Research: FLYNN and colleagues,

Listed in Issue 38


FLYNN and colleagues, University of British Columbia's (UBC) Department of Family Practice, Canada conducted a review of the literature in order to learn which factors influencing perineal integrity could be modified by physicians and pregnant women.



:The medical, nursing and midwifery literature were searched primarily for randomised controlled trials. Articles selected included perineal trauma pattern, sexual dysfunction or satisfaction, urinary incontinence and pelvic floor function. 80 papers were identified and 16 were analysed in detail.


The 5 factors which affected perineal integrity were: episiotomy; third-trimester perineal massage; mother's position in second-stage labour, method of pushing; and administration of epidural analgesia. Episiotomy did not improve perineal outcomes when used routinely. Third-trimester perineal massage was discussed only in inadequate studies and studies comparing position in birth chairs and recumbent versus upright positions were inadequate for making firm recommendations. Studies of methods of pushing and the use of epidural analgesia were limited and uncontrolled, therefore no recommendations were possible.


From this review, only limiting episiotomy can be strongly recommended, and in the absence of strong data to the contrary, women ought to be encouraged to engage in perineal massage if they wish to and to adopt the birth position of their choice. Caretakers need to be aware of the possibility of interfering with placental function when women hold their breath for a long time when pushing.


Flynn P et al. How can second-stage management prevent perineal trauma? Critical review. Can Fam Physician. 43(1): 73-84 Jan 1997.

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