Perineal massage with warm compresses did not add postpartum perineal pain

Design

Secondary analysis of a single-centre randomised controlled trial

Population

800 women at 37 to 41 weeks with planned vaginal cephalic birth

Primary outcome

Perineal pain (numerical rating scale) at 24 hours, 3 and 6 months

Effect

Numerically lower pain with massage and warm compresses; differences not statistically significant

A secondary analysis of a single-centre randomised trial in Portugal, published on 15 September, followed 800 women having planned vaginal births at 37 to 41 weeks. Half had perineal massage with warm compresses in the second stage; half had the standard hands-on technique.

Pain scores were numerically lower in the massage and warm compress group at 24 hours, 3 months and 6 months, but the differences were not statistically significant. Only 498 women were followed to 3 and 6 months. The factors that did drive pain at every time point were obstetric anal sphincter injury and episiotomy.

The reassurance is narrow but useful: a technique already used to protect the perineum does not appear to cost women pain afterwards. The bigger lever on postpartum pain remains avoiding sphincter injury and unnecessary episiotomy.

• Perineal massage with warm compresses in the second stage can be continued without concern about added perineal pain.
• Ask about perineal pain at the postnatal check, especially after episiotomy or a sphincter injury.
• Use episiotomy selectively; it was a main driver of pain at 24 hours, 3 and 6 months.
• Arrange pelvic floor follow-up for women with a sphincter injury, whose pain persisted longest.

Why it matters

It removes one concern about a perineal protection technique and points at the injuries that actually cause lasting pain.

Don't overread it

A non-significant difference is not proof of benefit, and almost 40% were lost to the 3- and 6-month follow-up.

The statistics, in plain English

Lower average pain that does not reach statistical significance means the difference could be chance. The study can say the technique did not add pain; it cannot say it reduced pain.

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