The effect of perineal massage during the second stage of birth on nulliparous women perineal
A randomization clinical trial
Keywords:
Perineal massage, Nulliparous, Laceration, Episiotomy, Second stageAbstract
Background: Childbirth and puerperium are of the most important periods in women’s lives and can affect different aspects of their lives.
Objective: To determine the effect of perineal massage in the second stage of labor on perineal lacerations, episiotomy, and perineal pain in nulliparous women.
Methods: This randomization clinical trial was conducted at Be’sat Hospital in Sanandaj, Iran, from 2013 to 2014. A total of 195 nulliparous women were included in the study. The participants were selected through convenience sampling, and randomly assigned to two groups: intervention and control groups. The intervention group received 30-minute perineal massage during second stage of labor. Subsequently, we analyzed perineal laceration, episiotomy, and perineal pain among the two groups. All of them were taught about postpartum perineal pain and its severity, and the researcher followed them up 3 days, 10 days, and 3 months after childbirth by telephone. The data were analyzed using SPSS version 18. We used descriptive statistics and analytical statistics, including t test, Chi-square test, and Fisher's test.
Results: Frequency of episiotomy was 69.47% in the intervention group and 92.31% in the control group, and the difference was statistically significant (p<0.05). The results revealed 23.16% of first-degree perineal laceration and 2.11% of second-degree perineal laceration in the intervention group, and no vestibular laceration or third- and fourth-degree lacerations in the intervention group. However, there were 5.13% of vestibular laceration, 7.69% of first-degree laceration, 2.56% of second-degree laceration, and 1.05% of third-degree laceration (one woman) in the control group. Based on the results, the postpartum perineal pain was significantly different in both groups.
Conclusion: Regarding the results of this study and those of other studies, perineal massage during the second stage of labor can reduce the need to episiotomy, perineal injuries, and perineal pain.
Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct.ID: IRCT2013090314556N1.
Funding: This study received by financial support of Kurdistan University of Medical Sciences, Sanandaj, Iran.
References
Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: A prospective
controlled trial. IMAJ. 2008; 10: 499-502. PMID: 18751626.
Kalichman L. Perineal massage to prevent perineal trauma in childbirth. Isr Med Assoc J. 2008; 10(7): 531- 3.
Fernando RJ. Risk factors and management of obstetric perineal injury. Obstet Gynecol Reproduct Med.
; 17(8): 238-43. doi: 10.1016/j.ogrm.2007.06.008. PMID: 18751635.
Williams A, Herron-Marx S, Knibb R. The prevalence of enduring postnatal perineal morbidity and its
relationship to type of birth and birth risk factors. J Clin Nurs. 2007; 16(3): 549-61. PMID: 17335531.
Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor
and reduction of genital tract trauma at birth: A randomized trial. J Midwifery Womens Health. 2005;
(5): 365-72. doi: 10.1016/j.jmwh.2005.05.012. PMID: 16154062, PMCID: PMC1350988.
Eogan M, Daly LO, Herlihy C. The effect of regular antenatal perineal massage on postnatal pain and anal
sphincter injury: a prospective observational study. J Matern Fetal Neonatal Med. 2006; 19(4): 225-9. doi:
1080/14767050600593155. PMID: 16854696.
Beckmann MM, Garrett AG. Antenatal perineal massage for reducing perineal trauma. Cochrane Database
Syst Rev. 2006; 25(1): CD005123. doi: 10.1002/14651858.CD005123.pub2. PMID: 16437520
Bodner- Adler B, Bodner K, Mayerhofer K. Perineal massage during pregnancy in primiparous women. Int
J Gynecol Obstet. 2002; 78(1): 51-3. PMID: 12113972.
Stamp G, Kruzins G, Crowther C. Perineal massage in labor and prevention of perineal trauma: randomized
controlled trial. BMJ. 2001; 322(7297): 1277-8. PMID: 11375230, PMCID: PMC31922.
Piri- Galledar A, Danesh Kojori M, Jamshidi Manesh M, Hosseini F. The effect of perineal massage on
labor second stage period, Perineal tear and its outcomes. J Shahrekord Univ Med Sci. 2012; 14(5): 24-33.
Thomson JF, Roberts CI, Currie M, Ellwood OA. Prevalence and persistence of health problems after
childbirth: associations with parity and method of birth. Birth. 2002; 29(2): 83-94. doi: 10.1046/j.1523- 536X.2002.00167.x.
Ivan Bagha R, Fardi Azar, Kamran Poor SZ, Ghochan Zadeh M. Comparing the effect of acetaminophen,
suppository diclofenac and ice on perineal pain after episiotpmy cutting epinephrine in patients teaching
hospital in Al-Zahra Tabriz. J Sabzevar Uni Med Sci. 2006; 13 (3): 145-51.
Fardi Azar Z, Zaheri F, Sedaghi Ghamene S, Mohamad Alizade S, Koshavar H. The effects of Lidocaine
% gel on pain and recovery period after delivery. J Ardabil Univ Med Sci. 2006; 6(1): 61-6.
Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia; a
prospective study. Eur J Obstet Gynecol Reprod Biol. 2008; 137(2): 152-6. doi:
1016/j.ejogrb.2007.06.005. PMID: 17681663.
Corroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2000; (2): CD000081.
Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal
symptoms three months after delivery. American Journal of Obstetrics & Gynecology. 2000; 182(1): 76-80.
doi: 10.1016/S0002-9378(00)70493-5. PMID: 10649159. 17) Attarha M, Vacillian C, Akbary Torkestany N, Heydary T. Effect of perineal massage during second phase
of labor on episiotomy and laceration rates among nuliparous women. Journal of Faculty of Nursing and
Midwifery. Tehran University of Medical Sciences. 2009; 15(2): 16-22.
Attarha M. Comparison of the effect of perineal massage with levander essential oil with just massage on
episiotomy and laceration. Complementary Medicen. 2011; 1: 47-54.
Zarea AM, Pasha H, Sadeghi Nia M, Kiapour A. The effect of second stage of perineal massage on
episiotomy and laceration. Family Health Journal Azad University of Medical Sciences. 2012; 1(2): 7-12.
Hastings-Tolsma M, Vincent D, Emeis C, Francisco T. Getting through birth in one piece: protecting the
perineum. MCN Am Matern Child Nurs. 2007; 32(3): 158-64. doi:
1097/01.NMC.0000269565.20111.92. PMID: 17479052.
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