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Culture Documents
DOI 10.1007/s00404-011-1919-5
M A T ER N O - F E T A L M E D I C I N E
Received: 4 November 2010 / Accepted: 28 April 2011 / Published online: 26 May 2011
Springer-Verlag 2011
Abstract
Purpose Maintaining an intact perineum is a highly
regarded aim in delivery procedures today. Since perineal
massage is a common practice during delivery, the present
study aims to investigate the eVect of perineal massage with
Vaseline on perineal trauma (rate of episiotomy procedures
and perineal tears).
Method Ninety primiparous women (aged between 18
and 30 years with gestational age of 3842 weeks) were
selected sequentially in Tehran in 2009. Once participants
characteristics were registered, they were randomly
assigned to the intervention (perineal massage with Vaseline) or control groups. In the massage group, perineal massage was performed in the second stage of delivery once the
genitalia were treated with sterilized Vaseline. The perineum was examined after the delivery in terms of episiotomy or tear and its severity degree.
Results The two groups were homogeneous in terms of
demographic data, weight gain during pregnancy, gestational age, abortion history and fetal weight. The second
stage of delivery was signiWcantly shorter in the massage
group than the control group and the massage group had
signiWcantly more intact perineum (P = 0.004). In addition,
lower episiotomy and higher Wrst- and second-degree perineal tears were seen in the massage group in comparison
with the control one (P < 0.001). Neither of the groups
suVered from third- and fourth-degree tears.
M. Geranmayeh Z. Rezaei Habibabadi Z. Khakbazan (&)
A. Mehran
Nursing and Midwifery School, Tehran University
of Medical Sciences, East Nosrat Ave., Touhid Sq., Tehran, Iran
e-mail: khakbaza@sina.tums.ac.ir
B. Fallahkish M. A. Farahani
Tehran, Iran
Conclusion The Wndings showed that the perineal massage with Vaseline in the second stage of labor increases
perineal integrity and decreases perineal traumas (episiotomy and tears). So, it seems that the perineal massage could
be an eVective way to preserve an intact perineum in labor.
Keywords Episiotomy Perineal tear
Perineal massage Vaseline Vaginal delivery
Introduction
Episiotomy, which is the most common surgical procedure
in midwifery [1], involves an incision through the perineum
made to enlarge the vaginal diameter. The prevalence of
episiotomy varies in diVerent countries, ranging from 8% in
Holland to 14% in the UK, 50% in the US and up to 99% in
East European countries [2]. Episiotomy is commonly performed in Asian countries because the shortness and tenacity of perineum in most Asian women makes them
susceptible to extensive tears [3]. In case of Iran, although
no oYcial statistics are published, various scattered studies
show a prevalence of 8897% of episiotomy procedure in
hospitals [4, 5].
Despite the widespread adoption of episiotomy, there is
no unanimous agreement over its most often claimed
advantage (preventing severe perineal tears) [6]. In numerous studies, episiotomy has been imputed with a risk factor
for third- and fourth-degree tears [7]. Furthermore, it has
been claimed that not only may episiotomy fail to protect
the perineal body, but also it may increase anal sphincter
incontinence due to the increased risk of incurring thirdand fourth-degree tears [8]. As a matter of fact, fecal incontinence in women who have undergone episiotomy is
higher than those with natural tears [9] by 46 times [10].
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Control
group
P value
Demographic characteristics
Control
group
P value
33 (73%)
30 (67%)
0.490b
23 (51%)
22 3
0.113
21 3
Oxytocin consumption
during labor (%)
18 (40%)
0.290b
9 (20%)
5 (11%)
0.245b
55 8
60 11
0.014a
37 20
3.3 0.4
0.437a
3.2 0.4
46 19
Perineal trauma
33 (73%)
43 (96%)
0.004b
Intact perineum
12 (27%)
2 (4%)
First-degree tear
15 (45%)
4 (9%)
Second-degree tear
3 (10%)
1 (2%)
Episiotomy
15 (45%)
38 (88%)
Age (years)
Height (cm)
Delivery characteristics
Gestational age (weeks)
Weight gain during
pregnancy (kg)
Abortion history
a
Chi-square test
Fishers exact test
Massage
group
158 7
158 6
0.884a
39.3 0.9
39.7 0.9
0.154a
13 5
1 (2%)
13 6
0.719a
4 (9%)
0.361
Perineal status
a
b
0.038a
<0.001b
pain and inXammation at perineum, which was not signiWcantly diVerent, however, in the two groups (P = 0.528).
Results
Discussion
The two groups were not signiWcantly diVerent in terms of
demographic variables (age, post-secondary education and
height) (P > 0.05). In terms of pre-pregnancy weight, the
control group was signiWcantly higher than the massage
group (P = 0.014). However, the two groups were not
diVerent in terms of weight gain during pregnancy
(P = 0.719). The two groups were also homogenous in
terms of gestational age and abortion history (P > 0.05).
Table 1 shows the demographic and pregnancy data of the
participants.
Table 2 includes data on delivery and its outcomes for
the two groups. The two groups were not signiWcantly
diVerent in terms of oxytocin consumption at labor, nuchal
cord and the neonates weight (P > 0.05). However, the
length of the second stage of birth was signiWcantly shorter
in the massage group compared with the control one
(37 20 and 46 19 min, respectively, P = 0.038). The
massage group had a signiWcantly higher frequency of
intact perineum (P = 0.004). Neither of the groups suVered
from third- and fourth-degree tears. In terms of perineal
traumas, massage could cause a decrease in episiotomy rate
and an increase in Wrst- and second-degree tears
(P < 0.001). The Apgar scores for all neonates in both the
groups were over 7 on 15 min, and neonatal complications
were detected. Furthermore, in the follow-up study within
10 days of delivery, the massage group showed no side
eVects associated with Vaseline and less than 10% of mothers in both the groups experienced eVects such as burning,
The Wndings in this study showed that the massage of perineum with Vaseline in the second stage of labor not only
reduces the length of the second stage, but also increases
the intact perineum, mainly by decreasing the frequency of
episiotomy. In addition, despite an increase in the frequency of spontaneous perineal tears in perineal massage
(compared with routine care), none of the tears were qualiWed as third or fourth degrees. Maternal and neonatal complications were also similar to those of a routine care.
Perineal stretching and massage in the second stage of
delivery are commonly performed by midwifes [11]. The
results are, however, mixed whether this method is eVective
on prevention of perineal traumas or not. The RCT studies
conducted by Albers et al. [20] and Stamp et al. [21]
showed no evidence of decrease in perineal traumas. However, a previous study in Iran [23] showed that the perineal
massage reduces the need for episiotomy and increases the
chance of an intact perineum, which is in line with our Wndings. Previous studies also showed that women in the massage group experienced less episiotomy and perineal tears
[18, 24]. This diVerence could be explained through the
exclusion of fetal macrosomia, instrumental birth and massage during pregnancy from the study and the lower rate of
episiotomy in those societies and also the anthropometric
diVerences of Iranian women. Therefore, the results of
these two experiments in the Iranian context, where most
vaginal deliveries involve episiotomy, have come to be
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Conclusion
The Wndings of the present study showed that the perineal
massage with Vaseline in the second stage of birth
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None.
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