Pelvic Floor Training Reduces Severe Birth Trauma in Pregnancy

A clinical trial published in Nature indicates that a structured pelvic floor muscle training (PFMT) program during pregnancy can significantly reduce the incidence of severe perineal trauma and shorten the duration of the second stage of labor.

The research, reported by the European Medical Journal, focused on the potential of antenatal PFMT to prevent third- and fourth-degree obstetric anal sphincter injuries (OASI), which are classified as severe perineal trauma.

Study Methodology and Participant Criteria

The prospective, non-randomized, patient-preference controlled trial was conducted at two tertiary centers between December 2, 2024, and September 2, 2025.

Researchers screened 358 women, of whom 300 completed the study. The participants were low-risk nulliparous women at or beyond 28 gestational weeks, defined as those with singleton, cephalic pregnancies at term without medical complications.

The participants were divided into two groups based on their preference: 150 women formed the PFMT group, while 150 women who declined the training received standard antenatal care as the control group.

Training Protocol and Intervention

The intervention for the PFMT group consisted of twice-weekly supervised training sessions. These were supplemented by daily home exercises, which required participants to perform three sets of 8–12 maximal contractions.

This training regimen continued until the women reached 34 weeks of gestation.

To maintain the integrity of the results and minimize detection bias, the clinicians responsible for assessing perineal outcomes were blinded to which group the participants belonged.

Key Findings on Birth Trauma and Labor

The study found that severe perineal trauma was significantly lower in the group that underwent pelvic floor training. The rate of severe trauma was 4.0% in the PFMT group compared to 14.7% in the control group.

In addition to reducing trauma, the training program influenced the timing of childbirth. The second stage of labor was significantly shorter for women in the PFMT group, averaging 49.7 ± 6.4 minutes, compared to 58.8 ± 20.4 minutes for those in the control group.

Other secondary outcomes monitored during the trial included the rate of episiotomies, first- and second-degree perineal tears, postpartum urinary incontinence, and 5-minute Apgar scores below 7.

Medical Context of Pelvic Floor Training

Pelvic floor muscle training is a widely recommended practice for the prevention of urinary incontinence. However, researchers noted that its potential to prevent perineal trauma during childbirth had previously remained uncertain.

Separate research has indicated that pelvic floor programs are associated with higher rates of intact perineums and significantly lower rates of both episiotomies and severe perineal trauma.

The findings suggest that structured antenatal PFMT may serve as an effective strategy for improving obstetric outcomes for low-risk first-time mothers.