Professional Documents
Culture Documents
Marie Hastings-Tolsma
Division of Women, Children & Family Health, University of Colorado
Denver, College of Nursing, Aurora, Colorado, USA
Correspondence to: Professor Marie Hastings-Tolsma, Division of
Women, Children & Family Health, University of Colorado Denver,
College of Nursing, 13120 East 19th Avenue, PO Box 6511, Room 4315,
Aurora, CO 80045, USA; Marie.Hastings-Tolsma@ucdenver.edu
Findings
Though there is some risk of blinding and reporting bias, the results
support antenatal digital perineal massage in late pregnancy. A reduction
in lacerations that require suturing (RR=0.91, 95% CI 0.86 to 0.96) and a
decrease in the likelihood of episiotomy (RR=0.84, 95% CI 0.74 to 0.95)
were observed, but only for women without prior vaginal birth.
Conversely, for women with prior vaginal birth, there was a signicant
decrease in the incidence of pain at 3 months postpartum (RR=0.45, 95%
CI 0.24 to 0.87). There were no differences in instrumental deliveries,
sexual satisfaction or incontinence for women practicing antenatal perineal massage.
Commentary
Commentary on: Beckmann MM, Stock OM. Antenatal perineal
massage for reducing perineal trauma. Cochrane Database Syst
Rev 2013;(4):CD005123
Context
Upwards of 70% of women experience perineal trauma during childbirth.1 Concern over such trauma is signicant for pregnant women, particularly for those from ethnic minorities, where cultural differences have
been found to increase worry about possible intervention, pain and discomfort associated with birth.2 Anecdotal reports have long suggested
that performing perineal massage during pregnancy and labour is of
benet in reducing perineal trauma when done. Perineal massage
involves digitally stretching perineal tissues by inserting lubricated
ngers 1.5 inches into the lower portion of the vagina and slowly massaging downward in a U-shaped movement. The value of the massage to
reduce more severe perineal lacerations during labour has been demonstrated.3 There has been similar suggestion that digital perineal massage
during pregnancy is benecial in reducing the risk of laceration and/or
the need for episiotomy.4 Despite these beliefs, there has not been
adequate research to determine the value of prenatal digital perineal
massage in reducing perineal trauma associated with vaginal birth.
Methods
Beckmann and Stock conducted a Cochrane systematic review aimed at
assessing the effect of digital antenatal perineal massage on perineal
trauma at birth and subsequent morbidity. The primary outcomes
included a type of perineal laceration, need for suturing and incidence of
episiotomy. Secondary outcomes included length of the second stage of
labour, instrumental delivery, patient satisfaction, urinary and faecal
References
1. Smith LA, Price N, Simonite V, et al. Incidence of and risk factors for perineal
trauma: a prospective observational study. BMC Pregnancy Childbirth 2013;13:59.
2. Redshaw M, Heikkil K. Ethnic differences in womens worries about labour and
birth. Ethn Health 2011;16:21323.
3. Aasheim V, Nilsen ABV, Lukasse M, et al. Perineal techniques during the second
stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2011;(12):
CD006672.
4. American College of Nurse Midwives. Perineal massage in pregnancy. Share with
patients. J Midwifery Womens Health 2005;50:634.
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