Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial

Midwifery. 2017 Jul:50:72-77. doi: 10.1016/j.midw.2017.03.015. Epub 2017 Mar 27.


Background: perineal injury is common after birth and may be caused by tears or episiotomy or both. Perineal massage has been shown to prevent episiotomies in primiparous women. On the other hand, pelvic floor exercises might have an influence by shortening the first and second stages of labour in the primigravida.

Aim: the aim of this study was to investigate the effects of a pelvic floor training following a birth programme on perineal trauma.

Design: a single-blind quasi-randomized controlled trial with two groups: standard care and intervention.

Setting: a tertiary, metropolitan hospital in Seville, Spain.

Participants: women (n=466) who were 32 weeks pregnant, having a singleton pregnancy and anticipating a normal birth were randomised. Women in the experimental groups were asked to perform a pelvic floor training programme that included: daily perineal massage and pelvic floor exercises from 32 weeks of pregnancy until birth. They were allocated to an intervention group by clusters (antenatal education groups) randomized 1:1. The control group had standard care that did not involve a perineal/pelvic floor intervention. These women were collected in a labour ward at admission 1:3 by midwives.

Results: outcomes were analysed by intention-to-treat. Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (50.56% versus 82.19%, p<0.001) and a higher likelihood of having an intact perineum (17.61% versus 6.85%, p<0.003). There were also fewer third (5.18% versus 13.12%, p<0.001) and fourth degree-tears (0.52% versus 2.5%, p<0.001). Women allocated to the intervention group also had less postpartum perineal pain (24.57% versus 36.30%, p<0.001) and required less analgesia in the postnatal period (21.14% versus 30.82%, p<0.001).

Conclusions: a training programme composed of pelvic floor exercises and perineal massage may prevent episiotomies and tears in primiparous women. This programme can be recommended to primiparous women in order to prevent perineal trauma.

Key conclusion: the pelvic floor programme was associated with significantly lower rates of episiotomies and severe perineal trauma; and higher intact perineum when compared with women who received standard care only.

Implications for practice: the programme is an effective intervention that we recommend to all women at 32nd week of pregnancy to prevent perineal trauma.

Keywords: Episiotomy; Pelvic floor exercises; Perineal massage; Perineal trauma.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Episiotomy / rehabilitation*
  • Exercise / physiology*
  • Female
  • Humans
  • Parturition / physiology
  • Pelvic Floor / physiology*
  • Perineum / injuries*
  • Perineum / physiopathology
  • Pregnancy
  • Prenatal Care / methods
  • Single-Blind Method
  • Spain
  • Tertiary Care Centers / organization & administration
  • Tertiary Care Centers / statistics & numerical data
  • Urban Population / statistics & numerical data