Women’s knowledge, attitudes and interest in antenatal perineal massage – a cross-sectional survey

Antenatal perineal massage (APM) is an established technique for preventing severe perineal trauma, but it is uncommonly practised in Hong Kong. This study aimed to investigate pregnant women’s knowledge, attitudes and interest in APM, and to identify factors that influence their interest in the technique. A prospective cross-sectional study was conducted over 7 months at Princess Margaret Hospital. Pregnant women aged 18 years or above and under 37 weeks of gestation were invited to participate via a bilingual questionnaire distributed during antenatal clinic visits. Descriptive and regression analyses were used. Out of 385 respondents, only 31.4% were aware of APM with social media (61.2%) as their main source of knowledge. Only 44.8% of the questions were answered correctly, with a median knowledge score of 3.0 out of 7. A majority were unaware of the long-term impacts of severe perineal injury (57.7%) and potential benefits of perineal massage (54.5%), highlighting a deficiency of knowledge. Interest in APM was high (66.2%). Non-Chinese, higher education, planned vaginal delivery and knowledge of the technique’s benefit are positive predictors of expressed interest. However, concerns about discomfort (38.5%) and embarrassment (38.5%) were notable barriers to participation. Among those who practised APM, the median Likert score was 4 out of 5, indicating a generally positive perception of its benefits. This study reveals important areas where knowledge regarding obstetric anal sphincter injuries (OASIS) and APM is lacking among some pregnant women in Hong Kong. There is a need to enhance education and resources regarding these topics in antenatal classes. Some women experience tearing around the vaginal area during childbirth, which may lead to pain, bladder or bowel issues, or discomfort during sex. One method that may help prevent these tears is a gentle massage of the area between the vagina and anus (called perineum) in the last few weeks of pregnancy. This study looked at how much pregnant women in Hong Kong know about this type of massage, how they feel about it, and whether they would be willing to learn it. We invited 385 women at a public hospital to complete a questionnaire during their pregnancy, and a follow-up section after they gave birth. We found that only about one-third had heard of perineal massage, and many did not know about the possible long-term effects of severe tearing during birth. However, two out of three women said they were interested in learning about the massage. Women were more likely to be interested if they had higher education, were not-Chinese, planned vaginal birth, or know about the massage’s benefits. At the same time, many of these women had concerns that made them unsure – such as discomfort, embarrassment or not knowing how to do the massage properly. These concerns may hold women back even when they are interested. This study shows that more education about perineal massage is needed during pregnancy to help women make informed choices.