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Perineal Massage During Labor Offers Limited Benefit

Am Fam Physician. 2001 Dec 1;64(11):1888-1889.

Perineal tears during childbirth may result in multiple long-term urinary and gynecologic problems, including dyspareunia, and urinary and fecal incontinence. Massage and stretching of the perineum during labor have been advocated to prevent perineal trauma, but no scientific trials to determine the effectiveness of massage and stretching have been conducted. Stamp and colleagues studied more than 1,000 Australian women during labor to assess the effect of perineal massage.

Deliveries were conducted by midwives in three teaching hospitals. The midwives were trained in massage techniques and supervised by research midwives. Eligible participants had uncomplicated singleton pregnancies with vertex presentation at 36 or more weeks' gestation. These mothers were randomly assigned to massage or normal practice. All perineal traumas after delivery were noted. Other outcomes included in the study were pain at three and 10 days. Pain, dyspareunia, and urgency and incontinence of urine or feces were also measured. Data were collected on 939 participants.

Comparison of Perineal Outcomes Between Treatment Groups*

Outcome Massage group (n = 708) Control group (n = 632) Absolute risk Relative risk (95% CI) P value

Intact perineum

198

171

0.97

1.03 (0.87 to 1.23)

0.76

Episiotomy

176

170

1.08

0.92 (0.77 to 1.11)

0.43

First-degree tear

122

106

0.97

1.03 (0.81 to 1.30)

0.88

Second-degree tear

190

164

0.97

1.03 (0.86 to 1.24)

0.76

Third-degree tear

12

23

2.11

0.47 (0.23 to 0.93)

0.04

Fourth-degree tear

0

1

Unspecified


*—Comparison of pain outcome at three days, 10 days, and three months' postpartum and sexual, bowel, and bladder outcomes at three months postpartum between treatment groups.

Reprinted with permission from Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ 2001;322:1279.

Comparison of Perineal Outcomes Between Treatment Groups*

View Table

Comparison of Perineal Outcomes Between Treatment Groups*

Outcome Massage group (n = 708) Control group (n = 632) Absolute risk Relative risk (95% CI) P value

Intact perineum

198

171

0.97

1.03 (0.87 to 1.23)

0.76

Episiotomy

176

170

1.08

0.92 (0.77 to 1.11)

0.43

First-degree tear

122

106

0.97

1.03 (0.81 to 1.30)

0.88

Second-degree tear

190

164

0.97

1.03 (0.86 to 1.24)

0.76

Third-degree tear

12

23

2.11

0.47 (0.23 to 0.93)

0.04

Fourth-degree tear

0

1

Unspecified


*—Comparison of pain outcome at three days, 10 days, and three months' postpartum and sexual, bowel, and bladder outcomes at three months postpartum between treatment groups.

Reprinted with permission from Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ 2001;322:1279.

The two groups were comparable in all important variables. Cesarean delivery rates and birth outcomes were also similar. The only significant difference was an 11-minute reduction in the second stage of labor in the massage group. The rates of delivery with intact perineum were almost identical in the massage and control groups, both overall and when analyzed by parity. The groups also had no difference in rates of episiotomy or first-or second-degree tears. Fewer third-degree tears (12 of 708) occurred in the massage group than in the control group (23 of 632), but this trend did not reach significance (see accompanying table).

The authors conclude that perineal massage did not increase the likelihood of delivery with an intact perineum, but a larger study is needed to clarify a potential reduction in third-degree tears.

Stamp G, et al. Perineal massage in labor and prevention of perineal trauma: randomised controlled trial. BMJ. May 26 2001;322:1277–80.

editor's note: Although the measured outcomes of massage in this study were disappointing, the authors note that other benefits, such as less discomfort during labor and differences in other soft tissue damage, could result. Massage has no apparent cost or potential harm, so it could be incorporated into the delivery practices of health care professionals who believe in its potential benefit.—a.d.w.

 

Copyright © 2001 by the American Academy of Family Physicians.
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