Authors: (including presenting author): :
Cheung NL, Li OC, Yip MY, Wong D
Affiliation: :
Department of Obstetrics & Gynaecology, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Antenatal Perineal Massage
Keyword 3: :
pain tolerance
Keyword 4: :
postpartum perineal pain
Keyword 5: :
labour duration
Keyword 6: :
natural birth
Introduction: :
In Hong Kong, maternity care involves high obstetric intervention rates, including episiotomy and pharmacological pain relief. Many women experience significant anxiety about labour pain, which heighten their sense of losing control and contribute to the medicalization of childbirth. After vaginal birth, approximately 90% of women suffer perineal trauma and wound pain, leading to physical and psychological complications, extended hospitalization, raised medical expenditures and adversely impacts women's overall well-being. Evidence supported that antenatal perineal massage (APM) is an effective, low-cost, non-invasive intervention to minimize perineal trauma. Research also suggested APM can decreased anxiety, improved pain tolerance, and enhanced satisfaction with the birth experience. Thus, PYNEH O&G has implemented APM to pregnant women since June 2024 to address these issues.
Objectives: :
♦ To enhance women’s psychological preparation for delivery ♦ To elevate pain tolerance in labour ♦ To reduce postpartum perineal discomfort ♦ To optimize the quality of care and birth experience
Methodology: :
A quasi-experimental study was conducted with 220 nulliparous women recruited from June 2024 to January 2025. The control group (n=110) received routine care, while the intervention group (n=110) attended a 30-minute pre-parenting APM workshop at 33-37weeks of gestation. Couples received a pamphlet and were instructed to perform 5-10minutes perineal massage daily from 35weeks onwards and kept a diary to enhance adherence. Evaluation and satisfaction survey were conducted upon delivery.
Result & Outcome: :
The intervention group showed significantly better outcomes compared to the control group. The use of pharmacological analgesia decreased, with lower rates of Entonox (56.4% vs 70%, χ²=4.396, p=0.036) and epidural analgesia (7.3% vs 17.3%, χ²=5.108, p=0.024). Exclusive use of non-pharmacological pain relief increased (40.9% vs 23.6%, p< 0.001), supporting natural birth and enhanced maternal outcomes. Labour was shorter in first-stage (5.19 vs. 6.47hours, p< 0.001, independent samples t-test) and second-stage (23.73 vs. 39.48minutes, p< 0.001, independent samples t-test). Furthermore, participants reported significantly lower pain scores after delivery and during first postpartum ambulation (standing, sitting and walking), with all differences being statistically significant (p< 0.001, independent samples t-test). A dose-response relationship was suggested, with more frequent practice correlating with better outcomes. 100% participants reported it provided better psychological preparation for delivery and believed it positively protected their perineum. Furthermore, all stated they would perform APM in future pregnancies and recommended it to others. Implementing APM program as a routine antenatal education could strengthen maternal autonomy, and support the goal of promoting natural birth.
