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Try out PMC Labs and tell us what you think. Learn More. Objective: Women frequently experience perineal damage after a vaginal delivery. This study aimed to investigate the effect of perineal massage PM during labor on the need for episiotomies. Participants comprised of nulliparous pregnant women aged from 18 to 35 years in the 37 th nd week of gestation, who referred to the Um-al-Banin Hospital of Mashhad from July to Octoberfor vaginal delivery and were in the active stage of labor.

Allocation to study groups was based on a random allocation list generated by a software application. PM was performed for the cases in the active stage four times, each lasting for two minutes at intervals of half an hour. The massage was continued at the beginning of the second stage of labor for ten minutes.

Control women received routine care.

The delivery was practiced by a midwife who was blinded to the study groups and the performance or non-performance of massage. Data were analyzed in SPSS software version Conclusion: PM had a ificant impact on the reduction of the need for episiotomies and the duration of the second stage of labor. Thus, it can be suggested as a safe, simple, low-cost, and effective technique to reduce the perineal damage during delivery.

As a human right and a social goal, health is considered a national priority in many countries. Over million infants are born worldwide every year. Labor and delivery can be associated with complications for the mother 1. Vaginal deliveries usually result in genital tract damage in primiparous women, who report complications such as short-term postpartum pain and discomfort as well as dyspareunia, than women who deliver with an intact perineum. Therefore, various interventions to reduce perineal trauma have been studied 2.

Pain, bleeding, and the need for wound healing are directly associated with the extent to which the genital tract trauma has occurred during delivery 3. Postpartum bleeding poses a threat to the health of the mother due to the large episiotomy incision, the extension of the tear, and delay in the episiotomy repair.

Moreover, the damages to the perineum and the resulting pain can cause postpartum problems such as difficulty walking, sitting, nursing, and care for the newborn 4. Perineal damage not only causes physical damage but also in the mother's emotional and psychological injury, and delayed healing of the wound due to poor anatomical outcomes, poor healing of the incision site, and increased perineal pain 5. As noted, perineal trauma following vaginal delivery can be associated with short- and long-term complications. The potential complications associated with vaginal birth are worrisome so any procedure that reduces the likelihood Trauma to the genital tract is suggested.

Some have recommended routine perineal massage to reduce the incidence of perineal trauma during vaginal delivery. Perineal massage may increase the flexibility of the perineal muscles, thereby reducing muscle resistance, causing the perineum to stretch during labor without rupture and no need for an episiotomy 6.

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Besides that, researchers are searching for ways that can reduce the severity of spontaneous perineal tears, some of which are concerned with the antenatal period, including the perineal message 7and some others have used various techniques and maneuvers during labor 8. The perineal massage PM technique using a lubricant is a potential physiotherapeutic method applied for the active phase of labor, which can lead to muscle dilation and trauma prevention upon vasodilatation and increased blood flow to the area 9. Since the studies conducted on the effect of PM on the prevention of perineal damages, their consequences, and the repair of episiotomy are few, we decided to examine the effect of PM on the need for an episiotomy.

This study is a randomized, double-blind clinical trial that included nulliparous pregnant women aged 18 to 35 years referring to Um-al-Banin Educational-Therapeutic Hospital in Mashhad from July to October Inclusion criteria comprised of singleton pregnant patients with a live fetus, occiput anterior presentation, week of gestation, tendency for vaginal delivery, estimated baby weight below 4 kg, active stage of labor first stage; 6 cm dilatation at admission, and written informed consent for participation.

Patients with posterior occiput, polyhydramnios, fetal distress, intrauterine perineum massage mann, prematurity, post-maturity, vacuum delivery, and reluctance to continue to participate in the study were excluded. The of samples in each group was calculated as However, a total of 50 was considered given the calculated attrition of 10 percent.

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Eventually, one of the mothers in the control group was excluded from the study due to vacuum delivery, leaving 49 patients in the control group and 50 in the intervention group. A convenience sampling method was adopted. First, the researcher explained thoroughly the goals of the study to the women who referred to the hospital for vaginal delivery. After they ed written consent forms, the demographic characteristics data including age, education, weight, and gestational week were collected.

The participants were randomly ased to an intervention group and a control group based on a random allocation list generated by a software application. Subsequently, the intervention group or control group titles were written inside sealed envelopes and coded.

They were pulled out from the envelopes sequentially according to the random allocation list during delivery whereby the patient was placed in either the intervention or control groups.

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All the massages were given by one of the research colleagues i. This study is double-blind, and only the midwife doing the delivery was not aware of the group allocations. The PM was performed for all the women in the intervention group at the active stage of labor from 6 cm dilatation of the cervix to the completion of cervical dilatation and the beginning of the second stage after completion of cervical dilatation until the baby was extubated. Before the massage, the emptiness of the intestines and the bladder were assured.

All the participants lied in the lithotomy position, and the massage began after the contraction severity of the muscles was reduced in the resting position. In the first phase of PM, the researcher wore gloves and rubbed two drops of lubricant on the fingers. She inserted fingers into the vagina cm and pressed both sides of the vaginal wall, continuing for two minutes.


The women had a minimum of 30 minutes of rest before the next massage session initiated. Four massage sessions were performed during the first stage of labor. At the start of the second stage of labor, the participants received a minute massage. Control group women received the routine care of the hospital and underwent a routine vaginal examination.

After delivery, the two groups were examined for perineal damages. In the end, the data were analyzed in the SPSS software version 16 and presented in tables and charts using descriptive statistical indices in terms of frequency. In case the data were distributed normally, independent t-test was used to compare the quantitative variables between the two groups; otherwise, the Mann-Whitney test was used. Chi-Square test was applied to compare qualitative variables between the two groups as well as Fisher's exact test, if necessary.

In all calculations, a ificant level of 0. In this study, 99 patients were included of whom 49 were in the control group and 50 in the intervention group. Primary outcomes in mothers with and without antenatal massage in the active phase of labor. The median duration of the active phase of labor until the completion of this phase in the PM group was lower than in the control group.

The mean duration of the second stage of labor in the control and PM groups were 55 and 45 minutes, respectively.

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Secondary outcomes in mothers with and without perineal massage in the active phase of labor per minute. Based on the of the present study, the need for episiotomy in the group receiving PM was ificantly lower than that of the control group, attributably because of the proper massage, which le to increased blood flow, elasticity, and perineal tissue softness.

Shahoei et al. The PM practiced in the study of Shahoei et al.

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Given the fact that the PM also reduced the need for episiotomy in our study, our correspond with those of Shahoei et al. In similar lines with the of the present study, Beckmann and Garrett investigated the effect of PM on the reduction of perilial tear rate in Australia, showing that the frequency of episiotomy was lower in the PM group. They also found that the decrease was more ificant in nulliparous than multiparous women, where the pain relief was also reported for up to three months after delivery.

They concluded that antenatal massage during pregnancy reduced the risk of perineal damage, episiotomy, and the subsequent postpartum perineal pain Besides, Labrecque et al.

Therefore, it was concluded that antenatal massage is useful for women who are experiencing their first vaginal delivery Other of the present study showed that the tear rate was ificantly higher in the group receiving the PM than the control group. There was no ificant difference in terms of the degree of the perineal tear between the mothers who did not perineum massage mann episiotomies and those who needed an episiotomy. However, the second-degree perineal tear was of a lower frequency among mothers who received PM. Therefore, it seems that PM does not have an effect on the of tears but reduces their depth.

Shipman et al. Their study in terms of the effect of PM on the reduction of perineal tears during delivery are consistent with the of our study. Nonetheless, the two studies differ as PM in our study was practiced only during the first and second stages of labor, while in Shipman et al.

In this regard, Vendittelli et al. In a systematic review, Eason et al. In a clinical trial by Albers et al. The prevalence of perineal and vaginal damage was not ificantly different in the groups. The authors stated that the central predictor of perineal damage was antenatal and macrosomia of the fetus and that the mother's sitting position during childbirth plays a preventive role against perineal damage 8. It is likely that the reason for the difference between the of our study and Albers et al.

In another study, Mei-dan et al.