Perineal Massage—Does It Really Help?
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By the time you get to the last few weeks of pregnancy, you probably feel pretty antsy and excited. You may check and recheck your hospital bag and you might go over your birth plan a few times (okay, you’ve probably got that memorized!). It seems that everything is ready. But what about your body? There are a few things you can do to help prepare your body for labor and delivery. Relaxation techniques, gentle stretching, and even something called perineal massage. Here’s what you need to know about perineal massage—and its potential benefits.
What is the perineum?
The perineum is the section of muscles and skin that spans between the vagina and anus. Its job is to attach to the muscles that make up your pelvic floor to support the uterus, bowels, and bladder. The perineum is naturally stretchy to let Baby’s head through during birth.
However—and we know this might be tough to read—sometimes all this expanding can result in a tear to the perineum and vagina (known as first- and second-degree tears), and occasionally the anal muscles (a third- or fourth-degree tear). These more serious tears can result in complications, like pain, pelvic floor issues, and incontinence.
Will my perineum tear during birth?
The American College of Obstetricians and Gynecologists estimate that 53 to 79% of vaginal births include some type of tearing, and about 60 to 70% of these tears require stitches. But—now here’s the good news—studies suggest that third- or fourth-degree tears occur in less than 3% of vaginal deliveries. (Phew!)
Factors that increase the risk of tearing include:
- It’s your first time giving birth.
- Forceps or a vacuum are used to assist the birth.
- You’re of Asian descent.
- The baby is above average in weight.
- Your baby isn’t positioned head-down.
- You’re over 35 (sometimes called an “advanced gestational age”).
Even though the risk of a serious tear is small, it’s understandable that expecting parents may still want to do everything in their power to prevent that outcome. That’s where perineal massage may help…
What is perineal massage?
Perineal massage is an exercise in gently stretching the perineum with your fingers in order to lower the risk of tearing during a vaginal birth. It’s an exercise that you can do before birth (by yourself or with help from a partner or midwife) or during labor.
What are the benefits of perineal massage?
It’s thought that perineal massage boosts blood flow to the perineum and makes it more elastic for Baby’s big debut. With that, massage may soften scar tissue from a previous perineum tear or episiotomy. And then there’s the benefit of perineal massage that expecting parents probably find most compelling: It may reduce the risk of serious tears and the need for episiotomy. But does it really? Let’s dig into the research about the benefits of perineal massage…
Does perineal massage help prevent tears?
There is evidence pointing to the effectiveness of perineal massage. A review of literature found that first-time moms who did perineal massage before birth had a 10% decrease in tears that required surgery and a 16% decrease in episiotomy risk. But if this isn’t your first rodeo (so to speak), you may not reap these perks. The same study found that second-time moms who participated in perineal massage didn’t experience the same reduction in tearing—though they did report a reduction in ongoing perineal pain three months postpartum.
A more recent literature review suggests that performing perineal massage during labor may also help ward off tears. The analysis published in the Journal of Maternal-Fetal & Neonatal Medicine reported that massage during labor—typically done by a midwife in the second stage of labor, either between or during pushing time—was associated with a significantly lower risk of third- and fourth-degree tears.
When to Do Perineal Massage
You can start doing perineal massage anywhere from 34 weeks of your pregnancy and on. In fact, as mentioned above, you—or your midwife—can perform perineal massage during labor.
When it comes to how often to do perineal massage, more may not be better! The same report that found that perineal massage may reduce tearing in first-time moms suggests that the women who massaged an average of 1.5 times per week were less likely to tear than those who massaged 1.5 to 3.4 times per week. And those who massaged more than 3.5 times per week didn’t experience any benefits!
How to Do Perineal Massage
- Before performing a perineal massage, wash your hands and clip and clean your nails (this helps keep germs and bacteria out of the vagina).
- Get into a comfortable position where you can reach your perineum without straining. You may lay on your back—perhaps propped up on a pillow or two—with your legs open and knees bent. Others prefer a standing position, so consider squatting, leaning against a wall, or raising a leg and resting it on a stool.
- Apply a lubricant or oil to your fingers and thumbs. Consider using an unscented oil (such as olive, sunflower, or grapeseed) or a gel-based lubricant that is designed for perineal massage—these are specially formulated for this sensitive area. Avoid baby oil, mineral oil, and Vaseline, which can be irritating.
- Once your hands are clean and your fingers and thumbs are well-lubricated, insert two fingers or thumbs about 1 to 1.5 inches inside your vagina. Rest your palms on the inside of the legs. Gently and slowly press down toward your anus and then out toward each side in a U-shaped movement until you feel a slight stretching sensation.
- Hold this stretch for a minute or two. Repeat the motion two to three times.
If your partner will be doing the massage, they’ll follow the same steps (massaging in the same downward and side-to-side U-shaped movement), but they’ll use their index fingers instead of their thumbs.
More on Preparing for Labor and Delivery:
- What to Eat Before Your Labor Induction
- Is Hypnobirthing Right for You?
- Affirmations to Prepare for Birth
- Natural Ways to Induce Labor
- What to Expect When Your Water Breaks
- American College of Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin, American College of Obstetricians and Gynecologists, June 2016
- Is It Possible to Predict or Prevent Third Degree Tears?, Colorectal Disease, July 2005
- Perineal Lacerations, StatPearls, June 2023
- Antenatal Perineal Massage for Reducing Perineal Trauma, Cochrane Database of Systematic Reviews, January 2006
- Perineal Massage During Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Journal of Maternal-Fetal & Neonatal Medicine, March 2020
- Perineal Massage in Pregnancy, Journal of Midwifery & Women’s Health, January 2016
- National Childbirth Trust: How to Do Perineal Massage
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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.