May 24, 2001 -- A method long recommended by nurse midwives and others to prevent trauma to a woman's genitalia during labor, and reduce the need for episiotomy, may not be all that effective.
Often when delivering a baby, the doctor will make a small cut in the perineum, the small area between the vagina and the rectum. The procedure, called an episiotomy, is performed to make more room for the baby's head and to prevent tearing of the vagina and perineum. The procedure can result in long-term pain and discomfort for the mother. Some women may also suffer from loss of bladder and bowel control and have difficulty resuming sexual intercourse in the months after birth.
A technique called perineal massage is advocated by many nurse midwives as a natural method to protect the perineum from tearing or needing to be cut during labor. The technique involves massaging and stretching the perineum during the second stage of labor.
Until now there have been few large scientific studies of the technique documenting its effectiveness. In the May 26 issue of the British Medical Journal, however, researchers from Australia who put perineal massage to the test in a group of over 1,300 women in labor say they saw virtually no difference in results between women who got the massage and those who did not.
Study author Georgina Stamp, PhD, a senior research fellow at the Centre for Research into Nursing and Health Care at the University of South Australia in Adelaide, reports that women in both groups had similar rates of tearing and need for episiotomy as well as similar postpartum frequency of perineum pain, pain during intercourse, time to resumption of intercourse, and bladder and bowel control.
Although women in the perineal massage group were less likely than those in the nonmassage group to have serious perineal tears, the authors say the difference was not significant enough that they would recommend the massage as a protective method against tearing.
Nevertheless, Stamp and colleagues found that the overwhelming majority of women in the massage group said they would participate in a similar trial again. That finding, combined with no apparent harm associated with the massage, leads the author to advise midwives to "follow their usual practice while taking into account the preference of individual women."
Certified nurse midwives who spoke with WebMD had mixed opinions on the value of the method.
Perineal massage came into being based on word-of-mouth that it helped, not based on any scientific studies that it works, says Marion McCartney, CNM, director of professional services for the American College of Nurse-Midwives.
"My experience as a nurse midwife has been some people find massage helped them and others didn't want you to do that," she says. "Some people just want warmth up against them ... warm compresses [on the perineum] often make them feel much better. It's just personal preference."
In the study, a water-soluble lubricant was used on the perineum during the massage, but McCartney says nurse midwives use a variety of substances including olive oil and vitamin E.
McCartney says despite the study's findings, the real value of perineal massage for many women is the relaxation and comfort it can provide.
"Anything that makes her feel better is good because she does a better job of pushing her baby out," she says.
But Gretchen Mettler, CNM, MS, RN, says how the massage is performed usually determines whether a women in labor finds it comforting or helpful.
"I've seen it done pretty hard to the point where it hurt ... and where it causes [swelling] of the perineum, and that doesn't help," says Mettler, an instructor of nursing at Case Western Reserve University's Frances Payne Bolton School of Nursing in Cleveland.
Some midwives recommend having the mother perform perineal massage during the last month of her pregnancy, but not during labor, says Mettler, who has been a nurse midwife for 17 years and says she has assisted in more births without massage than with it. She says a better way to prevent tearing and take pressure off the perineum is to have women push between contractions instead of with the contractions.
"Then there is more of a chance for the perineum to slowly stretch out and not tear," she says.