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Meta-Analysis
. 2013 Apr 30;2013(4):CD005123.
doi: 10.1002/14651858.CD005123.pub3.

Antenatal perineal massage for reducing perineal trauma

Michael M Beckmann  1 , Owen M Stock
Affiliations
Meta-Analysis

Antenatal perineal massage for reducing perineal trauma

Michael M Beckmann et al. Cochrane Database Syst Rev. .

Abstract

Background: Perineal trauma following vaginal birth can be associated with significant short-term and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma.

Objectives: To assess the effect of antenatal digital perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 10), PubMed (1966 to October 2012), EMBASE (1980 to October 2012) and reference lists of relevant articles.

Selection criteria: Randomised and quasi-randomised controlled trials evaluating any described method of antenatal digital perineal massage undertaken for at least the last four weeks of pregnancy.

Data collection and analysis: Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information.

Main results: We included four trials (2497 women) comparing digital perineal massage with control. All were of good quality. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (four trials, 2480 women, risk ratio (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat to benefit (NNTB) 15 (10 to 36)) and women practicing perineal massage were less likely to have an episiotomy (four trials, 2480 women, RR 0.84 (95% CI 0.74 to 0.95), NNTB 21 (12 to 75)). These findings were significant for women without previous vaginal birth only. No differences were seen in the incidence of first- or second-degree perineal tears or third-/fourth-degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.45 (95% CI 0.24 to 0.87) NNTB 13 (7 to 60)). 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.

Authors' conclusions: Antenatal digital 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.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 1 Perineal trauma requiring suturing.
1.2
1.2. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 2 1st degree perineal tear.
1.3
1.3. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 3 2nd degree perineal tear.
1.4
1.4. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 4 3rd or 4th degree perineal trauma.
1.5
1.5. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 5 Incidence of episiotomy.
1.6
1.6. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 6 Length of second stage.
1.7
1.7. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 7 Instrumental delivery.
1.13
1.13. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 13 Perineal pain at 3 months postpartum.
1.14
1.14. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 14 Painful sex at 3 months postpartum.
1.15
1.15. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 15 Woman's sexual satisfaction at 3 months postpartum.
1.16
1.16. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 16 Partner's sexual satisfaction at 3 months postpartum.
1.17
1.17. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 17 Uncontrolled loss of urine at 3 months postpartum.
1.18
1.18. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 18 Uncontrolled loss of faeces at 3 months postpartum.
1.19
1.19. Analysis
Comparison 1 Digital perineal massage versus control: results by parity, Outcome 19 Uncontrolled loss of flatus at 3 months postpartum.
2.1
2.1. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 1 Perineal trauma requiring suturing.
2.2
2.2. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 2 1st degree perineal tear.
2.3
2.3. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 3 2nd degree perineal tear.
2.4
2.4. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 4 3rd or 4th degree perineal trauma.
2.5
2.5. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 5 Incidence of episiotomy.
2.6
2.6. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 6 Length of second stage.
2.7
2.7. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 7 Instrumental delivery.
2.13
2.13. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 13 Perineal pain at 3 months postpartum.
2.14
2.14. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 14 Painful sex at 3 months postpartum.
2.15
2.15. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 15 Woman's sexual satisfaction at 3 months postpartum.
2.16
2.16. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 16 Partner's sexual satisfaction at 3 months postpartum.
2.17
2.17. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 17 Uncontrolled loss of urine at 3 months postpartum.
2.18
2.18. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 18 Uncontrolled loss of faeces at 3 months postpartum.
2.19
2.19. Analysis
Comparison 2 Digital perineal massage versus control: results by frequency of massage, Outcome 19 Uncontrolled loss of flatus at 3 months postpartum.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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