Pelvic Floor Training Combined With Perineal Massage Reduces Episiotomy to 5.7%

In recent years, there has been mounting interest in the application ofnon‐pharmacological modalities during labor and delivery. Pelvic floor muscle training(PFMT) has emerged as one of the most extensively studied antenatal strategies. Asystematic review and meta‐analysis of randomized clinical trials demonstrated that PFMTduring pregnancy significantly reduces the risk of urinary incontinence and third‐ orfourth‐degree perineal tears; however, its effect on episiotomy rates did not reachstatistical significance . Another meta‐analysis corroborated these findings, showingthat antenatal PFMT shortens the second stage of labor and lowers the incidence of severeperineal trauma . A more recent Bayesian network meta‐analysis ranked antenatal pelvicfloor exercise as the optimal first‐line strategy for overall perineal lacerationprevention, with a 50% risk reduction (RR = 0.50, 95% CrI 0.28‐0.87) .Perineal massage applied either antenatally or during the second stage‐represents anothereffective non‐pharmacological intervention. By increasing the elasticity anddistensibility of the perineal tissues, massage facilitates gradual stretching of thebirth canal. A meta‐analysis of randomized controlled trials reported that antenatalperineal massage was associated with a significantly lower incidence of episiotomies (RR= 0.79, 95% CI 0.72‐0.87, p < 0.001) and perineal tears, as well as reduced second‐stageduration and improved postpartum outcomes . When applied during labor, perineal massagehas also been shown to reduce the risk of severe perineal trauma, although itsindependent effect on episiotomy remains variable across studies .The Swiss ball, a widely accessible tool for promoting pelvic mobility and maternalcomfort during labor, constitutes a third non‐pharmacological option. Active pelvicmovements performed on a Swiss ball including pelvic anteversion, retroversion, lateraltilts, and circular hip movements have been shown in a randomized trial to reduce theduration of the first and second stages of labor, decrease pain intensity, diminishmaternal fatigue and anxiety, and lower the risk of cesarean section and vulvar swelling. An updated meta‐analysis of randomized controlled trials further confirmed thatbirthing ball exercises significantly reduce cesarean section rates and alleviate laborpain, supporting their use as a safe and effective intervention in low‐risk labormanagement .The present study was designed to address this knowledge gap. Investigators hypothesizedthat in pregnant women who completed nurse‐led pelvic floor education sessions at leastonce weekly until delivery, the addition of Swiss ball exercises or perineal massageduring labor would reduce episiotomy requirements. The primary objective was to comparethe effects of four non‐pharmacological interventions pelvic floor muscle training,combined PFMT and Swiss ball exercises, combined PFMT and perineal massage, and standardcare on delivery outcomes and episiotomy‐related parameters..