![]() The participants in the studies were women without medical complications who were expecting a vaginal birth. Twenty two trials were eligible for inclusion in this updated review but only twenty studies (involving 15,181 women), contributed results to the review. We searched for studies in September 2016. It is important to know if these do indeed reduce trauma and pain for women. Massage, warm compresses and different perineal management techniques are widely used by midwives and birth attendants. Also, different perineal techniques are being used to slow down the birth of the baby's head. Reducing the use of episiotomies will reduce trauma to the perineum. Third- and fourth-degree tears, affect the anal sphincter or mucosa, thus causing the most problems. The damage is described as first-, second-, third- and fourth-degree tears – first-degree tears being the least damage and fourth-degree tears being the most. Trauma to the perineum can cause pain and other problems for women after the birth. This is an update of a review that was published in 2011. The objective of this updated review was to assess the effect of perineal techniques during the second stage of labour on the incidence of perineal trauma. Different perineal techniques are being used to slow down the birth of the baby's head, and allow the perineum to stretch slowly to prevent injury. Perineal trauma can occur spontaneously or result from a surgical incision (episiotomy). Vaginal births are often associated with some form of trauma to the genital tract, and tears that affect the anal sphincter or mucosa (third- and fourth-degree tears) can cause serious problems.
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