Self Perineal Massage to Prevent Perineal Lacerations: A Pilot Study

Objectives: Perineal lacerations and obstetrical anal sphincter injuries are associated with burdensome pelvic floor disorders. Implementation of antenatal perineal massage has been associated with statistically significant decreases in perineal lacerations, episiotomies, and second stage of labor length in prior randomized control trials. Perineal massage involves the manual stretching of tissues that compose the birth canal. Our objective is to evaluate a specific regimen for antenatal perineal massage to decrease perineal laceration rates and determine patient satisfaction with self-perineal massage.

Methods: This prospective cohort study was conducted at an academic institution with IRB approval. 50 patients were enrolled from 4/1/2021-5/5/2022. 35 of total of 1576 historic controls obtained before the intervention were matched to 35 enrolled patients based on maternal age, race, parity, episiotomy status, and use of operative delivery. The inclusion criteria are as follows: adult obstetrical patients between 34-36 weeks gestational age at enrollment time, vaginal delivery candidates, and delivery at or above 37 weeks gestational age. Those with a history of pelvic floor disorders, pelvic cancers, connective tissue disorders, and active urinary tract and/or sexually transmitted infections were excluded. Patients were given informed consent, standardized instructions, and extra virgin olive oil for perineal massage during enrollment. These patients were called weekly to confirm compliance. A 6-week postpartum survey was administered with satisfaction scored via a 5-point Likert scale. Data was analyzed using descriptive statistics and Fisher’s exact test was performed for categorical data analysis.

Results: Within the control group, 57.1% of subjects did not have any perineal lacerations. 2nd-degree lacerations were the most common type in both control and intervention groups (31.4% and 40% respectively). There was no statistically significant difference in the rate of any perineal lacerations between the cohorts (42.9% vs 65.7%, OR 0.3587, 95% CI 0.1422 to 0.9381). Additionally, there was no statistically significant difference in the rate of 3rd and 4th-degree perineal lacerations between the cohorts. Of the 18 subjects that completed the follow-up survey, 77% would recommend to friends and family, 83% would repeat in a subsequent pregnancy and 66% disagreed that it was painful.

Conclusions: When considering perineal lacerations of any degree, self-perineal massage was not significantly associated with a higher rate of laceration. Self-perineal massage may be protective against obstetrical anal sphincter injuries; however, the difference in 3rd or 4th-degree laceration rates between groups was not statistically significant. Self-perineal massage is associated with a positive patient experience but does not appear to decrease the rate of perineal lacerations overall. As the effects of this intervention against obstetrical anal sphincter injuries has not been clearly elicited, high-quality studies are warranted. Self-perineal massage can serve as a low-cost preventative measure against serious perineal injuries and its unfortunate pelvic floor sequelae.