The Effect of Hands-off and Hands-on Methods on Perineal Status

Background and Perineal damage is one of the traumas most frequently suffered by women during delivery. There are several techniques aimed at reducing the perineal damage. The present study is aimed at determining and comparing the frequency and degree of perineal rupture in hands-off and hands-on techniques of protecting perinea during labor. Method and Materials: This blind clinical trial (with the CI of 95% and test power of 80%) involved 187 women who, after signing their informed consent, were divided into the hands-off (n= 98) and hands-on (n=89) groups through random allocation. In the experimental (hands-off) method, the midwife guides the parturient and observes the process of labor without touching the perineum or the head. In the control (hands-on) group, the midwife protects the infant's head using Ringen maneuver. The data were analyzed in SPSS using chi-square and Fisher's exact test. The result showed that the undamaged perinea in the hands-off group was 44.9%, versus 10% in the hands-on group, where the difference was statistically significant (P < 0.0001). Perineal laceration was 51% in the hands-off group and 47.2% in the hands-on group but the difference between the two groups was not significant (p = 0.55). Most ruptures were of the first-degree type (50% in the hands-off and 64.3% in the hands-on group). In the hands-off group, 3.1% underwent episiotomy as compared with 75.3% in the hands-on group. The results suggest that a policy of hands-off technique in protecting perinea can be safe and efficient technique and can be an alternative method in perineal protection during labor