Abstract Background Primiparas face a higher risk of perineal injury, which may adversely affect maternal and infant health. Perineal massage has been proposed as an intervention to improve birth outcomes, but evidence of its effectiveness remains inconsistent, and concerns about its safety persist. This study aimed to evaluate the effects and safety of late-pregnancy perineal massage on birth outcomes in primiparas using propensity score matching. Methods A retrospective cohort study was conducted involving 914 primigravid women who received routine perineal massage at a tertiary A-level maternity hospital in Hangzhou from January to December 2024, comprising the massage group. Using propensity score matching (PSM), 914 primigravid women without perineal massage during the same period were matched 1:1 from a pool of 3,104 eligible participants, forming the control group, for a total of 1,828 cases. Differences between the two groups were compared in terms of perineal integrity, episiotomy rate, degree of perineal laceration, duration of labor, postpartum hemorrhage, premature rupture of membranes, preterm birth, and neonatal asphyxia. Related influencing factors were further analyzed. Results The massage group showed a significantly higher rate of perineal integrity compared with the control group (2.2% vs. 0.5%, P = 0.02) and a lower episiotomy rate (16.3% vs. 21.2%, P = 0.02). The incidence of second-degree laceration was lower (22.9% vs. 24.7%, P = 0.02), and the second stage of labor was shorter (1.27 h vs. 1.42 h, P = 0.001). The rates of premature rupture of membranes (22.4% vs. 27.2%, χ² =7.567, P = 0.006) and postpartum hemorrhage (293 ± 130 ml vs. 306 ± 138 ml, P = 0.038) were also slightly lower in the massage group. No significant differences were observed between groups in preterm birth or neonatal asphyxia ( P > 0.05). The number of perineal massages was negatively correlated with both the degree of perineal injury ( OR = 0.723, 95% CI : 0.670–0.780, P < 0.001) and the duration of the second stage of labor (Spearman’s ρ=-0.303, P < 0.001). Optimal perineal protection was observed with approximately seven massage sessions (IQR: 3–8, P < 0.001). Conclusion The study find that regular perineal massage is effective in reducing the risk of perineal injury, shortening the duration of the second stage of labor without causing preterm labor, preterm rupture of membranes, or alteration of neonatal health, and has a favorable safety profile. The frequency of clinical massage (2–3 times per week, cumulative ≥ 7 times) is recommended to protect the perineum, shorten the duration of labor, and optimize labor outcomes.
Zhang et al. (Wed,) studied this question.