The effect of vaginal and perineal massage with duck oil on length of second stage of labor, episiotomy, and perineal laceration in nulliparous women: a randomized controlled trial

Document Type : Original Article

Authors

1 M.Sc. of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Associate Professor, Department of midwifery, Reproductive Health Promotion Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Assistant Professor, Department of Biostatistics, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Assistant Professor, Department of Pharmacognosy, Medicinal Plant Research Center, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

5 Assistant Professor, Department of Persian Medicine and Pharmacy, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Introduction: Adopting a safe method to accelerate labor can reduce maternal and fetal mortality and morbidity. Prolonged labor, perineal rupture and episiotomy can be associated with short and long-term maternal and fetal complications. This study was performed aimed to examine the effect of vaginal and perineal massage with duck oil on the length of the second stage of labor, the frequency of episiotomy, and perineal laceration in nulliparous women.
Methods: This randomized controlled trial study was performed in 2020 on 129 nulliparous women with singleton pregnancy aged 18-35 years, gestational age 37-42 weeks, and cephalic presentation. The participants were divided into duck oil group (n=43), lubricant gel group (n=43), and control group (n=43). During the second stage of labor, a gentle massage was performed with the index and middle fingers impregnated with duck oil (for the oil group) or lubricant gel (for the gel group). The control group received massage without gel or oil. Data were analyzed by SPSS software (version 23) and Kruskal-Wallis, paired comparison and Chi-square tests. P<0.05 was considered statistically significant.
Results: The mean length of the second stage of labor in the duck oil group (35.77 ±21.47) was significantly lower than the control group (49.65±17.54) and the gel group (44.19±21.35) (P=0.01). There was no significant difference among the groups in terms of perineal rupture and the frequency of episiotomy (p >0.05).
Conclusion: Perineal and vaginal massage using duck oil in the second stage of labor can shorten the length of the second stage of labor, but had no effect on episiotomy and perineal rupture.

Keywords


  1. Nolens B, van den Akker T, Lule J, Twinomuhangi S, van Roosmalen J, Byamugisha J. Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda. Tropical Medicine & International Health 2019; 24(5):553-62.
  2. Heydari A, Nasiri F, Kariman N. Effect of topical magnesium sulfate in latent phase on Bishop Score and latent phase duration in primiparous women. Iran J Obstet Gynecol Infertil 2020; 23(2):42-9.
  3. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse D, Spong CY, et al. Williams Obstetrics. 23nd New York: McGraw-Hill Education; 2011.
  4. Healy M, Nyman V, Spence D, Otten RH, Verhoeven CJ. How do midwives facilitate women to give birth during physiological second stage of labour? A systematic review. PloS one 2020; 15(7):e0226502.
  5. AmiriFarahani L, Shirazi V, Rajabalipoor F. The effects of different positioning on the duration of the second stage of labor in primiparous women. J Adv Med Biomed Res 2012; 20(80):105-14.
  6. Labrecque M, Eason E, Marcoux S, Lemieux F, Pinault JJ, Feldman P, et al. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. American journal of obstetrics and gynecology 1999; 180(3):593-600.
  7. Zang Y, Lu H, Zhang H, Huang J, Zhao Y, Ren L. Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews. International Journal of Nursing Studies 2021; 114:103812.
  8. Piri galledar A, danesh kojori M, Jamshidi Manesh M, Hosseini F. The effect of perineal massage on labor second stage period perineal tear and its outcomes. J Shahrekord Univ Med Sci 2012; 14(5):24-33.
  9. Williams A, Herron‐Marx S, Knibb R. The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors. Journal of Clinical Nursing 2007; 16(3):549-61.
  10. Royal College of Obstetricians and Gynaecologists. Third- and Fourth-degree Perineal Tears, Management (Green-top Guideline No. 29); 2007. https:// rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf.
  11. Shayan A, Farshchian F, Masoumi SZ, Soltani F, Mohammadi Y, Sepehr M, et al. The Effect of Pelvic Floor Exercises to Episiotomy in Nulliparous Women in Hamadan. Pajouhan Scientific Journal 2020; 18(2):13-19.
  12. Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC pregnancy and childbirth 2013; 13(1):1-9.
  13. Magoga G, Saccone G, Al-Kouatly HB, Dahlen H, Thornton C, Akbarzadeh M, et al. Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2019; 240:93-8.
  14. Hals E, Øian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstetrics & Gynecology 2010; 116(4):901-8.
  15. Laine K, Pirhonen T, Rolland R, Pirhonen J. Decreasing the incidence of anal sphincter tears during delivery. Obstetrics & Gynecology 2008; 111(5):1053-7.
  16. Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. Journal of midwifery & women's health 2005; 50(5):365-72.
  17. Kalichman L. Perineal massage to prevent perineal trauma in childbirth. The Israel Medical Association journal: IMAJ 2008; 10(7):531-3.
  18. Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, et al. Is there a correlation between pelvic floor dysfunction symptoms during pregnancy and the duration of the second stage of labor?. The Journal of Maternal-Fetal & Neonatal Medicine 2022; 35(22):4418-23.
  19. Hehir MP, Rouse DJ, Miller RS, Ananth CV, Wright JD, Siddiq Z, et al. Second-stage duration and outcomes among women who labored after a prior cesarean delivery. Obstetrics & Gynecology 2018; 131(3):514-22.
  20. Noori Moogahi S, Khanehzad M, Sadr M, Roholahi S, Kameli S. Comparative Effects of Alcea sulphurea and Bromhexine HCL on Mucociliary System of Chicken Trachea. J Med Plants 2013; 12(48):54-61.
  21. Zare O, Pasha H, Faramarzi M. Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health 2014; 6(1):10-14.
  22. Aasheim V, Nilsen AB, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews 2017(6).
  23. Riener R, Leypold K, Brunschweiler A, Schaub A, Bleul U, Wolf P. Quantification of friction force reduction induced by obstetric gels. Medical & biological engineering & computing 2009; 47(6):617-23.
  24. Dieb AS, Shoab AY, Nabil H, Gabr A, Abdallah AA, Shaban MM, et al. Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. International urogynecology journal 2020; 31(3):613-9.
  25. Aquino CI, Guida M, Saccone G, Cruz Y, Vitagliano A, Zullo F, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine 2020; 33(6):1051-63.
  26. Albers LL, Anderson D, Cragin L, Daniels SM, Hunter C, Sedler KD, et al. Factors related to perineal trauma in childbirth. Journal of Nurse-Midwifery 1996; 41(4):269-76.
  27. Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. American journal of obstetrics and gynecology 2000; 182(1):76-80.
  28. Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: incidence and its risk factors. Journal of Obstetrics and Gynaecology 2019; 39(2):206-11.
  29. Arzani MA. Tebb-e-Akbari.1nd Tehran: Jalal-aldin Press; 2008. Akbar's Medicine.
  30. Gorgani SI.  Zakhire Khwarazmshahi [The treasure of the khwarazm Shah]1nd ed. Compiled by Velayati, A. & Najmabadi, M. Tehran: Ettelaat publication; 1990.
  31. Montazer Alghaem A, Alian F, HosseinHashemi Z. The Study of Difficult Parturition in the History of Islamic Medicine. Journal of Islamic and Iranian Traditional Medicine 2017; 7(4):385-95.
  32. Schaub AF, Litschgi M, Hoesli I, Holzgreve W, Bleul U, Geissbühler V. Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation. Journal of perinatal medicine 2008; 36(2):129-35.
  33. Seval MM, Yüce T, Yakıştıran B, Şükür YE, Özmen B, Atabekoğlu C, et al. Effects of obstetric gel on the process and duration of labour in pregnant women: randomised controlled trial. Journal of Obstetrics and Gynaecology 2017; 37(6):714-8.
  34. Ashwal E, Aviram A, Wertheimer A, Krispin E, Kaplan B, Hiersch L. The impact of obstetric gel on the second stage of labor and perineal integrity: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine 2016; 29(18):3024-9.
  35. Romina S, Ramezani F, Falah N, Mafi M, Ranjkesh F. Effect of Perineal Massage with Ostrich Oil on the Episiotomy and Lacerations in Nulliparous Women: A Randomized Controlled Clinical Trial. Iranian journal of nursing and midwifery research 2020; 25(2):134.
  36. Al Mefarfesh A, Ahmed ER, Al Qahtani NH. Effect of applying extra virgin olive oil versus obstetric gel on the second stage of labor outcomes among primiparous women. J Nurs Health Sci 2015; 4(4):10-16.
  37. Geranmayeh M, Rezaei Habibabadi Z, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Archives of Gynecology and Obstetrics 2012; 285(1):77-81.
  38. Aquino CI, Saccone G, Troisi J, Zullo F, Guida M, Berghella V. Use of lubricant gel to shorten the second stage of labor during vaginal delivery. The Journal of Maternal-Fetal & Neonatal Medicine 2019; 32(24):4166-73.
  39. Aydıner B, Kıyak H, Mete F, Ekiz A, Polat İ, Gedikbaşı A. Nullipar gebelerde obstetrik jel kullanımı: Maternal-neonatal sonuçları. Perinatal Journal/Perinatoloji Dergisi 2017; 25(3):127-32.
  40. Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. American journal of obstetrics and gynecology 2009; 201(1):91-e1.
  41. Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. Bmj 2001; 322(7297):1277-80.
  42. Mei-Dan E, Walfisch A, Raz I, Levy A, Hallak MJ. Perineal massage during pregnancy: a prospective controlled trial. The israel medical association journal 2008; 10(7):499-502.
  43. Harlev A, Pariente G, Kessous R, Aricha-Tamir B, Weintraub AY, Eshkoli T, et al. Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial. The Journal of Maternal-Fetal & Neonatal Medicine 2013; 26(13):1328-31.
  44. Ibrahim H, Elgzar WT, Hassan HE. Effect of warm compresses versus lubricated massage during the second stage of labor on perineal outcomes among primiparous women. IOSR Journal of Nursing and Health Science 2017; 6(4):64-76.
  45. Lane TL, Chung CP, Yandell PM, Kuehl TJ, Larsen WI. Perineal body length and perineal lacerations during delivery in primigravid patients. InBaylor University Medical Center Proceedings 2017; 30(2):151-3.
  46. Deering SH, Carlson N, Stitely M, Allaire AD, Satin AJ. Perineal body length and lacerations at delivery. The Journal of reproductive medicine 2004; 49(4):306-10.
  47. Moya-Jiménez LC, Sánchez-Ferrer ML, Adoamnei E, Mendiola J. New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy. International Urogynecology Journal 2019; 30(5):815-21.