Effect of Perineal Massage on the Rate of Episiotomy
AbstractObjective: Women frequently experience perineal damage after a vaginal delivery. This study aimed to investigate the effect of perineal massage (PM) during labor on the need for episiotomies.Materials and methods: The study is a double-blind randomized clinical trial conducted with 99 patients (n=49 controls; n=50 cases). Participants comprised of nulliparous pregnant women aged from 18 to 35 years in the 37th-42nd week of gestation, who referred to the Um-al-Banin Hospital of Mashhad from July to October 2018, for vaginal delivery and were in the active stage of labor. Allocation to study groups was based on a random allocation list generated by a software application. PM was performed for the cases in the active stage four times, each lasting for two minutes at intervals of half an hour. The massage was continued at the beginning of the second stage of labor for ten minutes. Control women received routine care. The delivery was practiced by a midwife who was blinded to the study groups and the performance or non-performance of massage. Data were analyzed in SPSS software version 16.Results: The need for episiotomy was significantly lower in the PM group than in the control group (p = 0.05). Spontaneous perineal tears were significantly higher in mothers of the PM group (p = 0.05. The spontaneous tear degree in the 20 mothers who did not require episiotomy (p = 0.5) and the degree of perineal tear in mothers who needed an episiotomy (n = 79; p = 0.1) were not significantly different in the two groups. In the PM group members who did not require episiotomy (n = 14) and the mother underwent a spontaneous tear, first-degree tears were more frequent than second-degree ones. The median duration of the active stage of labor until the stage completion was lower in the PM group than in the control group, although the difference did not reach statistical significance (p = 0.3). The median of the second stage duration in the control and intervention groups were 55 and 45 minutes, respectively, where the difference was significant (p = 0.002), and the median time of completion of the active stage until delivery in the PM group had reduced.Conclusion: PM had a significant impact on the reduction of the need for episiotomies and the duration of the second stage of labor. Thus, it can be suggested as a safe, simple, low-cost, and effective technique to reduce the perineal damage during delivery.
2. Seehusen DA, Raleigh M. Antenatal perineal massage to prevent birth trauma. Am Fam Physician 2014; 89:335-6.
3. Kushavar H, Shirinkam R, Ivan Baga R, Sohrabi M. A comparison of" hands off versus" hands-on"(ritgen) techniques on perineal trauma during birth in nulliparous women. Journal of Ardabil University of Medical Sciences (JAUMS) 2009; 9: 235-41.
4. McCandlish R. Perineal trauma: prevention and treatment. J Midwifery Womens Health 2001; 46: 396-401.
5. Ghaffari L. Frequency and complications of episiotomy in Mirza Kochak-khan Hospital in Tehran. M.Sc Thesis. Tehran University of Medical Sciences, 1996. [Persian]
6. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 2013; (4): CD005123.
7. Heit M, Mudd K, Culligan P. Prevention of childbirth injuries to the pelvic floor. Curr Womens Health Rep 2001; 1: 72-80.
8. Albers LL, Borders N. Minimizing genital tract trauma and related pain following spontaneous vaginal birth. J Midwifery Womens Health 2007; 52: 246-53.
9. Albers LL. Reducing genital tract trauma at birth: launching a clinical trial in midwifery. J Midwifery Womens Health 2003; 48: 105-10.
10. Shahoei R, Zaheri F, Nasab LH, Ranaei F. The effect of perineal massage during the second stage of birth on nulliparous women perineal: A randomization clinical trial. Electron Physician 2017; 9: 5588-95.
11. Demirel G, Golbasi Z. Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet 2015; 131: 183-6.
12. Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 2006; (1): CD005123.
13. 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: 76-80.
14. Shipman MK, Boniface DR, Tefft ME, McCloghry F. Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial. Br J Obstet
Gynaecol 1997; 104: 787-91.
15. Vendittelli F, Tabaste JL, Janky E. [Antepartum perineal massage: review of randomized trials]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30: 565-71.
16. Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000; 95: 464-71.
17. Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J 2008 ; 10: 499-502.
18. Boland Hemmat M, Salari P, Tafazzoli M, Mazlom S R. The Effect of perineal massage during Pregnancy on perinea tears in nulliparous women. J Sabzevar Univ Med Sci 2001; 8: 60-70.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.