Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth

Leah L. Albers, CNM, DrPH; Noelle Borders, CNM, MSN

Disclosures

J Midwifery Womens Health. 2007;52(3):246-253. 

In This Article

Late Pregnancy: Perineal Massage

Two randomized trials have been published on the effects of perineal massage in the latter weeks of pregnancy, to assess whether regular massage leads to reduced perineal trauma at birth. Shipman et al.[12] in the United Kingdom asked 681 nulliparas to perform daily pelvic floor (Kegel) exercises during the last 6 weeks of pregnancy, and half of the women were randomly assigned to perineal massage for 4 minutes, three to four times per week. Labrecque et al.[13] in Canada randomly assigned 1034 nulliparas and 493 multiparas to either perineal massage or usual care for the last 6 weeks of pregnancy. Perineal massage was to be done daily for 10 minutes. Both studies assessed intervention fidelity by reviewing women's entries in daily diaries, and one-third of the women in each study complied fully with the respective study protocol. Both studies defined an intact perineum as no trauma, or minor and unsutured trauma, and both conducted intent-to-treat analyses.

Shipman et al.[12] found a 6% reduction in trauma (second degree or more) in women who did antenatal massage, with the largest benefit found in women aged 30 or older. Labrecque et al.[13] found a 9% reduction in sutured trauma in first-time mothers in the massage group, but no significant differences in multiparous women. The greatest benefit was seen in those women who fully complied with the prescribed frequency of perineal massage, suggesting that regular massage is better. Labrecque et al. also assessed women's views and found that perineal massage was highly acceptable; women would use it again in a future pregnancy, and would recommend it to other women. No harmful effects of perineal massage in late pregnancy were found in either study.

Together, these studies indicate that perineal massage in the later weeks of pregnancy may help some first-time mothers avoid sutured obstetric trauma. Daily massage appears of greater benefit than occasional or intermittent massage. These techniques may help women recognize and tolerate the stretching and pressure sensations they may feel when giving birth. A patient education handout on antenatal perineal massage was distributed in a recent issue of this Journal[14] and explains how to perform perineal massage.

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