Objective To study the effects of antenatal perineal massage on subsequent perineal outcomes at Design A randomised, single-blind prospective study.Setting Department of Obstetrics and Gynaecology, Watford General Hospital.Participants Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995. ResultsComparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P = 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P = 0-094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P = 0.024 and P = 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30. ConclusionAntenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.delivery. INTRODUCTIONSeveral studies have been undertaken to identify factors which may influence perineal outcome during childbirth. Variables which appeared to be related to perineal outcome, namely nulliparity, age greater than 20 years, length of second stage greater than one hour, epidural or pudendal anaesthesia, and specific indication for episiotomy (i.e. fetal distress and forceps delivery), have been identified in a previous study'. Birth position as a factor in perineal outcome has been considered by several researchers, but no clear association has been Birthweight, breech presentation, and occipitoposterior position also increase perineal t r a~m a ' ,~-~.Much has been written about the effectiveness of antenatal perineal massage in reducing perineal tears at delivery. Information advocating the use of antenatal perineal massage is widely disseminated by many groups involved in childbirth. The National Childbirth Trust advocates its use in its pregnancy book, as does the Active Birth CentreB. Some midwives and doctors also recommend the practice. Of several studies concerned with antenatal perineal massage one examined the effects of two methods of teaching perineal massage and concluded that there was no difference between the instruction methods with respect to the practice of perineal massage. Episiotomy and laceration rates were also not affected by teaching method9. Another study randomly allocating 20 women to either a massage or no massage group concluded that women who practise perineal massage at least four times per week would have a lower incidence of episiotomies and lacerations that those who do not. The sample was very small and was not limited to a nulliparous populationlo. A later study compared 29 nulliparous women who practised perineal massage ...