Clinical recommendation	Evidence rating	Comments
Digital perineal self-massage starting at 35 weeks' gestation reduces perineal lacerations during labor in primiparous women with a number needed to treat of 15 to prevent one laceration.5	A	Cochrane review involving four trials with 2,497 women
Perineal massage, warm compresses, and perineal support during the second stage of labor reduce anal sphincter injury.11,12	A	Cochrane review with four studies involving 1,799 women for warm compresses, six studies involving 2,618 women for perineal massage, and a systematic review of manual perineal support including six randomized and nonrandomized studies involving 81,391 women
Repairing hemostatic first- and second-degree lacerations does not improve short-term outcomes compared with conservative care.2	B	Cochrane review involving two studies with 154 women showing similar results in both groups
During a suture repair of a first- or second-degree laceration, leaving the skin unsutured reduces pain and dyspareunia at three months postpartum.24	B	Randomized controlled trial of 1,780 women with first- or second-degree lacerations
Surgical glue can repair first-degree lacerations with similar cosmetic and functional outcomes with less pain, less time, and lower local anesthetic use.22	B	Randomized controlled trial of 102 patients, with 74 patients randomized to surgical glue
Continuous suturing of second-degree perineal tears reduces short-term pain and pain medication use.23	A	Cochrane review involving 16 studies with 8,184 women showed improvements in continuous suture group but no differences in long-term pain
Local perineal cooling during the first three days after perineal repair reduces pain.33	B	Cochrane review involving 10 studies with 1,825 women showed improvement in pain compared with no treatment