title: Perineal massage during pregnancy: a prospective controlled trial.
abstract: BACKGROUND
  Women frequently suffer perineal trauma while giving birth. Interventions to increase the possibility for an intact perineum are needed.
  
  
  OBJECTIVE
  To evaluate the effectiveness of antenatal perineal massage in increasing the likelihood of delivering with an intact perineum.
  
  
  METHODS
  This single blinded prospective controlled trial included 234 nulliparous women with a singleton fetus. Women allocated to the study group were instructed to practice a 10 minute perineal massage daily from the 34th week of gestation until delivery. Primary outcome measures included the episiotomy rate; first, second, third and fourth-degree perineal tear rates; and intact perineum. Secondary outcomes were related to specific tear locations and the amount of suture material required for repair.
  
  
  RESULTS
  Episiotomy rates, overall spontaneous tears and intact perineum rates were similar in the study and control groups. Women in the massage group had slightly lower rates of first-degree tears (73.3% vs. 78.9%, P = 0.39) and slightly higher rates of second-degree tears (26.7% vs. 19.3%, P= 0.39), although both of these outcomes did not reach statistical significance. The rates of anterior perineal tears were significantly higher in the massage group (9.5% vs. 3%, P = 0.05), whereas internal lateral tears rates were slightly lower but without statistical significance (11.5% vs.13.1%, P=0.44).
  
  
  CONCLUSIONS
  The practice of antenatal perineal massage showed neither a protective nor a detrimental significant effect on the occurrence of perineal trauma.
authors.affiliation: Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel. eladmei@yahoo.com
authors.forename: Elad
authors.initials: E
authors.lastname: Mei-dan
authors.forename: Asnat
authors.initials: A
authors.lastname: Walfisch
authors.forename: Iris
authors.initials: I
authors.lastname: Raz
authors.forename: Amalia
authors.initials: A
authors.lastname: Levy
authors.forename: Mordechai
authors.initials: M
authors.lastname: Hallak