FPIN's Help Desk Answers

Antepartum Perineal Massage for Intrapartum Lacerations


Am Fam Physician. 2021 Jan 15;103(2):115-116.

Clinical Question

Does antepartum perineal massage reduce intrapartum lacerations?

Evidence-Based Answer

Digital antepartum and intrapartum perineal massage did not decrease perineal lacerations compared with a control group. (Strength of Recommendation: A, based on a meta-analysis.) Digital antepartum perineal massage reduced the incidence of trauma requiring suturing by 9% and the likelihood of episiotomy by 16% in patients without a previous vaginal birth. Digital intrapartum perineal massage resulted in higher rates of intact perineum and a lower incidence of episiotomy in nulliparous patients.

Evidence Summary

A 2013 Cochrane review analyzed four randomized controlled trials (RCTs) and quasi-RCTs (N = 2,497) in which patients planning on vaginal delivery received self- or partner-administered digital antepartum perineal massage.1 This was defined as three to 10 minutes of intravaginal perineal massage with almond oil, three to seven days a week, starting at 34 weeks' gestation until delivery. Three of the studies included patients without previous vaginal births; the last trial included patients with previous vaginal birth. The primary inclusion criterion was any digital perineal massage during the last four weeks of pregnancy. Patients at high risk of cesarean delivery were excluded. Participants were instructed not to inform their birth attendants of their allocation. In patients without a previous vaginal birth who had digital antepartum perineal massage, there was a 9% decrease in perineal trauma that required suturing (relative risk [RR] = 0.91; 95% CI, 0.86 to 0.96; number needed to treat [NNT] = 15) and a 16% decrease in episiotomy (RR = 0.84; 95% CI, 0.74 to 0.95; NNT = 21).

There was no difference between patients receiving perineal massage and the control group for having a first- (RR = 0.96; 95% CI, 0.78 to 1.19), second- (RR = 0.99; 95% CI, 0.85 to 1.15), or third- or fourth-degree laceration (RR = 0.81; 95% CI, 0.56 to 1.18). Three of the four studies included attestation

Address correspondence to Susie Wenstrup at swenstrup@schsa.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

Copyright © Family Physicians Inquiries Network. Used with permission.


1. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;(4):CD005123.

2. Aquino CI, Guida M, Saccone G, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2020;33(6):1051–1063.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.



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