Key messages
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Evidence on the effect of perineal techniques to prevent post-birth injury and blood loss is very uncertain due to poor study quality and small studies.
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Further large, well-conducted studies are needed and should measure post-birth haemorrhage, adverse effects and maternal satisfaction.
What is post-birth injury?
Post-birth injury can occur in the perineal area (the area between the vulva and anus) during active labour. Women with post-birth injury can experience heavy blood loss.
What did we want to find out?
We wanted to find out which perineal technique (for example warm compresses, massage, vocalisation or oils) was better than usual care during active labour to improve perineal injury and blood loss.
We also wanted to find out if different perineal techniques were associated with any unwanted (adverse) effects.
What did we do?
We searched for studies that looked at whether the application of perineal techniques, such as massage, warm compress, vocalisation or oils, in the active phase of labour results in a reduction in perineal injury and blood loss during birth compared to usual care.
We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and the number of women included.
What did we find?
We found 17 studies that included a total of 13,695 women who received a perineal technique or usual care during active labour.
What are the limitations of the evidence?
Half of the studies included were undertaken before 2010 and therefore present older evidence on techniques that may not be frequently used in current clinical practice. Very few studies reported blood loss, women's or health workers' experience of the techniques used, or other important outcomes.
How up-to-date is this evidence?
The evidence is up-to-date to 16 April 2024.
Overall, the evidence for the effectiveness of perineal techniques to reduce perineal trauma and postpartum haemorrhage is very uncertain.
Very few studies reported rates of postpartum haemorrhage, adverse events, women’s or health workers' experience or other important outcomes that allow us to understand the effectiveness and acceptability of perineal techniques to reduce perineal trauma. Prior to any further large trials, research is needed to clarify the types of interventions, including a clear description of the process of development and involvement of relevant stakeholders. There is a need to clarify how the intervention is proposed to achieve its effects. Trials would benefit from process evaluation alongside, to explore context, mechanisms and effects.
To assess the effect of perineal techniques during the second stage of labour on the incidence of and morbidity associated with perineal trauma to prevent postpartum complications.
We searched four databases and two trial registers up to 16 April 2024. We checked references, searched citations and contacted study authors to identify additional studies.
This Cochrane review was funded (in part) by WHO (APW 2024/1475460). TF, VL and the CIDG editorial base are funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies.
Registration and protocol: PROSPERO, CRD42024537252. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024537252.