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Background Conservative "hands on" birth manual perineal protection (MPP) is one of the most common OB procedures-60% of births in 1979, 24.5% in 2004 in American and that was 90% in China at the same year with routine episiotomy.The new concept of childbirth is a non-invasive "hands off" nature delivery; midwives will not protect the perineum, only control fetal head during delivery.