Nurse-Midwifery M.S.

Year Approved


First Advisor

Meyer, Alison


Background/Purpose: The purpose of this review of research is to determine if the use of perineal massage or warm compress in the second stage of labor decreases perineal trauma, including spontaneous lacerations or the need for an episiotomy. Theoretical Framework: Betty Neuman’s Systems Model asserts that each person will interact with the environment with their own set of variables. Neuman’s Systems Model focuses on maintaining health with the prevention of three categories of stressors: primary, secondary and tertiary. Nurse-midwives work to prevent perineal trauma by considering what interventions strengthen the defense of each women to the environment stressors of physiologic birth. Methods: Twenty research articles were reviewed with the purpose of determining if perineal trauma, including spontaneous lacerations or the need for an episiotomy, is decreased with the use of perineal massage or warm compress during the second stage of labor. Additional aspects of review analyzed the effects of perineal massage and warm compress on birth outcomes including maternal pain and neonatal Apgar scores. Lastly, components surrounding birth culture and their effects on research were examined. Results/Findings: This critical review concluded that there are inconsistencies among data in perineal massage and warm compress for perineal protection against lacerations and episiotomies. Conclusions can be made that warm compress shows more benefit in terms of perineal protection and maternal pain perception. Neonatal Apgar scores were unaffected with either intervention. It was also determined the birth culture plays an active role in perineal integrity measures taken by providers. Implications for Research and Practice: This critical review determined that more research needs to be performed in the United States within a birth culture that operates under the umbrella of recommendations by organizations such as the American College of Nurse-Midwives (ACNM). Episiotomy rates need to be recorded by nation, region, hospital, and provider in order to focus efforts for optimal rates worldwide. The research for warm compress application is more consistent and can be recommended for nurse-midwives to utilize in the second stage of labor. Nurse-midwives should offer shared decision making and the right to self-determination for all women in regards to measures taken to promote perineal integrity, reduce maternal pain, and support positive neonatal outcomes. Keywords: perineal trauma, second stage, warm compress perineal massage, perineal protection and perineal integrity.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis