Research: BECKMANN and STOCK,

Listed in Issue 230

Abstract

BECKMANN and STOCK, (1)Mater Health Services, Brisbane, Australia michael.beckmann@mater.org.au assessed the effect of antenatal digital perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.

Background

Perineal trauma following vaginal birth can be associated with significant short-term and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma.

Methodology

The author searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 10), PubMed (1966 to October 2012), EMBASE (1980 to October 2012) and reference lists of relevant articles. Selection Criteria: Randomized and quasi-randomized controlled trials evaluating any described method of antenatal digital perineal massage undertaken for at least the last four weeks of pregnancy. Data Collection And Analysis: Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. They authors contacted study authors for additional information.

Results

The included four trials (2497 women) comparing digital perineal massage with control. All were of good quality. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (four trials, 2480 women, risk ratio (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat to benefit (NNTB) 15 (10 to 36)) and women practising perineal massage were less likely to have an episiotomy (four trials, 2480 women, RR 0.84 (95% CI 0.74 to 0.95), NNTB 21 (12 to 75)). These findings were significant for women without previous vaginal birth only. No differences were seen in the incidence of first- or second-degree perineal tears or third-/fourth-degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.45 (95% CI 0.24 to 0.87) NNTB 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage.

Conclusion

Antenatal digital perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.

References

Beckmann MM(1), Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev: 4:CD005123. doi: 10.1002/14651858.CD005123.pub3. 30 Apr 2013. Comment in   Evid Based Nurs.;17(3):77.  Update of  Cochrane Database Syst Rev. 2006;(1):CD005123. Jul 2014.

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