Impact of antenatal perineal massage in primiparous women on the occurrence of childbirth-related perineal trauma: A propensity score matched retrospective cohort study.

BACKGROUND

Perineal trauma during vaginal birth affects most primiparous women. It is associated with substantial maternal morbidity. Antenatal perineal massage (APM) has been proposed as a preventive intervention.

OBJECTIVE

To evaluate the association between APM and childbirth-related perineal trauma. The primary focus was on episiotomy use among primiparous women.

METHODS

We conducted a propensity score-matched retrospective cohort study. Electronic medical records were obtained from a tertiary A-grade obstetrics and gynaecology hospital in Shanghai, China. The analysis included primiparous women with singleton cephalic pregnancies. All women gave birth vaginally at 36 weeks or later between 1 February and 31 July 2025. A subset of women received a structured APM from 36 weeks of gestation, with frequency categorised as 1-4, 5-8, or >8 sessions. Outcomes assessed included the episiotomy rate, incidence of perineal tears, duration of the second stage of labour, total blood loss, and neonatal outcomes.

RESULTS

Among 3820 eligible women, 346 (9.1%) undertook APM. After 1:1 propensity score matching, 674 women were included (337 per group). The APM group had a lower episiotomy rate (17.5%vs 26.4%, RR 0.66, 95% CI 0.50-0.89, p = 0.005). For women who did not have an episiotomy (278 in the APM group and 248 in the non-APM group), the APM group showed a higher rate of intact perineum (4.0%vs 0.8%, RR 4.91, 95% CI 1.10-21.92, p = 0.020) and a lower rate of second-degree perineal tears (75.9%vs 85.1%, RR 0.89, 95% CI 0.82-0.97, p = 0.008). The difference in the rate of first-degree perineal tears (20.1% in the APM group vs 14.1% in the non-APM group) was not statistically significant (RR 1.43, 95% CI 0.97-2.10, p = 0.068). No significant differences were found in the duration of the second stage of labour, total blood loss, or neonatal outcomes.

CONCLUSION

In this cohort study, APM was associated with lower episiotomy use and less severe perineal trauma. The optimal benefit was observed after 5-8 sessions. These findings suggest that incorporating structured APM education into prenatal care may be beneficial for primiparous women.