Efficacy of perineal massage in second stage of labour for prevention of perineal trauma: a randomized controlled trial.

BACKGROUND: High-quality intra-partum care is crucial for all expectant mothers to ensure safe delivery and favourable postpartum recovery. Vaginal delivery when associated with perineal trauma makes postpartum period painful and increases risk of long-term morbidity. Perineal trauma has been reported to be more common among Asian women. Interventions which minimise the perineal trauma will enhance the experience of motherhood. Various strategies have been explored but there is no firm consensus on their usage. We conducted this study to evaluate the effectiveness of perineal massage during the second stage of labor in reducing perineal trauma. METHODS: A randomised controlled study was conducted at a referral centre. Four hundred and fifty women were randomised into two groups of 225 women. Second stage of labor was managed with perineal massage along with fetal head flexion and perineal support in group A and only fetal head flexion and perineal support was given in group B. The rate of intact perineum, episiotomy, perineum tears, duration of second stage and acceptability of perineal massage were compared between the 2 groups. RESULTS: Group A showed a significantly higher rate of intact perineum (p = 0.03) and a lower rate of episiotomies (p = 0.04). Overall rates of perineal tears between groups were not statistically different (p = 0.95). The duration of the second stage of labor was significantly shorter in Group A (p < 0.001). Women experienced significant perineal discomfort but 81.8% said they would opt for it in the subsequent delivery. CONCLUSION: Perineal massage is a simple, easily applicable and cost-effective technique. It reduced episiotomy rates and duration of second stage of labor significantly. Its routine use can be offered with appropriate counselling to all labouring women.