title: A comparison of the "hands-off" and "hands-on" methods to reduce perineal lacerations: a randomised clinical trial.
abstract: OBJECTIVE
  The objective of the current study was to compare the "Hands-off" and "Hands-on" methods to reduce perineal lacerations.
  
  
  METHODS
  We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 600 nulliparous expectant mothers, who were divided equally between the "hands off" and "hands on" groups (n_300 per group).
  
  
  RESULTS
  A total of 147 (49 %) women in the "Hands-on" and 143 women (47.7 %) in the "Hand -off" groups encountered perineal trauma (p = 0.74). In the "Hands-on" group, 8 women (2.7 %) experienced a third degree trauma compared with (0.3 %) that in the "Hands-off" method (p = 0.1). Episiotomy was performed on 38 women (12.7 %) from the "Hands-on" and 17 (5.7 %) women from the "Hands-off" (p = 0.003) groups. In addition, 28 women (9.3 %) from the "Hands-on" group and 47 women (15.7 %) from the "Hands-off" group experienced periurethral tears (p = 0.01) that did not need mending.
  
  
  CONCLUSIONS
  Application of the "Hands-off" method for vaginal delivery has a positive effect on the mother's health because of the reduction of Episiotomy and third degree tearing. Therefore, we conclude that the "Hands-off" method offers a safer alternative for perineal control during labor.
authors.affiliation: Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Rozita
authors.initials: R
authors.lastname: Rezaei
authors.affiliation: Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Sussan
authors.initials: S
authors.lastname: Saatsaz
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.affiliation: Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hamid Sharif
authors.initials: HS
authors.lastname: Nia
keywords: Hand off; Hands-on; Perineal lacerations