(Poster 153) Video Instructed Compliance of Antenatal Massage (VICAM)

Objectives: Vaginal delivery lacerations can cause significant discomfort in the immediate postpartum period and can lead to long term complications due to trauma of the pelvic floor. Studies have shown that antenatal perineal massage can reduce the severity of perineal tears and/or need for episiotomy. Studies have reported on patient compliance with antenatal perineal massage (APM) previously, but only in studies with significant and regular provider instruction and reminders. A pilot study was performed comparing video versus written instructions for APM with limited provider input beyond providing the instruction media. The hypothesis was that the video/visual presentation of the perineal massage technique and the related information would improve patient compliance with at-home APM performance rates compared to a written format.

Methods: This was a randomized comparative single-blinded pilot study. Patients were recruited during routine prenatal visits and at 32 weeks were sent either written or video instructions on how to perform APM and advised to record their compliance using a free mobile app known as “Symple”. Delivery data was collected using the electronic medical record and patients were surveyed 2 weeks postpartum regarding their experience with perineal massage including details of factors that inhibited their compliance.

Results: 5 multiparous and 10 nulliparous patients were randomized into our intervention groups of video and written instructions. 4 of the nulliparous patients had cesarean deliveries while none of the multiparous patients did. Of the multiparous patients, 0 had an intact perineum, in the written group (0%) and 1 in the video group (33%). Of the nulliparous patients, none had an intact perineum in the written group and 1 in the video group (25%).
On average patients with video instruction were more compliant than our written instruction group (80.3% compliance vs 52.7% compliance). This effect was more pronounced when we stratified by parity with nulliparous patients in the video group reporting the most compliance (85.6%). The largest barriers to compliance were technical barriers such as not being able to reach the perineum (n=6). Patients that had their partners help all or almost all the time were found to be more compliant, with 76.7% compliance versus 45.6% compliance in those who reported their partner did not help them perform massage.

Conclusions: Similar to studies with heavy provider instruction and reminders, we found nulliparous patients realizing the most benefit from perineal massage. There were similar compliance impactors such as partner involvement and physical perineal access restrictions. Our pilot study found that those in the video group were more likely to be more compliant, thus strategies like using video instruction and encouraging partner participation may increase massage compliance and in turn improve outcomes for patients undergoing vaginal delivery.