Perineal massage may reduce third-degree tears, labor time
Massage Magazine, Issue #97, May/June 2002
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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Massages performed during the last few weeks of pregnancy appear to be effective at preventing a type of injury that commonly occurs during delivery, Canadian researchers report. When women give birth, especially for the first time, many experience tears in the perineum, the area between the vagina and the anus. But among women who had never given birth vaginally, massaging this area during the last few weeks of pregnancy significantly reduced the risk of so-called perineal injury, a new study has shown.
Among these 1,034 women, the rate of giving birth without tearing the perineum was 61 percent higher in those who had performed the massages beginning in the thirty-fourth or thirty-fifth week of pregnancy than in women who did not massage themselves, according to researchers led by Dr. Michel Labrecque of Laval University in Quebec City. Seventy-six percent of women who had the massages suffered perineal injury during childbirth, while 85 percent of those who didn’t have massage were injured. A normal pregnancy lasts from 37 to 42 weeks. However, massages did not have a significant effect among the 493 women in the study who had delivered a child vaginally in the past, Labrecque and colleagues reported in the March issue of the American Journal of Obstetrics and Gynecology.
Learning how to prevent damage to the perineum is important, since such injuries can cause pain and sexual problems in the months after delivery, according to the researchers. Massage appears to prepare a woman’s body for delivery somehow, they noted. Performing a massage during the last few weeks of pregnancy may help some women during delivery, but ‘it’s not the end of the world’ if a woman chooses not to do so, according to a Baltimore expert. Although the reduction in perineal injury among first-time mothers was statistically significant, it was not very large, noted Dr. Adam Duhl, an instructor of maternal-fetal medicine in the department of gynecology and obstetrics at Johns Hopkins Hospital.
Up until the 1980s, almost all women were given an episiotomy, during which a doctor makes a cut below the vagina to make it easier for a baby to be born. Proponents of the procedure believe that it often prevents tearing during delivery, he said. When these tears occur, a physician repairs them with stitches. But Duhl said that routine episiotomies have fallen into disfavor with some physicians, who believe that the cut made during an episiotomy may take as long or longer to heal as a tear that occurs during delivery. [This is classic cultural denial of the fact that there is extensive scientific evidence that episiotomies cause more harm than they provide benefit, yet episiotomy rates in the U.S. are still over 50%. Note the way this article talks about the way some physicians ‘believe’, as if it’s merely a matter of opinion. The truth is that most practitioners continue to cut episiotomies despite overwhelming and readily available evidence that it is harmful to the woman.]
The Johns Hopkins physician said that the benefit of massage appears to be small, but the technique is not harmful for most women. However, he stressed the importance of discussing massage with a doctor, since it could be dangerous for women who have bleeding or infection around the vagina or who are otherwise at risk for premature labor. Dr. John J. Botti of Hershey Medical Center in Hershey, Pa. agreed that the benefit of massage appears to be modest. However, he noted that most women did not perform the massage each day. According to the study, 66 percent of the first-time mothers performed the massage four or more times a week for at least three weeks. Botti said it would be interesting to see if the rate of perineal tears declined further if more women performed the massage every day.
In the study, the researchers asked the women to massage themselves every day. To perform a perineal massage, a woman or her partner places one or two fingers about an inch to an inch and a half into the vagina. The researchers recommend applying downward pressure for 2 minutes, and then applying pressure to the either side of the vaginal opening for 2 minutes each. Women were given sweet almond oil to use for lubrication.
Copyright 1999 The New York Times Syndicate. All rights reserved.