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A.The perineum is the area of skin between the vagina and anus. This is where episiotomies are made. Tears can also occur in this area as the baby is being born. Until recently it was not clear whether massaging and stretching the skin in the perineum during labour would reduce the risk of a tear occurring or an episiotomy being required. Researchers in Australia have recently conducted a study to determine if perineal massage in labour is useful in preventing tears.

Over 1340 women were studied. They were randomly allocated to receive either perineal massage with every contraction during the second stage of labour or routine midwifery care for delivery. The number of women requiring an episiotomy or who had a tear was similar in both groups, although there was a tendency for fewer severe tears involving the anus to occur in the women who had the massage. There was no difference in pain or other problems after delivery between the groups. So massaging the perineum does not appear to prevent episiotomies or tears or reduce pain after delivery.

Acupuncture may be a useful form of pain relief in labour

Acupuncture has been used in China for thousands of years. It is the insertion of special needles at strategic points on the body. This appears to be able to relieve pain. While it has been used by some women for relief of labour pain, doctors are uncertain how effective it is and also how it compares with other forms of pain relief like opiate medication and epidurals. A Swedish group of researchers have recently studied this.

The researchers randomly allocated 100 women in labour to receive either acupuncture or no acupuncture for pain relief. The acupuncture could be used on its own or combined with conventional forms of pain relief. So all the women were able to use any of the conventional methods of pain relief such as TENS, opiate medication, epidural, and ‘gas and air’. In the group who had acupuncture the number of women using epidurals was 12% compared to 22% in the group who did not receive acupuncture. The women receiving acupuncture also tended to feel more relaxed during labour and fewer of them used TENS. There was no difference in problems during labour or delivery between the two groups. These findings suggest that acupuncture could be valuable in the management of labour pain, in particular reducing the need for epidurals. However, further trials with greater numbers of patients are necessary before the value of acupuncture can be confirmed and also to establish whether it works by relieving pain or by improving relaxation in labour.

*Reference: Ramnero et al BJOG 2002;109:637.