Listed in Issue 137


BECKMANN and GARRETT, QE2 Jubilee Hospital, Kessels Road, Coopers Plains, Queensland, Australia, 4108,, have reviewed (35 references) antenatal perineal massage for the reduction of episiotomies.


Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. The aim of this study was to assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.


Relevant databases were searched for randomized and quasi-randomized controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy.


Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (relative risk 0.91). This reduction was statistically significant for women without previous vaginal birth only (relative risk 0.90). Women who practised perineal massage were less likely to have an episiotomy (relative risk 0.85). Again this reduction was statistically significant for women without previous vaginal birth only (relative risk 0.85). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. 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.


Antenatal 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.


Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews (1) : CD005123, 2006.

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