Perineal massage reduced the incidence of episiotomy by 15% among primigravidas compared with controls (RR=0.85; 95% CI, 0.74-0.97; NNT=20); the largest reduction occurred in primagravidas who massaged as often as 1.5 times per week (RR=0.72; 95% CI, 0.57-0.91). This effect was not seen in primagravidas who massaged more often. Multigravid patients didn’t experience a statistically significant reduction in episiotomy.
Perineal massage didn’t affect the overall incidence of first- and second-degree perineal lacerations (first-degree laceration: RR=0.95; 95% CI, 0.78-1.16; second-degree laceration: RR=0.98; 95% CI, 0.84-1.15), nor the incidence of third- or fourth-degree lacerations (RR=0.81; 95% CI, 0.56-1.15). No difference was noted in the incidence of instrument delivery (RR=0.94; 95% CI, 0.81-1.08).
Massage means less pain for multigravidas
Massage reduced postpartum perineal pain in multigravidas, according to a questionnaire administered at 3 months in 1 study, to which 376 of 493 women (76%) responded (RR=0.45; 95% CI, 0.02-0.87; NNT=13).3 A subgroup of women who massaged more often than 3.5 times a week had a larger reduction in pain (RR=0.51; 95% CI, 0.33-0.79; NNT=11). At 3 months, massage produced no difference in rates of dyspareunia, sexual satisfaction, or incontinence of urine or feces when compared with standard care.
Recommendations
We found no expert or advocacy group guidelines on this topic.