Perineal Massage: a Way to Prevent Tearing During Childbirth?
Giving birth is an incredible experience, but there are a lot of things that can happen to your body during the sometimes grueling process. One less-than-desirable possibility? Tearing while delivering vaginally. According to the American College of Obstetricians and Gynecologists (ACOG), up to 79 percent of women who have a vaginal delivery experience some type of laceration.
Since tearing and its aftermath are about as fun as they sound, it’s natural to want to do what you can to lower the risk that it’ll happen to you. One proactive option moms-to-be repeatedly have turned to: perineal massage. But exactly what is perineal massage, how do you do it, what tools or oils are needed and, most importantly, does it work? We reached out to ob-gyns for all the answers.
A perineal massage is “a massage in the most superficial area of the vaginal canal that separates the vagina from the rectum,” says Francisco Orejuela, MD, an associate professor of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas.
Using your fingers, you can manipulate the perineal tissue (the spot between your vulva and anus), helping to stretch it and ready it for the pressure of childbirth, says Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women & Babies in Orlando, Florida,
People perform perineal massage in an effort to reduce the risk of tearing or needing an episiotomy (a small incision made between the vagina and anus) during a vaginal delivery. “It has been used as a strategy to increase the elasticity in the vaginal area and reduce the resistance from the muscles to decrease the amount of tearing during the vaginal deliveries,” Orejuela explains.
In a practice bulletin, ACOG specifically states that a perineal massage can lower your risk of tearing during a vaginal delivery, and there is research to support this recommendation. For example, one Cochrane review analyzed four trials of 2,479 pregnant women. Some did a perineal massage starting from 35 weeks before giving birth, others did not. The women who did perform perineal massages were 9 percent less likely to tear during birth and 14 percent less likely to need an episiotomy. Orejuela points out that the change in risk of tearing was “modest” but statistically significant. He adds, “these results were seen only in first-time mothers.”
Don’t worry, you don’t need to begin practicing the second you get a positive pregnancy test. You’ve got plenty of time to get used to the idea. Perineal massage is usually started around week 35 of pregnancy, according to Greves. Of course, it’s also totally optional—not doing it doesn’t mean you’re guaranteed to tear. But if you want to give perineal massage a go, there doesn’t seem to be a down side.
For more comfort—and to make the massage easier—you may want to use some form of oil. In general, Orejuela says that using water-soluble oils or natural oils like olive, almond or coconut are best. “They are less irritating and better tolerated,” he says. You can also use a vaginal lubricant. Greves advises against using baby oil and mineral oil, as well as warming lubricants, which can irritate your skin.
You don’t need any perineal massage tools other than oil, although you may want to have a hand mirror to help you see what you’re doing, Greves says. Here’s how to do perineal massage:
- Wash your hands.
- Sit with your legs apart and have your back supported.
- Apply a water-based lubricant or perineal massage oil to your fingers.
- Place your thumb or finger about two inches into your vagina.
- Use your finger to gently stretch the wall of your vagina towards the sides.
- While continuing to stretch the wall of your vagina, move your fingers down toward the bottom of your vagina and then the top.
- Keep repeating this.
How long should a perineal massage last?
In general, a perineal massage should last about five minutes, Greves says.
There’s no set recommendation for how often you should do a perineal massage. “Studies have used different protocols, but they could vary between two to four times per week or even daily,” Orejuela says. But he’s quick to point out that data hasn’t shown that doing perineal massage more often will further lower your risk of tearing or needing an episiotomy.
Tips for partners performing perineal massage
While you can do a perineal massage yourself, you can also have your partner help. Greves offers up these additional tips for your partner for doing the massage:
- Read up on how to do the massage in advance.
- Go slowly.
- Make sure your partner doesn’t feel pain. If they do, stop the massage.
If you want to do a perineal massage but have questions or concerns about it, ask your ob-gyn or midwife at your next appointment. They should be able to help guide you. It’s certainly not required, but, as long as you’re being careful and following the appropriate directions, it can’t really hurt. It may even save you some pain and recovery later on.
About the experts:
Christine Greves, MD, is an ob-gyn at the Winnie Palmer Hospital for Women & Babies in Orlando, Florida. She earned her medical degree from the University Of South Florida College Of Medicine.
Francisco Orejuela, MD, is an associate professor of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas. He received his medical degree from Pontificia Universidad Javeriana inColombia.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.