The Evidence of Perineal Massage
Perineal massage is a technique used to prevent/reduce perineal trauma during a vaginal delivery. Several studies have been conducted over the years to determine the evidence regarding the effectiveness of perineal massage and how to implement it. Here are the main take home points that you may want to consider when deciding whether or not to use this technique:
The use of perineal massage and warm compresses may reduce the incidence of third and fourth degree tears (Aasheim et al., 2017 & Abdelhakim et al., 2020).
• These tears are known as OASIS (obstetric anal sphincter injuries) and involve the anal sphincter, while first and second degree tears do not.
It is particularly recommended to implement perineal massage if it is your first delivery. There is not strong evidence that perineal massage is helpful after subsequent vaginal deliveries (Labrecque et al., 1999).
While there is much discussion of using perineal massage before delivery, there has also been research into using the technique during active labour. Demirel et al. (2015) found that the application of perineal massage during active labour reduced the frequency of episiotomies.
In addition, perineal massage during labour is associated with lower risk of third and fourth degree tears when done during or between pushing time with the index and middle finger and water based lubricant (Aquino et al., 2020).
It is suggested that the index and middle fingers are inserted into the vagina approximately 3-4 cm (Labreque et al., 1999). If a women is doing the stretching without her parter, it is recommend that she use her thumbs.
The most common techniques studied are the dynamic “U” stretch moving from 3 to 9 o’clock (Shipmen et al., 1997) and the sustained hold or “clock stretch” at 4, 6 and 8 ‘clock (Labreque et al., 1999).
The recommended dosage is variable among studies; however, a general range to aim for is 2-5X/week starting at 34 weeks gestation for 4-10 minutes (Aquino et al., 2020).
If you’re still unsure about whether or not it is worth it to practice perineal massage before or during labour, the research shows there is no detrimental effect of incorporating this strategy into your routine (Mei-Dan et al, 2008). The only contraindications to perineal massage are active vaginal infection, vaginal bleeding, ruptured membranes and/or pelvic rest.
Perineal massage can seem daunting, but your pelvic health physiotherapist will help guide you through it. They will do the massage with you, send you written instructions and visual aids.
References:
Aasheim, Vigdis, et al. “Perineal techniques during the second stage of labour for reducing perineal trauma.” Cochrane Database of Systematic Reviews 6 (2017).
Abdelhakim, Ahmed, et al. “Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials” International Urogynecology Journal, May (2020).
Mei-Dan, Elad, et al. “Perineal massage during pregnancy: a prospective controlled trial.” The Israel Medical Association Journal 10.7 (2008): 499.
Demirel, G., & Golbasi, Z. (2015). Effect of perineal massage on the rate of episiotomy and perineal tearing. International Journal of Gynecology & Obstetrics, 131(2), 183-186.
Labrecque, Michel, et al. “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.” American journal of obstetrics and gynecology 180.3 (1999): 593-600.
Aquino, Carmen Imma, et al. “Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials.” The Journal of Maternal-Fetal & Neonatal Medicine 33.6 (2020): 1051-1063.
Shipman, M. K., et al. “Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial.” BJOG: An International Journal of Obstetrics & Gynaecology 104.7 (1997): 787-791.