, Volume 22, Issue 10, pp 1279-1285
Date: 25 May 2011

Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS)

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Introduction and hypothesis

There seems to be a temporal association between increasing use of “hands off” the perineum in labour and reduced use of episiotomy with an increasing rate of anal sphincter injuries. We aimed to determine how common the practice of “hands off” the perineum is.


An observational postal questionnaire study of 1,000 midwives in England in which the main objective was to obtain an estimate of the number of midwives practising either “hands on” or “hands off” was conducted.


Six hundred and seven questionnaires were returned; 299 (49.3%, 95% CI 45.2–53.3%) midwives prefer the “hands-off” method. Less-experienced midwives were more likely to prefer the “hands off” (72% vs. 41.4%, p < 0.001). A higher proportion of midwives in the “hands-off” group would never do an episiotomy (37.1% vs. 24.4%, p = 0.001) for indications other than fetal distress.


The “hands off” the perineum technique is prevalent in the management of labour. We hypothesise that a possible consequence might be an increased incidence of obstetric anal sphincter injury.