Peer-reviewed article

Effects of Perineal Heat Stimulation Combined With Massage Pre-Adaptation on Perineal Injury and Maternal Psychological Well-Being in Primiparous Women.

Wang Y, Yin J, Wu J, Wei T, Ai Z et al. · 1 Jul 2026

Abstract

Aims/background Perineal injuries remain a common complication of vaginal birth, particularly among primiparous women. This study assessed the effects of a perineal heat stimulation-massage plus pre-adaptation protocol, started at 34 weeks of gestation, on perineal outcomes and maternal psychological well-being in primiparous women. Methods This retrospective cohort study enrolled 500 primiparous women who delivered at Jiangxi Maternal and Child Health Hospital between May 2025 and October 2025. Participants were divided into an intervention group (n = 247) and a control group (n = 253) based on antenatal records and self-reports of receiving the structured protocol. Outcomes compared between the two groups included perineal injury, duration of all labor stages, postpartum blood loss within 2 hours, perineal pain at 48 hours, neonatal Apgar scores, and maternal psychological well-being assessed using the Childbirth Self-Efficacy Inventory (CBSEI) and the State-Trait Anxiety Inventory (STAI). Results Compared with routine care, the intervention group had a significantly better rate of intact perineum (34.01% vs. 15.02%, p < 0.001) and lower rates of both episiotomy (36.03% vs. 46.25%, p = 0.020) and perineal tears (29.96% vs. 38.74%, p = 0.039). Labor progressed more efficiently in the intervention group, with shorter median durations of the first (439 vs. 514 min), second (55 vs. 74 min), and third stages of labor (8 vs. 12 min). The intervention group also had reduced median postpartum blood loss within 2 hours (233 vs. 244 mL) and lower perineal pain at 48 hours (Visual Analog Scale [VAS] 3 vs. 4; p < 0.001). Furthermore, women in the intervention group reported significantly higher childbirth self-efficacy (CBSEI, 108 vs. 94 scores, p < 0.001) and lower state anxiety (STAI 35 vs. 41 scores, p < 0.001). The two groups did not differ in neonatal outcomes, including Apgar scores. Conclusion The "antenatal heat stimulation-massage combined pre-adaptation protocol" was associated with reduced perineal injury and more efficient labor, along with lower postpartum distress and improved childbirth experience through psychological empowerment, without adverse effects on neonatal outcomes. These observations support the approach as a practical, non-pharmacological antenatal care framework and inform future prospective studies assessing the integrated mind-body preparation model in maternity care.