BACKGROUND:
Perineal trauma is a common complication of vaginal birth that affects maternal well-being and postpartum recovery. The World Health Organization emphasizes the importance of a positive childbirth experience through respectful, evidence-based, and physiological care, aligned with Sustainable Development Goal (SDG) 3.1 to reduce maternal morbidity. Enhancing midwifery competence in gentle birth techniques such as spontaneous pushing and hands-off perineal support may play a crucial role in minimizing birth-related trauma.

OBJECTIVES:
To evaluate the effectiveness of gentle birth practices in reducing the incidence and severity of perineal tears and to assess the influence of maternal age, parity, and infant birthweight on perineal outcomes.

METHODS:
A cross-sectional comparative study was conducted involving 32 women who gave birth in two midwifery-led clinics. Sixteen women delivered using gentle birth techniques (spontaneous pushing and hands-off), while 16 received conventional care. Chi-square tests, Mann–Whitney U tests, and binary logistic regression were employed for statistical analysis.

RESULTS:
The incidence of perineal tears was significantly lower in the gentle birth group (75.0% no tear vs. 12.5% in the conventional group; p < 0.001). The degree of perineal tear was also significantly reduced (mean rank 10.75 vs. 22.25; p < 0.001). Logistic regression identified birth technique as the strongest influencing factor (p = 0.054), while maternal age, parity, and birthweight were not significant. Interestingly, higher birthweight (>3500g) was associated with less severe tearing (p = 0.002), likely due to overlap with the gentle birth group.

CONCLUSIONS:
Spontaneous pushing and hands-off technique are effective in protecting the perineum and should be integrated into midwifery training. These findings support the WHO framework and contribute to achieving maternal health targets under the SDGs.

KEY MESSAGE:
Spontaneous pushing and hands-off techniques empower midwives to reduce perineal tears without routine manual intervention, aligning with woman-centered care principles. Poster session 2 (Group A)