2024 Perineal Massage Publications

What can be Done to Reduce Pelvic Floor Injury During Vaginal Birth?

Title: Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis

This systematic review and meta-analysis examined the effects of perineal massage at different stages—either antenatally or during the second stage of labor—on preventing perineal injuries and improving postpartum pelvic floor function in primiparous women. The study analyzed 10 randomized controlled trials involving 1,057 women. It found that perineal massage during the second stage of labor significantly reduced perineal pain immediately postpartum. Antenatal perineal massage was associated with a reduction in fecal and flatus incontinence three months postpartum, although it did not significantly impact urinary incontinence. The findings suggest that incorporating perineal massage both antenatally and during labor can be beneficial in reducing perineal injuries and enhancing pelvic floor function postpartum.

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Variability in Perineal Trauma Management Among Spanish Midwives

Title: Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

This observational cross-sectional study explored the practices of 305 midwives in Spain regarding the prevention and repair of obstetric perineal trauma, focusing particularly on the use of episiotomy. The study revealed significant variability in how midwives approached these practices. A notable finding was that 83% of midwives did not regularly use intrapartum perineal massage, a technique often recommended for reducing perineal trauma. Additionally, 61% of midwives used warm compresses on the perineum. When it came to episiotomies, 42.3% of midwives adopted a restrictive approach, performing them in fewer than 10% of cases, while 16.7% performed episiotomies in over 20% of cases. The study also found that midwives who attended home births, worked in teaching hospitals, or had recently completed their training were more likely to use episiotomy restrictively. These findings underscore the variability in perineal trauma prevention practices, particularly in the use of perineal massage and episiotomy, among midwives in Spain.

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Understanding and Managing Obstetric Perineal Lacerations

Title: Perineal Lacerations

Obstetric perineal lacerations are common during vaginal childbirth and can range from minor first-degree tears to severe third- and fourth-degree injuries, including obstetric anal sphincter injuries (OASIS). While most minor lacerations heal without long-term complications, severe tears can lead to significant issues like pelvic floor dysfunction, incontinence, and sexual dysfunction. The risk of perineal lacerations is heightened by factors such as first-time childbirth, larger babies, and certain fetal positions. Although episiotomies, particularly midline ones, can increase the risk of severe lacerations, the use of mediolateral episiotomies may reduce this risk. Preventative measures, including perineal massage during late pregnancy, have been shown to decrease the severity of perineal trauma. Proper identification and repair of these lacerations during delivery are crucial to minimizing long-term complications, and follow-up care is essential for ensuring effective recovery.

Link to Abstract