EFFECT OF PERINEAL MASSAGE ON REDUCTION OF PERINEAL TRAUMA AMONG PRIMIGRAVIDAE AT FEDERAL MEDICAL CENTRE (FMC) YENAGOA, BAYELSA STATE

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ABSTRACT


The study examined the effect of perineal massage on perineal trauma among primigravidae in Federal medical centre (FMC) Yenagoa Bayelsa State. Six research questions and five hypotheses were developed to guide the study. Related Literature on the subject matter was reviewed. An experimental study design (Ramdomised Controlled Trial) was used for the study. The study population consists of all primigravidae attending antenatal Clinic at Federal Medical Centre (FMC) Yenagoa. A sample size of one hundred (100) was used for the study after estimation with the use of power analysis. However only eighty- one (81)  participants were used in the study as nineteen  of them were excluded from analysis for emergency caesarian section during labour. Instrument for data collection were daily massage compliant form and data collection form for attending doctors/midwives adapted from another study.  Data was analysed using Statistical Package for Social Science (SPSS) version 17.0. Findings from the study shows that perineal massage from the 37th week of pregnancy seems to have a beneficial effect of increasing intact perineum by 19%, although this did not reach statistical significance. Major findings show no significant difference between primigravidae who performed perineal massage and those who did not perform perineal massage in the occurrence of perineal trauma. There was no significant relationship between the risk factors of fetal birth weight, maternal age, gestational age and Body Mass Index (BMI) and the occurrence of perineal trauma. Although there were weak positive and negative relationship observed between risk factors and occurrence perineal trauma, these did not reach statistical significance. The study concluded that although there was no significant difference between primigravidae who performed perineal trauma in the last week of pregnancy, perineal massage increase the likelihood of delivering with an intact perineum. Based on this, recommendations were made to encourage women who wish to perform perineal massage to do so.

TABLE OF CONTENTS

Title page
Abstract
Table of Contents
List of Tables
List of Figures

CHAPTER ONE: INTRODUCTION
Background to the Study
Statement of Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
 Scope of the Study
Operational Definition of Terms

CHAPTER TWO: REVIEW OF RELATED LITERATURE
Concept of Perineal Massage
Types of Perineal Massage
Procedure for Perineal Massage
Benefits of perineal massage
Concept of perineal trauma/episiotomy
Determinants of Perineal Trauma
Degrees of Perineal Trauma
Morbidity associated with Perineal Trauma
Theoretical Review
Application to the Study
Conceptual Model
Empirical Review
Summary of Literature Review

CHAPTER THREE: RESEARCH METHOD
Research Design
Area of study
Population of the Study
Sample
Inclusion criteria
Sampling Procedure
Recruitment of study participants
Training Sessions
Study Protocol
Data Collection Instrument
Ethical Consideration and Consent
Procedure for Data Collection of Data
Method of Data Analysis

CHAPTER FOUR
Presentation of Results
Test of Hypothesis
Summary of Major Findings

CHAPTER FIVE
Discussion of Major Findings
Implications of the Study
Limitations of the Study
Suggestions for Further Studies
Summary of the Study
Conclusion
Recommendations
References

Appendices

CHAPTER ONE
INTRODUCTION
Background to the Study
Maternal and perinatal health have emerged as the most important issue that determines global and national wellbeing because every individual, family and community is at some point intimately involved in pregnancy and the success of child birth (World Health Organization, 2005). Pregnancy and child birth is still considered a perilous journey despite the honor bestowed on womanhood and the appreciation of the birth of a new born baby.

According to World Health Organization (WHO) report, recent estimates revealed that over 350,000 women worldwide die from complications of pregnancy and childbirth- a reduction from the previous estimates of 536,000 per year (Hogan, Foreman & Naghavi, 2010; WHO, 2010; Khan, Wojdyla & Say, 2006). Out of this figure, 99% occur in the developing countries and 1% in the industrialized ones. The maternal mortality rate is highest in Sub-Saharan African countries, as the risk of dying from pregnancy-related cause is 1:16 in Africa but only 1:4000 in some developed countries (Lucas & Gilles, 2003). However for the first time in 2010, data showed that there is significant progress made in reducing maternal death globally (Gahr, 2011).
In Nigeria, the Maternal Mortality rate is still high as 59,000 women still die every year during pregnancy and childbirth (Centre for Reproductive Rights, 2012). These deaths are largely preventable. Equally of concern is that yearly, about 1,080,000 - 1,620,000 Nigerian women and girls suffer disabilities caused by complications during pregnancy and childbirth (Utoo, Musa Karshima & Ifenne, 2012). For every one that dies, 20- 30 more women suffer long term and short term disabilities such as chronic anaemia, maternal exhaustion or physical weakness, vesico-vaginal or recto-vaginal fistulae, stress incontinence, episiotomy wound breakdown, perineal trauma, chronic pelvic pain, Pelvic Infammatory Disease (PID), Infertility, ectopic pregnancy, emotional depression (Adedokun,2013).
Perineal trauma is one of the morbidities that results from childbirth. It is defined as any damage that occurs to the genitalia during childbirth spontaneously or intentionally by surgical invasion termed episiotomy (Kettle &Tohill, 2011). Women frequently incur perineal trauma at delivery (Fahami, Shokoni & Kianpour, 2012). About 70% of women giving birth vaginally sustain some degree of perineal trauma and it is associated with postnatal morbidity (Kettle, 2011; Smith, Price, Simonite &Burns, 2013). Several studies have reported the incidence of perineal trauma in the developed countries among women and the increased morbidity associated with it (Kettle & Tohill, 2011; Marsh, Lynne, Christine & Alison, 2011; Roos, Thakar & Sultan, 2010).
Perineal trauma could be in the form of first to fourth degree tears or an unnatural straight-edge cut from an episiotomy (Chapman, 2006). Episiotomy is a common surgical procedure experienced by women (Marsh et al, 2011). It is frequently done among pregnant women in labour and its practice dates back to the 16th century (Lang, Wong & Pun, 2006). Studies have revealed that episiotomy accounts for a large proportion of perineal trauma and there is no evidence that it prevents severe lacerations (Kumar, Ooi & Nicoll, 2012; Kettle & Tohill 2011; Fahami et al. 2012).

 Few studies carried out in Nigeria on episiotomy and perineal trauma also revealed high incidences of episiotomy rate and perineal trauma among women (Chigbu, Onwere, Alika&Adibe, 2008; Enyindah, Tiebai, Anya &Okpanu, 2007). Enyindah et al, (2007) in the study carried out in University of Port Harcourt Teaching Hospital revealed that perineal trauma is one of the most common occurrences in vaginal deliveries with 40% of primigravida and 20% of multiparous women affected. Chigbu, et al (2007) assert that episiotomy rate in Abia State University Teaching Hospital, which constitute 45% of 100 vaginal deliveries is associated with major perineal lacerations.
Possible deleterious effects of perineal trauma are dyspareunia (painful intercourse) urinary and faecal incontinence as well as perineal pain (Kalichman, 2008). Some women report continued perineal pain 8 weeks after birth (22%) and others for up to a year or longer. The likelihood of perineal pain and sexual problem in the post partum period is the least for women with intact perineum,while women with episiotomy tend to report more pain with intercourse 3 months after delivery (Klein et al, 1994 in Kalichman, 2008; Marsh et al, 2011).Studies have shown that perineal massage can reduce the likelihood of perineal trauma and ongoing perineal pain and is well accepted by women (Aasheim, Nilsen, Lukasse & Reinar, 2011; Beckmann & Stock, 2013).


Perineal massage is a procedure which involves the gentle stretching of the tissues surrounding the vagina and the perineum. It is thought to improve perineal outcomes by stretching out the vaginal tissues, promoting perineal relaxation and improving circulation to the tissues. It is advocated during pregnancy to increase elasticity of the perineal muscles and reduce the risk of perineal trauma from episiotomy and spontaneous tear (Begley, 2014)...... 

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