Perineal techniques during the second stage of labour for reducing perineal trauma

Department of Postgraduate Studies, Bergen University College, Møllendalsveien 6, PO Box7030, Bergen, Norway, 5020.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 12/2011; 3(12):CD006672. DOI: 10.1002/14651858.CD006672.pub2
Source: PubMed


Most vaginal births are associated with some form of trauma to the genital tract. The morbidity associated with perineal trauma is significant, especially when it comes to third- and fourth-degree tears. Different perineal techniques and interventions are being used to prevent perineal trauma. These interventions include perineal massage, warm compresses and perineal management techniques.
The objective of this review was to assess the effect of perineal techniques during the second stage of labour on the incidence of perineal trauma.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2011), the Cochrane Central Register of ControlledTrials (The Cochrane Library 2011, Issue 2 of 4), MEDLINE (January 1966 to 20 May 2011) and CINAHL (January 1983 to 20 May 2011).
Published and unpublished randomised and quasi-randomised controlled trials evaluating any described perineal techniques during the second stage.
Three review authors independently assessed trails for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy.
We included eight trials involving 11,651 randomised women. There was a significant effect of warm compresses on reduction of third- and fourth-degree tears (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.28 to 0.84 (two studies, 1525 women)). There was also a significant effect towards favouring massage versus hands off to reduce third- and fourth-degree tears (RR 0.52, 95% CI 0.29 to 0.94 (two studies, 2147 women)). Hands off (or poised) versus hand on showed no effect on third- and fourth-degree tears, but we observed a significant effect of hands off on reduced rate of episiotomy (RR 0.69, 95% CI 0.50 to 0.96 (two studies, 6547 women)).
The use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma. The procedure has shown to be acceptable to women and midwives. This procedure may therefore be offered to women.

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Available from: Mirjam Lukasse, Mar 13, 2014
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    • "The authors of a recent CSR ( Aasheim et al . , 2012 ) concluded that there was reasonable data to support the use of warm compresses on the perineum during the birth , which resulted in a reduction in SPT ( risk ratio ( RR ) 0 . 48 , 95% confidence interval ( CI ) 0 . 28 – 0 . 84 ) . A reduction in episiotomy was seen with hands off technique ( RR 0 . 65 , 95% CI 0 . 50 – 0 . 96 ) and a "
    Midwifery 09/2014; 31(1). DOI:10.1016/j.midw.2014.09.004 · 1.57 Impact Factor
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    • "The main finding in this study is that the midwives relate to both an accepted truth that a skilled midwife can prevent an anal sphincter tear and at the same time to a more complex belief in relation to the phenomenon. Since the scientific evidence for the accepted truth is limited [9–11] the question is where this truth derives from. The problem of the increased incidence of OASIS was highlighted in the few first years after 2000. "
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    ABSTRACT: Background The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The consequences of these injuries can be devastating for women and have an impact on their daily life and quality of health. The aim of this study was to obtain a deeper understanding of midwives’ lived experiences of attending a birth in which the woman gets an obstetric anal sphincter injury. Methods A qualitative study using phenomenological lifeworld research design. The data were collected through in-depth interviews with 13 midwives. Results The essential meaning of the phenomenon was expressed as a deadlock difficult to resolve between a perceived truth among midwives that a skilled midwife can prevent severe perineal trauma and at the same time a coexisting more complex belief. The more complex belief is that sphincter injuries cannot always be avoided. The midwives tried to cope with their feelings of guilt and wanted to find reasons why the injury occurred. A fear of being exposed and judged by others as severely as they judged themselves hindered the midwives from sharing their experience. Ultimately the midwives accepted that the injury had occurred and moved on without any definite answers. Conclusions Being caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife’s own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally. Further research is needed to implement and evaluate the effect of reflective practices in relation to midwifery care and whether this could benefit women in childbirth.
    BMC Pregnancy and Childbirth 08/2014; 14(1):258. DOI:10.1186/1471-2393-14-258 · 2.19 Impact Factor
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    • "Mei-Dan (2008) suggested that perineal massage had not affect on frequency of intact perineal and there weren't the significant difference in rate of trauma perineal [3]. But Aasheim (2011) and Attarha et al. (2009) believed that perineal massage reduces 3rd and 4th tears rather than noncontact technique [15] [16]. In a study, Attarha et al. [11] observed that perineal massage with lavender essence at the second stage of labor increased blood flow, softened perineal tissues and made it more flexible in the involved group rather than the control group. "
    Health 01/2014; · 0.51 Impact Factor
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