intact preneal to 10%.…”

“…Perineal massage and expansion are used to prevent perineal tear. It is also for relaxation to eliminate more episiotomy [12]. This research had done to evaluate the effect of perineal massage with lubricant on the incidence of episiotomy and perineal laceration in the second stage of childbirth.…”