Perineal massage may reduce third-degree tears, labor time
"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.