Our goal was to determine the frequency, degree, and location of perineal lacerations and the neonatal outcomes associated with the use of two techniques of perineal protection—expectant (“hands off) and interventionist (“hands on”)—during childbirth. We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 70 nulliparous expectant mothers, who were divided equally between the “hands off and “hands on” groups (n = 35 per group). Perineal laceration occurred in 81.4% of the women. Among these, first-degree lacerations were predominant (82.5%). Lacerations in the anterior and posterior regions of the perineum occurred with similar frequencies. Laceration rates did not differ between the “hands off and “hands on” groups (P > .05). Neonatal outcomes were similar in both groups. The use of “hands off technique of perineal protection does not alter the frequency or degree of perineal lacerations in childbirth, relative to a “hands on” technique.