JKM (Jurnal Kebidanan Malahayati),Vol 8, No.3. July 2022,
ISSN (Print) 2476-8944 ISSN (Online) 2579-762X, Hal 499-507
DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan 499
EFFECT OF PERINEUM MASSAGE ON PERINEUM RUPTURE INCIDENCE
IN PREGNANCY

Dwi Nopitasari
1
, Nurul Isnaini
2*
, Devi Kurniasari
3

1,2,3
Program Studi DIV Kebidanan Konversi Universitas Malahayati
Corresponding [email protected]

ABSTRAK

Latar Belakang: Ruptur perineum merupakan laserasi yang terjadi pada saat persalinan. Salah satu upaya untuk
mencegah laserasi pada perineum adalah dengan melakukan perineum message. Pra-survey yang dilakukan pada
10 Februari 2020 di PMB Wilayah Kerja Puskesmas Wates menghasilkan sepuluh ibu bersalin. Delapan dari
sepuluh wanita (80%) mengalami ruptur perineum.
Tujuan : Untuk mengetahui pengaruh pesan perineum terhadap kejadian ruptur perineum pada ibu bersalin di
Wilayah Kerja Puskesmas Wates Kabupaten Lampung Tengah Tahun 2020.
Metode: Penelitian ini merupakan penelitian kuantitatif dengan desain pre-experiment dan static group comparison.
Populasi terdiri dari seluruh ibu hamil dengan usia kehamilan 34 sd 36 bulan periode April sd Juni 2020 yang
terdaftar di Wilayah Kerja Puskesmas Wates. Ada 30 responden setelah dilakukan purposive sampling. Analisis
dilakukan melalui Uji-T univariat dan bivariat.
Hasil: Hasil penelitian menunjukkan bahwa rata-rata skor ruptur perineum pada wanita yang mendapat pesan
perineum adalah 0,67 dengan deviasi 0,617. Rata-rata skor wanita tanpa pesan perineum adalah 1,20 dengan
0,676 perineum.
Kesimpulan: Ada pengaruh ruptur perineum setelah dilakukan perineum message pada ibu bersalin di Wilayah
Kerja Puskesmas Wates Kabupaten Lampung Tengah Tahun 2020 (p value 0,032).
Saran: Sebaiknya ibu hamil mengikuti kelas ibu hamil secara rutin dan melakukan pesan perineum untuk
mengantisipasi pecahnya perineum dalam persalinan.

Kata kunci : Ruptur Perineum, Pijat Perineum


ABSTRACT

Background: Perineum rupture is a laceration that happens during delivery. One of attempts to prevent the
laceration on the perineum is doing perineum message. A pre-survey conducted on February 10, 2020 at PMB of
Wates health Center Working Area resulted ten partum women. Eight out of the ten women (80%) suffered
perineum rupture.
Purpose: To know the effect of perineum message on perineum rupture incidence on parturient women at
Wates Health Center Working Area of Lampung Tengah Regency in 2020.
Methods: This was a quantitative study with pre-experiment design and static group comparison. The
population consisted of the whole pregnant women with 34 to 36 months of pregnancy in the period of April to June
2020 registered at Wates Health Center Working Area. There were 30 respondents after doing purposive sampling.
The analysis was through univariate and bivariate T-Test.
Result: The result of this study showed that the average score of perineum rupture on women got perineum
message was 0.67 with 0.617 deviation. The average score of women without perineum message was 1.20 with
0.676 perineum.
Conclusion: There was an effect on perineum rupture after doing perineum message on parturient women
at Wates Health Center Working Area of Lampung Tengah Regency in 2020 (p value 0.032).
Suggestion: The pregnant women should take pregnant women class routinely and do perineum message
in order to anticipate perineum rupture in the delivery.

Keywords : Perineum Rupture, Perineum Massage

Dwi Nopitasari, Nurul Isnaini, Devi Kurniasari
500 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan
INTRODUCTION
Postpartum hemorrhage is a cause of
maternal death, the primary cause of postpartum
hemorrhage (PPH) in recent years has been
abbreviated to the four Ts, namely: tone / tone -
uterine atony, atony can occur after vaginal delivery,
operative delivery or abdominal delivery, birth canal
trauma such as episiotomy laceration , hematoma,
uterine rupture, expansion of the incision during
cesarean section and uterine inversion are some of
the traumas that cause profuse bleeding. One of the
causes of bleeding is a tear in the birth canal
(perineal rupture) (Saifudin, 2014).
Perineal rupture is an injury to the birth canal
that occurs at the time of the baby's birth either using
a tool or not using a tool. Perineal rupture is caused
by parity, birth spacing, baby weight, improper
delivery leadership, cunam extraction, vacuum
extraction, instrument trauma and episiotomy
(Winkjosastro, 2016).
In Asia, perineal rupture is also a problem that
is quite a lot in society, 50% of the incidence of
perineal rupture in the world occurs in Asia. The
prevalence of maternity mothers who experience
perineal rupture in Indonesia in the 25 -30 year age
group is 24%, while the 32-39 year old maternal age
group is 62%. Perineal rupture is the cause of
postpartum maternal bleeding (Lailatri, 2014).
Perineal rupture is the cause of postpartum
maternal bleeding . Postpartum hemorrhage is the
main cause of 40% of maternal deaths in Indonesia.
The decline in MMR in Indonesia occurred from 1991
to 2007, from 390 to 228. In 2015 the MMR in
Indonesia was 305 maternal deaths per 100,000.
The five biggest causes of maternal death are
bleeding, hypertension in pregnancy (HDK),
infection, prolonged/obstructed labor, and abortion.
Maternal mortality in Indonesia is still dominated by
three main causes of death, namely bleeding 30.3%,
hypertension in pregnancy (HDK) 27.1%, and
infection 7.3% (Kemenkes, 2016).
Based on death data from Lampung Province
in 2017, the maternal mortality rate during vaginal
delivery was 118 mothers and the highest mortality
was in Lampung Province, then East Lampung
Regency with 14 mothers, and Central Lampung
Regency with 12 deaths. In 2018 numbers Maternal
mortality in vaginal delivery with a total of 102
mothers, with the highest maternal mortality being in
Lampung Province, namely 14 mothers, Tanggamus
Regency 12 mothers and Central Lampung Regency
with 10 maternal deaths (Health Profile Lampung
Province, 2019).
The highest maternal mortality rate in
Lampung Province in 2017 was in Lampung Province
with a total of 16 maternal mortality rates which were
divided into bleeding 6 mothers, hypertension in
pregnancy 5 mothers, circulatory system disorders 3,
others 2. In 2018 Lampung Province was still in a
state of the highest mortality rate with complications
of bleeding 1 mother, hypertension 3, infection in 1
mother, metabolic disorders 2 and others 7. In 2019
the maternal mortality rate was still at 14 women with
bleeding complications in 1 mother, hypertension in
2 mothers, etc. another 11 mothers (Health Profile of
Lampung Province, 2019).
Perineal rupture can occur because of a
spontaneous tear or an episiotomy. Perineal rupture
performed with an episiotomy itself must be
performed on indications such as: large baby, rigid
perineum , delivery with abnormal position, delivery
using either forceps or vacuum. Because if the
episiotomy is not performed on indications in
circumstances that do not need to be done with the
above indications, it will cause an increase in the
incidence and severity of damage to the perineal
area which is more severe. While the perineal wound
itself will have its own impact on the mother, namely
discomfort and discomfort bleeding, while
spontaneous perineal rupture occurs due to tension
in the vaginal area during childbirth, it can also occur
due to the psychological burden of facing the labor
process and more importantly, perineal rupture
occurs due to a mismatch between the birth canal
and the fetus, because the effects of perineal rupture
are very severe. complex (Triyanti et al, 2017).
The results of a study from the Research and
Development Center (Puslitbang) Bandung, which
conducted research from 2009-2010 in several
provinces in Indonesia, it was found that one in five
maternity mothers who experienced perineal rupture
would die with a percent (21.74%) (Wulandari, 2015).
Perineal laceration is the second cause of
bleeding after uterine atony, this often occurs in
primigravida because in primigravida the perineum is
still intact, the fetal head has not passed so it will
easily tear the perineum. The perineal tissue in
primigravida is denser and more resistant than in
multiparas. Laceration wounds are usually mild but
extensive wounds can also occur which can cause
bleeding so that it endangers the life of the mother
(Dartiwen, 2016).
One of the efforts that can be done to prevent
tearing of the perineum during childbirth is with or
massage the perineum. Perineal massage is one of
the oldest and surest ways to improve health, blood
flow, elasticity, and relaxation of the pelvic floor
muscles. If a perineal rupture occurs, perineal
massage can accelerate the perineal healing
process (Beckmann and Andrea J, 2006).

JKM (Jurnal Kebidanan Malahayati),Vol 8, No.3. July 2022,
ISSN (Print) 2476-8944 ISSN (Online) 2579-762X, Hal 499-507
DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan 501
Perineal massage is one way to improve
health, blood flow, elasticity, and relaxation of the
pelvic floor muscles. This technique, if practiced in
the late stages of pregnancy (starting the 34th week)
before delivery, will also help identify and familiarize
oneself with the tissues to be relaxed and the parts
the baby will pass through (Mutmainah, 2019).
The results of a presurvey conducted on
February 10, 2020 at PMB Wates Health Center
working area for 10 mothers giving birth, obtained as
many as 8 mothers (80%) experienced perineal
rupture. The results of interviews conducted in an
unstructured manner showed that 3 mothers with
ruptured perineum due to large babies weighing
around 3500 - 40000 grams, 5 mothers with ruptured
perineum said that the mother could not control
herself during childbirth and just gave birth at this
time.
The novelty of this study from previous
research is related to the research design. Previous
research conducted by Damayanti, Dewi Suri et al
used a cross sectional design, while this study used
a static group comparison design.
On the above background, researchers are
interested in conducting research with the title Effect
of massage perineum to the incidence of perineal
rupture in pregnant women in the UPTD Work Area
of the Wates Inpatient Health Center, Central
Lampung in 2020.

METHODOLOGY
The type of research used in this research is
quantitative research is a research method that can
be interpreted as a method based on the philosophy
of positivism used to examine certain populations or
samples, data collection using research instruments
quantitative data analysis with the aim of testing
hypotheses that have been determined (Sugiyono,
2017).
The study was conducted on pregnant
women at the Wates Health Center, Central
Lampung, the respondents in this study were
pregnant women with gestational age 36 weeks and
met the inclusion and exclusion criteria of 30
respondents obtained using purposive sampling
technique. The variable in this study was perineal
massage for pregnant women. The intervention was
carried out on respondents who were pregnant with
gestational age 36 weeks by doing perineal massage
4 times with a frequency of 2x a week, each massage
for 5 minutes for 15 respondents and 15 other
respondents as controls. Observations were carried
out using an observation sheet and were carried out
directly at the time of postpartum, where the baby
was born spontaneously. Data analysis was carried
out with the help of a computer program (SPSS).
Univariate data analysis was carried out to determine
the frequency distribution, bivariate analysis was
carried out by t-test.

RESULT
Table 1.
Frequency Distribution

Variable Categori Amount Percentage
Age <20 years 3 10,0
20-35 years 27 80,0
>35 years 0 0
Parity Primipara (G1) 14 46.7
Multipara (G2) 16 53.3
Grandepara (G3) 0 0

Based on the table, it is known that the most
age group is 26-30 years old, which is 13 people
(43.3%), the most pregnancies were first
pregnancies (G1) with 14 people (46.7%).

Univariate Analisys

Table 2.
Average Perineal Rupture in Mothers Who Received Perineal Massage

Variable Mean SD Min Max N
Rupture Degree Perineum 0,67 0,617 0 2 15

Based on table 2, the average perineal rupture of mothers who were given perineal massage

Dwi Nopitasari, Nurul Isnaini, Devi Kurniasari
502 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan
was 0.67 with a standard deviation of 0.617.

Table 3.
Average Perineal Rupture in Mothers Who Didn't Get Perineal Massage

Variabel Mean SD Min Max N
Rupture Degree Perineum 1,20 0,676 0 2 15

Based on table 3, the average perineal rupture
of mothers who were not given perineal massage
was 1.20 with a standard deviation of 0.676.

Bivariate Analisys

Table 4.
Effect of Perineal Massage to Perineal Rupture

Hasil Mean SD t-test p-value N
Perineal massage 0,67 0,617
2,256 0,032
15
No Perineal massage 1,20 0,676 15

Based on the results of the bivariate test
analysis in table 4.5 above, the statistical test results
obtained p-value = 0.032 (p value < = 0.05) which
means that there is an effect of perineal massage on
the prevention of perineal rupture in women giving
birth in the working area of the UPTD Puskesmas
Inpatient Wates Central Lampung 2020.

DISCUSSION
The average perineal rupture of mothers who
were given perineal massage
Based on the results of the study, the average
perineal rupture of mothers who were given perineal
massage was 0.67 with a standard deviation of
0.617.
In line with the theory expressed by Aprilia
(2010) the perineum consists of skin and muscles
between the vagina and anus. When the fetal head
protrudes into the vagina, the perineum itself
stretches to make way for the fetus to escape.
Perineal massage carried out in the last
months of pregnancy increases hormonal changes
that soften the connective tissue, so that the perineal
tissue is more elastic and stretches more easily, this
at the same time trains mothers-to-be to actively
relax the perineum when they feel pressure when the
baby's head appears, this can also reduce pain.
stretching pain.
Increased elasticity of the perineum will
prevent the occurrence of perineal tears and
episiotomy. Perineal massage/perineal massage is
also very important for successful hypno-birthing.
One of the efforts that can be done to prevent tearing
of the perineum during childbirth is with or massage
the perineum. Perineal massage is one of the oldest
and surest ways to improve health, blood flow,
elasticity, and relaxation of the pelvic floor muscles.
If a perineal rupture occurs, perineal massage can
accelerate the perineal healing process (Angraini,
2015).
In line with the research conducted by Savitri
(2014) the effect of perineal massage in primigravida
on the incidence of perineal rupture during delivery at
Independent Practice Midwives in Bengkulu City in
2014. The incidence of perineal rupture in the
intervention group after perineal massage was only
21.4%. Anggraini's research (2015) with the title of
the relationship between perineal massage and birth
canal tears in primiparous mothers at BPM South
Metro District, Metro City in 2015. The results
showed that from 70 mothers with no tears who did
perineal massage as many as 59 people. Dartiwen's
research (2015) The Effect of Perineal Massage in
Primigravida on the Incidence of Perineal
Lacerations During Delivery at Independent Practice
Midwives (BPM) Working Area of Margadadi Public
Health Center, Indramayu Regency in 2015, the
results of research conducted on 45 primigravida,
namely the incidence of perineal lacerations in the
Experimental group after perineal massage only
13.3%.
In the opinion of researchers, the minimum
perineal tear can occur because when the mother is
massaged the perineal muscles around the mother's
perineum will be more relaxed, causing an increase
in the elasticity of the birth canal which can facilitate
the birth process and reduce the incidence of
perineal tears. For mothers who are about to give
birth, fear and anxiety during childbirth will decrease
because during pregnancy the muscles around the

JKM (Jurnal Kebidanan Malahayati),Vol 8, No.3. July 2022,
ISSN (Print) 2476-8944 ISSN (Online) 2579-762X, Hal 499-507
DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan 503
perineum have been massaged so that the tissue
around the perineum becomes elastic. Some of the
benefits for the mother if the mother does perineal
massage can help the perineal and vaginal muscles
become elastic so as to minimize the risk of tearing
and episiotomy. Streamlining blood flow in the
perineal and vaginal areas, as well as the flow of
hormones that help relax the pelvic floor muscles so
that the birth process becomes easier. Accelerates
the recovery of tissues and muscles around the birth
canal after delivery. Helping mothers control
themselves when pushing, because the "way out" for
the baby is well prepared.
The average perineal rupture of mothers who
were not given perineal massage Based on the
results of the study, the average perineal rupture of
mothers who were not given perineal massage was
1.20 with a standard deviation of 0.676. Perineal
rupture is a tear that occurs when the baby is born
either spontaneously or by using a tool or action.
Perineal tears generally occur in the midline and can
become extensive if the fetal head is too fast.
Perineal tears occur in almost all primiparas
(Winkjosastro, 2007).
The perineum or perineum is the area
between the vagina and anus. This area is a network
that is "rich" in nerve endings so it is very sensitive to
touch, and tends to tear during the natural birth
process. When experiencing that tearing, whether
natural or intentional episiotomy, allegedly can cause
pelvic floor muscle dysfunction, thereby reducing the
quality of life of the mother after giving birth. The
occurrence of perineal rupture is caused by maternal
factors (parity number, birth spacing, baby weight),
improper delivery leadership, history of delivery,
cunam extraction, instrument trauma extraction and
episiotomy. The vacuum, advantage, of theperineal
massage technique is not only to help prepare the
perineal tissue, but also to help you learn the
sensations of labour (especially when the fetal head
is crowning). Thus it will help you to be more relaxed
in the face of the labor process later (Aprilia, 2010)
In line with the research conducted by Savitri
(2014) the effect of perineal massage in primigravida
on the incidence of perineal rupture during delivery at
the Independent Practice Midwife in Bengkulu City in
2014. The incidence of perineal rupture in the
intervention group after perineal massage in the
control group was 71.4%.
Anggraini's research (2015) with the title of
the relationship between perineal massage and birth
canal tears in primiparous mothers at BPM South
Metro District, Metro City in 2015. The results
showed that of 70 mothers with tears who did not do
perineal massage as many as 46 people. Dartiwen's
Research (2015) The Effect of Perineal Massage on
Primigravida on Incidence of Perineal Laceration in
Independent Practice Midwives (BPM) Working Area
of Margadadi Public Health Center, Indramayu
Regency In 2015, the results of research conducted
on 45 primigravida were the incidence of perineal
laceration in the control group was 63.3%.
In the opinion of the researcher, the perineal
tear that occurred in the control group was because
the respondent did not receive a perineal massage
intervention so that it could not minimize the perineal
tear. Perineal tears that occur in each respondent
can be caused by factors that influence the
occurrence of perineal tears. Rigid perineal
conditions, where the condition of the perineum
contributes to the incidence of perineal rupture,
where the rigid perineum inhibits the second stage of
labor which increases the risk of infant death and
causes extensive damage to the birth canal.

Effect of Perineal Massage
Based on the results of the study, it was found
that p-value = 0.032 (p-value < = 0.05) which means
that there is an effect of perineal massage on the
prevention of perineal rupture in women giving birth
in the working area of the UPTD Health Center
Inpatient Wates Central Lampung in 2020.
A perineal tear can actually be prevented by
a very simple method that everyon can do, namely
by doing massage on the perineal area or vaginal
perineum. Research shows that massage in the
perineal area reduces tearing and the possibility of
an episiotomy, improves the ability of the perineum
to stretch at the opening of the first stage of labor,
improves blood flow, maintains the tissue around the
perineum, and reduces the use of other birthing aids.
Many mothers feel a change in the stretchability of
their perineal area after one to two weeks of massage
(Aprilia, 2010).
Perineal massage will be very useful and
effective when applied to primigravida (first time
pregnant), and less than optimal results when
performed on multigravida who have had an
episiotomy before, because the scars from the
episiotomy (have been pregnant several times)
become weaker than normal tissue, so the perineum
will be more likely to tear in the next delivery. Perineal
massage can be done by the mother alone with the
help of a mirror, or it can also be assisted by the
husband. Perineal massage can even be done by
health workers when the client performs (Ante Natal
Care) ANC/treatment during pregnancy. Choose a
special time, and before massaging this sensitive
area, hands should be washed and nails cut short
(Aprilia, 2010). Perineal massage is a technique of

Dwi Nopitasari, Nurul Isnaini, Devi Kurniasari
504 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan
massaging the perineum during pregnancy or a few
weeks before delivery to increase blood flow to this
area and increase the elasticity of the perineum. The
theory states that by doing regular perineal massage
after 34 weeks of gestation, it can help the perineal
and vaginal muscles become elastic, thereby
reducing the risk of tears and episiotomy. This may
also be supported because the mother pushes
correctly and gets the right way to support the
perineum during childbirth (Herdiana in Anggraini,
2015).
In line with research conducted by Savitri
(2014) the effect of perineal massage in primigravida
on the incidence of perineal rupture during delivery at
Independent Practice Midwives in Bengkulu City in
2014. The incidence of perineal rupture in the
intervention group after perineal massage was only
21.4% while in the control group 71.4%. The results
of the study prove that there is an effect of perineal
massage on primigravida to the incidence of perineal
rupture (p<0.05). This study concluded that perineal
massage in primigravida affects the incidence of
perineal rupture at the time of delivery. Research
published in the American Journal of Obstetrician
and Gynecology concluded that perineal massage
during pregnancy can protect perineal function for at
least 3 months postpartum. The Cochrane Review
recommends that this perineal massage should
always be explained to pregnant women so that they
know the benefits of this perineal massage. This
perineal massage is very safe and harmless.
Based on the results of the study, where when
going to do treatment in the form of perineal
massage, the researchers recommended that the
mother cut the nails short with the aim of preventing
injuries to the skin or discomfort in the body when
doing perineal massage. Before the massage,
mothers are required to wash their hands first
thoroughly with soap and water. Do not let germs into
the birth canal. So, make sure to wash your hands
properly before starting. The researcher taught the
mother to adjust the position in the perineal massage
because if the mother did the massage herself, the
position was standing with one foot on the floor and
one foot lifted and placed on the chair. Use your
thumb to massage. If a partner is massaged, the
mother's position should be half lying down,
supporting her back, neck, head, and both legs with
a pillow. Stretch your legs, then place a pillow under
each leg. Use your partner's middle and index fingers
or the second forefinger to massage. In doing
massage, to facilitate the implementation of perineal
massage, the mother can use a mirror to find out the
perineal area, and when the mother is used to doing
perineal massage, the mirror is not required to
always be used.
The next step at the time of the study, the
researchers taught mothers to use gloves during
massage to keep the perineum clean and hygienic.
After the gloves are used, the mother can apply or
pour olive oil on the palms and perineum, the
researcher teaches the mother to do massage before
bathing in the morning and evening by inserting her
thumb into the vagina about 3-4 cm (maximum 7 cm)
with a bent position , and the other finger outside the
perineum. Press down and then sideways at the
same time. Slowly try to stretch the area until the
mother feels a hot sensation (slight burning). Gently
massage under the vagina. Massage in the shape of
a "U" by moving the thumb up and down repeatedly,
the mother is recommended to relax the muscles
during this massage, the movement is carried out for
two to three minutes. Researchers suggested to
mothers to repeat the massage until about 6 minutes
of massaging to completion. After the massage was
completed, the researcher taught the mother to apply
a warm compress to the perineal tissue for
approximately 10 minutes carefully because the
benefits of the warm compress will increase muscle
relaxation and have been shown to protect the
perineum.
The results showed that the perineal
massage intervention was carried out by the
researcher 10 respondents and 5 respondents did
the perineal massage themselves with the direction
of the researcher, the perineal massage was carried
out according to the SOP that had been made, from
the results of the perineal massage that was carried
out, 1 respondent got the result that there was a tear.
perenium degree 2, 8 respondents with perenium
degree 1 and 6 respondents did not have perineal
tear. Meanwhile, in the control group, 2 mothers did
not experience perineal rupture, 8 mothers
experienced 1st degree rupture and 5 women
experienced 2nd degree of rupture. From the results,
it can be seen that the experimental group
experienced 2nd degree of rupture less than the
control group.
Perineal rupture is caused by many factors,
such as maternal factors, namely maternal age,
primipara/ multi, precipitous parturition, pushing too
hard, edema and fragility of the perineum, flexibility
of the birth canal, delivery with action while the
helping factor itself. Based on the factors causing
perineal rupture, the authors took sub-factors from
the fetus and the mother, namely the weight of the
newborn with and parity.
The results showed that age affects the
perineal tear, seen in the results of the study in the
experimental group, it was found that at the age of

JKM (Jurnal Kebidanan Malahayati),Vol 8, No.3. July 2022,
ISSN (Print) 2476-8944 ISSN (Online) 2579-762X, Hal 499-507
DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan 505
<20 years, there was a grade 2 perineal rupture, at
the age of 20-30 years,
a grade 1 tear was obtained. In the control
group, the age was 20-30 there were 5 respondents
experienced perineal rupture. In this study, mothers
who gave birth were aged 20 to 35 years but
experienced perineal rupture. Although it is safe for
pregnancy, perineal rupture can occur due to high-
risk delivery and referral from BPM, with various
pathological diagnoses such as childbirth with PEB
+KEK PEB + Oligohydramnios + Hypoglycem,ia,
KPP, PEB, KEK and so on.
Medical obstetrics and gynecology which
contains a study from the Royal College of
Obstetricians and Gynecologists, states that "the
safe age for pregnancy is at the age of 20 to 35
years". Some facts stated by medical experts are as
follows: women tend to experience more many
complications like preeclampsia, miscarriage,
stillbirth, ectopic pregnancy etc if they are pregnant
over the age of 35 years. Egg fertility also begins to
decline after the age of 30, making it more difficult for
women to conceive. The ideal program is to have the
first child in their early or mid-20s and the next child
in their late twenties or early thirties (Ramli, 2015).
In the opinion of the researcher, the results of
the study indicate that there are still mothers who do
perineal massage but experience a grade 2 perineal
rupture where the mother is 19 years old and the
current pregnancy is the first pregnancy, in the
opinion of the researcher, the tear that occurs is
something that can happen in connection with the
mother's age. who are still young and are included in
the risky age category because they are less than 20
years old. At the age of < 20 years, the reproductive
organs have not functioned perfectly, so that when
pregnancy and childbirth occur, complications will
occur more easily. In addition, the strength of the
muscles of the perineum and abdominal muscles
have not worked optimally, so that prolonged or
obstructed labor often occurs which requires action.
At that age, the perineum is usually still very stiff and
thick, so it is very likely that if you don't do exercises
for eating elasticity, you will experience a tear and
based on observations, it is also seen that mothers
sometimes forget to do the advice from the
researcher, where the researcher recommends
doing perineal massage every day. carried out in the
morning and evening but the results of the
observations showed that the mother did not carry
out the recommendations that had been conveyed by
the researcher. If you do perineal massage regularly,
you can feel the benefits. For best results, perineal
massage needs to be done constantly every day.
The results will not be obtained within a day. In
addition, the occurrence of perineal tears is also
influenced by several factors, including maternal,
fetal and rescue factors. Maternal factors include
fragile perineum, primigravida, narrow pelvic inlet,
flexibility of the birth canal, pushing too hard, labor
prespitatus, and delivery with procedures such as
vacuum extraction, forceps. Fetal factors include a
large fetus, abnormal positioning, and shoulder
dystocia. Helper skills, including how to lead pushing
when the opening is complete and contractions
perineum during expulsion of the fetal head, and in
the supine position.
The results of the study obtained the effect of
perineal rupture including maternal parity, in the
experimental group based on the results obtained
from 6 mothers with primiparas, it was found that 3
respondents had perineal rupture, from 9
respondents with multipara there were 5 respondents
with rupture. While in the group control obtained 7
primirara respondents and overall rupture of the
perineum. In 8 multiparas, 6 respondents had
perineal rupture. This shows that the perineal
massage group found that the incidence of perineal
rupture was less than the control group.
Parity is the number of children ever born to
the mother, both live and stillborn to a married
couple. In pregnancies that are too frequent, it will
cause the reproductive organs to have not recovered
and are not ready to undergo the labor process
again, causing the perineal area to rupture easily.
Parity 2-3 is the safest parity in terms of mortality.
Primiparas have a higher risk of rupture, because
they have never had experience in childbirth
compared to multiparas or grand multiparas
(Wiknjosastro, 2016).
In the opinion of researchers that primiparas
have a greater risk of experiencing perineal tears
than mothers with more than one parity. This is
because the birth canal has been traversed by the
baby's head so that the perineal muscles have not
stretched. The causes of rupture of the perineum in
primiparas are due to the flexibility of the birth canal
/ elasticity of the perineum, hasty straining, irregular.
Meanwhile, multiparas can occur due to large baby
weight, perineal fragility, poor maternal care so that
labor is not controlled, such as tired mothers, slow
labor.
In the opinion of researchers, perineal
massage has various advantages, all of which are
aimed at reducing the incidence of trauma during
childbirth. The advantages include stimulating blood
flow to the perineum which will help speed up the
healing process after giving birth, helping the mother
relax more during a vaginal examination (Vaginal
Touche), helping the mother mentally prepare for the

Dwi Nopitasari, Nurul Isnaini, Devi Kurniasari
506 DOI 10.33024, http://ejurnalmalahayati.ac.id/index.php/kebidanan
pressure and strain of the perineum when the baby's
head is about to come out and avoiding the
occurrence of an episiotomy or an episiotomy.
tearing of the perineum during childbirth by
increasing the elasticity of the perineum. So one way
to avoid lacerations is by doing perineal massage.
Perineal massage is active, which means it is carried
out by pregnant women, although it is possible that
the partner in this case is the husband, although this
may not be in accordance with our culture or habits
in our relationship with husband and wife. Perineal
massage is generally useful for flexing or relaxing the
muscles around the perineum so that It is expected
to reduce the occurrence of tears in the perineum
either by itself or intentionally to facilitate the delivery
process.
Researchers believe that the sooner it starts,
the better the results. Within a few weeks after doing
perineal massage, the mother will feel the perineal
area becomes more elastic. Perineal massage can
be given or done when pregnant women attend
maternal classes. The purpose of the antenatal class
is to increase knowledge, attitudes and practices
(behavior) of pregnant women regarding pregnancy
check-ups, breast care, pregnancy exercise, perineal
massage, delivery care which includes signs of labor
and the delivery process. So by taking a mother's
class, it is hoped that pregnant women can re-
practice what has been taught and start preparing for
childbirth as early as possible.

CONCLUSION
The average perineal rupture of mothers who were
given perineal massage was 0.67 with a standard
deviation of 0.617.The average perineal rupture of
mothers who were not given perineal massage was
1.20 with a standard deviation of 0.676.There is an
effect of perineal massage on the prevention of
rupture of the perineum p value 0.032.

SUGGESTION
Pregnant women are expected to attend
classes for pregnant women regularly at least 3 times
during pregnancy or in accordance with the
agreement between the mother and the facilitator
and perform perineal massage in anticipation of
perineal rupture during delivery.
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