Perineal Care Strategies and Perineal Outcomes in Primiparous Women: A Prospective Observational Pilot Study

Background: Pregnancy and childbirth expose the pelvic floor and perineal tissues to substantial biomechanical stress, increasing the risk of obstetric perineal trauma and subsequent maternal morbidity. Objectives: This prospective observational pilot study aimed to explore the association between antenatal perineal massage and perineal outcomes at birth, as well as postpartum pelvic floor findings, in primiparous women. Methods: Women attending an antenatal education programme at the Family Counselling Centre of Francavilla al Mare (Italy) between May and November 2024 were recruited and followed through childbirth and the postpartum period. Results: Twenty-seven primiparous women who experienced spontaneous vaginal birth underwent a comprehensive perineal assessment 6–10 weeks after delivery. Fifteen women (55.6%) self-reported regular antenatal perineal massage during the final weeks of pregnancy, whereas 12 (44.4%) did not perform massage or practiced it only sporadically. Women self-reporting regular perineal massage showed a different distribution of perineal outcomes compared with those in the no/sporadic massage group, with a higher proportion of intact perineum or first-degree tears. Antenatal perineal massage was also associated with a higher frequency of upright birth positions and warm compress use during labour, as well as differences in postpartum vulvar gaping, genital trophism, perineal tone, and pelvic floor muscle performance assessed by the PC-Test. Urinary incontinence and postpartum perineal pain were observed only among women who did not report massage practice. Conclusions: These findings represent exploratory associations and cannot establish causal relationships or demonstrate the independent effect of antenatal perineal massage. Because massage practice clustered with other perineal protection strategies, larger studies with adequate adjustment for potential confounding factors are required to clarify the contribution of individual interventions to perineal and postpartum outcomes.