Background
The researchers Ugwu et al. (2018) conducted a randomized control trial to understand the benefit of Antenatal perineal massage in reducing perineal trauma and postpartum morbidities. The vaginal birth has severe complications, especially for women who are having delivery of the first newborn (Kjerulff and Brubaker 2018). The authors observed that around 30 to 80% of the women who undergo normal or vaginal delivery suffer from moderate to severe perineal trauma. The women who receive this massage also like to have their perineum intact after the birth of the child which could lower the risk of perineal trauma. The episiotomy is a significant risk factor that occurs due to the perineal tears (Djusad, Purwosunu and Hidayat 2021). Malposition is another risk factor associated with the perineal trauma. This is also associated with the macrosomia, nulliparity and the maternal obesity. As this increase, the occurrence of wound disruption, urinary incontinence, postpartum dyspareunia, rectovaginal fistulas as well as there can be physical and psychological outcomes because of the social isolation and marginalization (Mbagwu 2019). Hence, it can be concluded from the author’s background information that perineal tears can cause both psychological and physical stress. The authors also highlighted the importance of massage. The antenatal perineal massage is a type of massage technique that is usually performed on the pregnant women before 4 to 6 weeks of delivery. This technique is known to increase the flow of blood to the perineum (Abd-Ella, Kandeel and Gouda, 2021).
The research assignment critically analyses the article – “Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial” using the CASP tool.
The PICO search is a methodological framework for discussing about several healthcare and clinical topics in-depth for evidence-based practices. Employing PICO will assist in defining the topic and determining the most information retrieval keywords and type of study to address the research topic. A convenience search strategy enables the readers to evaluate the usefulness of the methodology applied in the research (Sorkin et al. 2021). The key terms used for the search are “undergoing labour” “antenatal perineal massage” “perineal trauma” and “postpartum complications”. The databases used for the finding the secondary and the primary articles are as follows, Google Scholar and PubMed. The limiters such as the time frame of 5 years and full-text availibility are implied in the search. The Boolean operators AND and OR is used in between the keywords to find the articles.
- “Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial” BY Emmanuel Onyebuchi Ugwu1,2 , Eric Sunday Iferikigwe2 , Samuel Nnamdi Obi1,2, George Uchenna Eleje3 and Benjamin Chukwuma Ozumba IN 2018.
- The authors adopted a very comprehensive search strategy. The researchers Ugwu et al.(2018) took data from the pregnant women who are attending the antenatal clinic in the University of Nigeria.
Search Strategy
The critical analysis is implied in the research in order to broaden the in-depth understanding and perspective of the issue (Fleming 2018). It allows the reader to evaluate and analyse the evidence, and have better clarity of the introduced issue. The CASP tool is a generalized evaluation tool which are implied in qualitative research methodology’s for understanding the advantages and weaknesses of the paper. The CASP tool is a questionnaire with 10 questions which analyze the research methodology of a qualitative and quantitative paper. This tool aid readers in reading and evaluating scientific studies for credibility, findings, and usefulness.
The researchers conducted the research with a clear aim. This helped in understanding the relevance of the study and also helped to analyse the objective of the study (Palmatier, Houston and Hulland 2018). The aim of the research is to understand the Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities. A clear aim helps in understanding the context of the research. As this study had a proper aim this helped in understanding the structure of the research project.
Design:
The quantitative method applied in the research was also appropriate. The researchers Ugwu et al. (2018) conducted a Randomised controlled trial (RCT) to gather the data. The researchers conducted with the RCT method use reliable evidence to determine the effectiveness of the interventions (Clinton 2019).
The research design in the study was appropriate. Research design is a type of framework which allows the researchers to choose a suitable study design on which their study would be based on (Halkias and Neubert 2020). The researchers here have chosen the RCT method. The Randomized control trial (RCT) is chosen by the researchers as this method measures the effectiveness and provide an in-depth analysis of a new intervention and treatment (Hughes, Williamson and Young 2022). The RCT is an experimental form of research where the data is collected from a random population or a control group that is completely chosen at random from the eligible population. The RCT is a type of controlled, comparative and quantitative study. Here the research investigates two or more interventions among the series of individuals and receives them in a random order.
Yes, the strategy was implied in the research was appropriate. The researchers clearly explain how the women were selected for the study and also explained the inclusion and exclusion criteria (Krnic Martinic et al. 2019).
Data collection method and tool
Research Critique
The data collection procedure in the research was justified. The entire setting of the collection of data was elaborated properly. The research conducted quantitative random controlled methods research which is an appropriate procedure for the analysis with the help of SPSS software (Mengist, Soromessa and Legese 2020). The researchers collected the data from 133 eligible women with the help of the groups. The researchers excluded around 11 participants for not matching with the inclusion criteria. The randomised data was collected from in total of 122 participants. The researchers divided the participants into two groups that is the antenatal perineal massage group and the control group with 61 participants in each group. 5 participants have excluded from the antenatal perineal group due to refusal of giving permission from family members and 3 participants were excluded due to the delivery elsewhere. From the control group due to delivery elsewhere parameter, the 6 participants were excluded. In total 53 participants’ data were analysed from the allocated group and 55 participants’ data were analysed from the control group. After the selection of data was analysed with the help of The Statistical Package for Social Sciences (SPSS) computer software version 21.
Sampling
This is was a randomised control trial the participants for the study were mainly the women who were 34-36 weeks into gestation period and without any uterine contraction. It is a qualitative type of research hence the relationship between the researchers and participants was considered (Geerligs et al. 2018). However, compared with the secondary articles the sampling was conducted in the primary paper is more comprehensive and easier to understand.
Ethics
The authors maintained the ethics in the entire study. The authors received consent from all the participants before carrying out the research. The researchers received a written form of consent from the women and the participants whose consent was not received were excluded from the study. In a qualitative analysis receiving consent from the participants is essential to make the study ethical and bias free (Lam et al. 2018). The researchers additionally received the ethical clearance certificate from the review board of the institute. Hence, in the research, the authors mentioned in their paper that not any conflicts of interest is noted while conducting this research. Yes, the authors adhere to the four principles of ethics.
Data Analysis
The researchers analysed the paper in-depth. The researcher incorporated sufficient data in the research which could support the findings. The data for the research was analysed in the form of statistical analysis with the help of SPSS software (Sajid et al. 2018). The authors analysed 122 participants divided into two groups. The participants selected were the women who were 34-36 weeks pregnant and does not have any uterine contractions. The researcher observed that in 72 participants who have received the antenatal perineal massage had their perineum intact during the time of vaginal birth. The episiotomy cases were also significantly lowered in the intervention group than in the control group. The researchers of the secondary article Abdelhakim et al. (2019) observed that the antenatal message is also associated with better healing of the wound and the less perineal pain which is very much evident with the antenatal perineal massage. The researchers further observed that the antenatal perineal massage reduced the duration of the labour, the value was observed to be p =0.005 and anal incontinence was p = 0.003.
Aim
Main findings
The researchers clearly demonstrated the findings in details and also provided adequate information regarding both the for and against the motion of the research arguments (Tian et al. 2019). The key outcomes of the research were to highlight the efficacy of the perinatal massage. The perineal massage in pregnancy helps to soften and increase the elasticity of the perineal tissue. The research highlighted the benefit throughout the paper. The authors also further highlighted that perineal tear require stitching and as well as there was a significant decrease for episiotomy. Abdominal incision, third- and penultimate postoperative tears, postpartum perineal discomfort, and anal leakage are all reduced by antenatal perineal therapy. It also causes the second stage of labour to be quicker, the healing process to be quicker, and Apgar scores to strengthen. As a result, medical providers need to understand and offer antenatal perineal stimulation as a standard labour synthesis method.
The authors conducted research with the aim to understand the effectiveness of antenatal perineal massage in reducing perineal trauma and postpartum morbidities. During the time of pregnancy if care is not provided to the woman the child after birth may face terrible difficulties (Ayers et al. 2019). This is mainly due to the trauma that the mothers go through during the time of vaginal delivery. One of the major or significant issue the child face during the time of vaginal delivery is being born underweight and as well further there can be more complication related to the organ functioning of the child (Aditi, Jaiswal and Singh 2022). The mother-child relationship would face more complications. Hence, the antenatal message can act as an intervention for the mothers with vaginal birth. There are many other protocols available that may not provide appropriate care to the patients. Moreover, there is a gap in the skills of the nursing professionals and associates and there is also a lack of resources. Therefore, this massage can act as an intervention in several emerging literature. This paper is selected as it provides an in-depth analysis of the antenatal perineal massage benefit in reducing the perineal tear trauma among women who gave vaginal birth. This is the research context of the entire research. Concerns during vaginal childbirth are common, particularly among first-time parents (Dawson, Strickland and Rosen 2022). Perineal trauma affects 30 to 85 percent of women who have a vaginal delivery, with a 0.5 to 10% severity perineal trauma. Episiotomy is therefore no more suggested as a regular procedure due to a lack of verifiable evidence-based scientific evidence supporting its usage (Rodrigues and Néné 2019). Malposition, surgical delivery, abrupt labour, fetal congenital malformations, postpartum obesity, and infertility are all possible causes of perineal damage. The post-operative injuries are associated with the highest rates of wound interruption, emotional turmoil or encourage dysuria, fatal and bowel problems, infection, chronic wound’s ability to heal, prenatal dyspareunia, pelvic organ prolapse, and rectovaginal fistulas, among other complications. Furthermore, psychologically and physically results for women who sustain significant perineal trauma throughout pregnancy can be complicated, with few women may go through the social exclusion and discrimination as a result of their persistent symptomatology (Jones et al. 2021). Extreme perineal trauma appears to impair not just a woman’s medical and mental health well-being, but also the perception of her gender orientation. The researchers highlighted that the massage have therapeutic benefit since history and also increases the bond between the mother ran the child. The massages increase the muscle relaxation and also increases the flow of blood. The researchers highlighted that the antenatal perinatal massage is linked with the reduction of the episiotomy surgery and also the reduce the risk of perineal laceration (Dieb et al. 2020). The researcher’s highlight in their study that antenatal massage can successfully decrease the cost of the analgesics which is a benefit for the low-income countries. Hence, the authors conducted a randomized control trial to understand and understand the efficacy of antenatal perineal massage and such is valuable or not.
Design
Yes, the research context was clearly discussed and was highly implacable in understanding the effectiveness of the antenatal perineal massage among pregnant women who are 34-36 weeks into gestation period.
The researchers Ugwu et al. (2018) observed on 27 women out of 53 women in the group a that the perineum was intact during the birth, however, in group B, only 16 such cases were observed. The risk ratio (RR) was found to be 1.75 and 95% Confidence interval (CI) was around 1.07-2.86. The episodes of the episiotomy also showed a reduced result in the A than B. The RR was observed to be 0.65 and the 95% CI was around 0.43-0.98. The researchers did not observe any difference on the duration of the delivery. The researchers Abdelhakim et al. (2019) explained that antenatal perinatal massage significantly reduces the problems of perineal tears the rate of RR was found to be 0.79 and CI was found to be 95%. The massage is also linked with reducing the risk of perineal tears (Wilson and Homer 2020). The research also found out that there is decreased in the episodes of the episiotomy. The RR was again found 0.79 and CI was found to be 95%. In authors did not identified any increase or reduction in the duration of second stage labour. The researched evaluated the perineal pain with the help of visual analogue scale (VAS) (Hartinah et al. 2021). The researchers observed that perineal pain was less among the women who have received the antenatal perineal massage, the CI was found to be 95%. The researchers also observed that there were participants who have received antenatal perinatal massage are also associated with faster wound healing. However, in the study, the authors did not have observed any significant difference in terms of anal incontinence.
Conclusion
From the analysis of the researcher, it can be concluded that antenatal massage has significant benefits and is an appropriate intervention for reducing the risk of perineal tears and episiotomy. The researchers Ugwu et al. (2018) conducted a randomized control trial to understand the benefit of Antenatal perineal massage in mitigating the issue of perineal trauma and postpartum morbidities. The vaginal birth has severe complications, especially for women who are having delivery of the first newborn. The authors observed that around 30 to 80% of the women who undergo normal or vaginal delivery suffer from moderate to severe perineal trauma. The women who receive this massage also like to have their perineum intact after the birth of the child which could lower the risk of perineal trauma. The key findings of the research were to highlight the effectiveness of the perinatal massage. The perineal massage in pregnancy helps to soften and increase the elasticity of the perineal tissue. The research highlighted the benefit throughout the paper. The authors also further highlighted that perineal tears require stitching and as well as there was a significant reduction in = episiotomy. Abdominal incision, third- and penultimate postoperative tears, postpartum perineal discomfort, and anal leakage are all reduced by antenatal perineal therapy.
Data Collection Method and Tool
The above assignment critically analyses the selected research paper with the help of the CASP tool. It was analysed that antenatal massage is an effective massage that could be promoted among pregnant women for delivery without any complications. Hence, the antenatal message can act as an intervention for mothers with vaginal birth.
References
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Abd-Ella, N.Y., Kandeel, H.A.M. and Gouda, A.M.I., 2021. Effect of Late Pregnancy Self-Perineal Massage on the Perineal State of the Primiparturients. Tanta Scientific Nursing Journal, 23(4), pp.52-73.
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Sampling
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Ugwu, E. O., Iferikigwe, E. S., Obi, S. N., Eleje, G. U., & Ozumba, B. C. (2018). Effectiveness of antenatal perineal massage in reducing perineal trauma and post?partum morbidities: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 44(7), 1252-1258. doi:10.1111/jog.13640
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Formatting
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