Clinical Abstracts
With Comments by Adriane Fugh-Berman, MD
Perineal Massage in Labor
August 2001; Volume 3; 63
Source: Stamp G, et al. Perineal massage in labor and prevention of perineal trauma: Randomised controlled trial. BMJ 2001; 322:1277-1280.
Design/Setting/Subjects: One thousand three hundred forty English-speaking women, carrying singleton pregnancies, who were receiving prenatal care at one of three tertiary hospitals in Australia. Women were enrolled at their 36-week prenatal visits, and were stratified by nulliparity or multiparity.
Treatment: Perineal massage during the second stage of labor. Perineal massage was performed by a midwife, who lubricated her fingers with water-soluble lubricant, inserted two fingers inside the vagina and used a sweeping motion to stretch the perineum.
Results: There were no differences in rates of intact perineum between the treatment group and control group among either nulliparous or multiparous women. There were no differences between groups in number of episiotomies or first- and second-degree tears. Third-degree tears were less common in the massage group (12) compared to the control group (23) (Relative risk 0.47, 95% confidence interval, 0.23-0.93, P = 0.04). One fourth-degree tear occurred in the control group and none in the massage group. There were no differences between groups in terms of pain at three days, 10 days, or three months or in dyspareunia at three months postpartum. There was no difference between groups in urinary or bowel urgency or incontinence. Birth outcomes and infant outcomes were similar between groups.
Funding: Research and Development Grants Advisory Committee of the Commonwealth Department of Health Housing and Community Services (now National Health and Medical Research Council) and the Australian College of Midwives. Johnson and Johnson provided lubricant.
Comments: Perineal massage during labor was not impressive in this study, but the significant reduction of third-degree tears is intriguing and should be followed up with a larger study. It is unfortunate that stratification was not also done by age, as that has made a difference in a previous study of prenatal perineal massage. Starting six weeks before the estimated due date, 861 nulliparous women with singleton pregnancies performed perineal massage (3-4 times/wk for four minutes).1 Women younger than 30 years experienced no reduction in tears or instrument deliveries, but women older than 30 years experienced a significant reduction in both tears and instrument deliveries.
Another randomized controlled trial of 1,034 women without a previous vaginal birth and 493 women with more than one previous vaginal birth tested the effect of perineal massage (5-10 min/d) starting at 35-34 weeks gestation.2 Perineal massage did not affect third- and fourth-degree perineal lacerations, but there was a significantly higher rate of intact perineum among women without a previous vaginal birth (24.3% in the massage group vs. 15.1% in the control group). Three months after delivery, there were no differences between the massage and control groups in perineal pain; dyspareunia; sexual satisfaction; or incontinence of urine, gas, or stool among women with a previous vaginal birth.3 Significantly more women assigned to massage (93.6%) vs. controls (85.8%) were free of perineal pain at three months.
Perineal massage is clearly safe, and the prenatal version may benefit nulliparous women, especially those who are older than age 30. Perineal massage during labor may reduce third-degree tears but does not increase the chances of maintaining an intact perineum.
References
1. Shipman MK, et al. Antenatal perineal massage and subsequent perineal outcomes: A randomised controlled trial. Br J Obstet Gynaecol 1997;104:787-791.
2. Labrecque M, et al. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol 1999;180:593-600.
3. Labrecque M, et al. Randomized trial of perineal massage during pregnancy: Perineal symptoms three months after delivery. Am J Obstet Gynecol 2000;182:76-80.
August 2001; Volume 3; 63
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