Preparo do períneo para o parto vaginal: análise de evidências para proposição de protocolo

Abstract

Analyze available evidence in the literature on perineal preparation for vaginal birth, aiming at providing a basis for the proposal of a protocol. Method: This is an applied methodological study with a protocol proposal for intervention based on scientific evidence and clinical experience. The bibliographic search was conducted on Lilacs, PubMed/MedLine, Scielo, and Cochrane Library data bases; the sample was constituted of 151 studies. Results: The proposed protocol, with combined techniques, i.e., pelvic floor muscle training (PFMT), perineal massage, and Epi-no®, is based on theoretical approaches and pre-natal education practices, perineal and body awareness, breathing, relaxation, labor postures, and expulsive guidance. It includes three stages — awareness, activation, and relaxation — with an initial evaluation and a reevaluation after birth, as well as supervised exercises and activities done at home. Conclusion: The obtained data allowed us to point out the most important aspects of each technique, regarding the best results in preventing perineal trauma and its consequent morbidities. We concluded that studies lack a more comprehensive and greater methodological rigor on the methods of perineal preparation for vaginal birth. Our proposed protocol has evidence to be applied and evaluated in other research projects in this field, in order to reveal professional and multidisciplinary integrated obstetrical practices and thus prevent pelvic dysfunctions resulting from perineal traumas, enable greater interest by women in vaginal birth, strengthen their autonomy, empower for active childbirth, thus humanizing it and contributing to public policies associated to an increase in vaginal birth rates in Brazil.