Listen up all you pregnant women out there, for I have good news for you today. Unless you are about to give birth any day now, that is, in which case best of luck with that!
When I was pregnant, more than a decade ago, it was all yoga and perineal massage in my bit of the woodland. I also went into labour fully equipped with essential oils to sniff from a hanky for pain relief should things get a bit ouchy. By the time I was begging for hard pain-relieving drugs it was too late anyway. But it seems that all that fumbling in the nether regions is worth doing. Trauma from tears or episiotomy, a cut made to enlarge the vaginal opening, are common in women giving birth vaginally and especially in those doing so for the first time. The idea is that massaging the perineum in pregnancy makes the muscles more flexible and more likely to stretch during delivery without tearing.
A Cochrane review has just been updated and brings together evidence from four good quality randomised controlled trials with 2497 women, which show that digital perineal massage may well be of benefit in reducing perineal trauma and ongoing pain. By digital we mean with the fingers – we’re talking hands-on here, nothing virtual or remote about this! Women who had perineal massage, done by themselves or their partner for at least the last four weeks of pregnancy, were compared with control group women who had no perineal massage. All trials recommended a similar technique done at a similar stage. Most of the women (2004) had not had a previous vaginal delivery.
Here’s what they found:
- Women in the perineal massage group overall were 9% less likely to have trauma needing stiches and 16% less likely to have an episiotomy
- These findings were only significant for women having their first vaginal delivery
- Those who massaged up to an average of 1.5 times a week were less likely to need stiches or episiotomy than those who massaged more frequently
- Women who massaged more often than three times a week were more likely to have a longer second stage of labour; overall no differences were seen between massage and control groups
- No difference between groups in first- or second-degree tears or third- or fourth-degree perineal trauma
- Only women who had previously given birth vaginally reported a significant reduction in pain three months after the birth. Women who massaged most frequently were least likely to report ongoing perineal pain.
- No difference between groups in the use of instruments to aid delivery, sexual satisfaction or incontinence
- Most women reported that they would massage again and recommend it to others.
The authors conclude:
Women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.
The findings that those who massaged more frequently did not have less perineal trauma than other massagers and tended to have a longer second stage were surprising and the review authors discuss possible explanations for this, including the influence of the woman’s motivation and preferences.
So the, er, bottom line? For every 15 women who practice digital perineal massage from around 35 weeks of pregnancy, one fewer will be stitched after the birth and this is largely because of the reduced risk of episiotomy. There are leaflets explaining the technique, such as the one available from the link below. I hope it works for you!
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub3.
Antenatal perineal massage. Information for women. [PDF] Oxford Radcliffe Hospitals NHS Trust.