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R
E S E A R C H
Perineal
massage may reduce third-degree tears, labor time
Perineal
massage in the second stage of labor showed a trend toward fewer
third-degree tears of the perineum, shorter length of labor and
a general lack of harm, according to a study published in the British
Medical Journal.
"Perineal massage in labour and
prevention of perineal trauma" was conducted by Georgina Stamp
of the Centre for Research into Nursing and Health Care, at the
University of South Australia; Gillian Kruzins of the North Adelaide
Women's and Children's Hospital; and Caroline Crowther of the University
of Adelaide Department of Obstetrics and Gynecology.
The study involved 1,340 women, at 36
weeks' gestation, who expected the normal birth of a single baby.
The women were randomly assigned to either the perineal-massage
group or the control group.
Women in the massage group received
massage and stretching of the perineum with each contraction during
the second stage of labor. With two fingers inside the vagina, the
midwife would use a sweeping motion and water-soluble lubricating
jelly to gently stretch the perineum. For women in the control group,
midwives used their normal techniques but did not employ perineal
massage.
Degree of perineal trauma was the main
outcome measured by the researchers. Standard definitions of such
trauma were used: An intact perineum is one that does not require
suturing; a first-degree tear involves the skin of the perineum
and vaginal mucosa; a second-degree tear involves deeper layers
of perineal muscle; a third-degree tear involves the anus; and a
fourth-degree tear involves the anus and rectal mucosa.
Secondary measurements were pain at three
days, 10 days and three months postpartum; resumption of sexual intercourse;
and urinary and faecal urgency. Additional details of labor and infant
outcomes were collected and compared, as well.
"There was a trend toward reduced
risk for the rarer outcome of a third degree tear in the perineal
massage group," state the study's authors. "The only fourth
degree tear was sustained by a woman in the control group."
There was no significant difference
between the two groups in terms of intact perineums, first- and
second-degree tears, or the secondary outcomes.
"Although perineal massage in labor
did not increase the likelihood of an intact perineum, our trial
does provide good evidence of lack of harm that in itself may be
of value," state the authors.
The trial also provided evidence that
perineal massage may reduce the amount of time a woman is in labor.
"Although difference between groups in the length of the second
stage was not a hypothesis," wrote the authors, "the mean
length of the second stage for nulliparous women [those who have
not previously born children] in the massage group was 11 minutes
shorter than the control group."
- Source: Centre for Research
into Nursing and Health Care. Authors: Georgina Stamp, Gillian Kruzins,
Caroline Crowther. Originally published in the British Medical Journal,
Vol. 322, pp. 1,277-1,280.
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