Research question Does perineal massage help reduce perineal trauma?
Answer Yes. Women who massage their perineum during the last few weeks of pregnancy have fewer episiotomies than other women
Why did the authors do the study? Perineal tears and episiotomies are very common during vaginal deliveries, particularly among women having their first baby. Massaging the perineum in the weeks before delivery has been suggested to make the muscles more flexible, allowing them to stretch safely during the final stages of labour. These authors wanted to review all the randomised evidence on perineal massage to find out if it works and, if it does, which groups of women are most likely to benefit.
What did they do? They systematically searched for published and unpublished randomised trials in any language that evaluated perineal massage in pregnant women. They searched established databases such as Embase, Medline, and the Cochrane Central Register of Controlled Trials. They also hand searched journals, hand searched article references, and contacted experts in the subject for ongoing trials.
They found three relevant trials and graded them for methodological quality. The trials included published and unpublished data on a total of 2434 women.
The authors pooled the trials' results to find out if perineal massage had any measurable effect on 16 different outcomes including the risk of perineal trauma, instrumental delivery, perineal pain, incontinence, or painful sex after childbirth.
What did they find? The women in these trials who did perineal massage from around the 35th week of pregnancy were slightly less likely to have perineal trauma needing stitches than other women (relative risk 0.91, 95% CI 0.86 to 0.96). The beneficial effect of massage was almost entirely accounted for by a 15% reduction in the risk of episiotomy (0.85, 0.75 to 0.97) and was largely confined to women having their first baby. Massage did not prevent birth trauma among women who had delivered vaginally before, but it did reduce perineal pain at three months (0.45, 0.24 to 0.87). Only one trial included this subgroup of women.
The authors estimate that overall, 16 women need to do perineal massage to prevent one woman needing stitches (95% CI 10 to 39). The number needed to treat to prevent one episiotomy was 23 (13 to 111).
Perineal massage did not protect women against first, second, third, or fourth degree tears. Nor did it help prevent instrumental deliveries. Perineal massage had no effect on women's sex life after the birth.
What does it mean? Perineal massage, which can be done by pregnant women or their partners, is simple and non-invasive. It seems to work best for women having their first baby, mostly by reducing their risk of an episiotomy. Massaging once or twice a week for about four weeks seems to be enough. The authors say the trials were methodologically good, so their combined results are likely to be sound, although further trials are needed in women who have given birth vaginally before.
Beckmann MM, et al. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 2006;(1): CD005123.16437520
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