New perspectives on perineal massage, and pushing

Patient- or partner-administered perineal massage during the last 4 or 5 weeks of pregnancy reduces the number of episiotomies by about 15%, according to a review of trials in the Cochrane Library.

The review included data from three trials involving about 2,400 women. The benefit was strongest for women delivering vaginally for the first time, although the number of women with prior vaginal deliveries was small in comparison and, thus, may have been statistically underpowered to demonstrate a benefit.

A second study found that coached pushing-which involves someone telling the laboring woman when to push-can lead to pelvic floor dysfunction later in life. The reason is that coaches often instruct women to push earlier in a contraction than they would instinctively, which can injure the perineum.

Bloom SL, Casey BM, Schaffer JI, et al. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol. 2006;194:10-13.

Kuehn BM. Massage during last weeks of pregnancy reduces episiotomies during delivery. JAMA. 2006;295:1361-1362.