Will Perineal Massage Keep You From Tearing During Childbirth?

You’re in the last few weeks of your pregnancy, and among all the other things you may be worried about, you’re also concerned about tearing “down there.”

Vaginal tearing is a common worry, and one that your healthcare provider is thinking about, too, says Ob/Gyn Salena Zanotti, MD.

In an effort to try to avoid stitches after delivery, some providers and online forums recommend an at-home perineal massage — massaging your perineum a few times a week — in preparation for delivery.

But does it work?

Dr. Zanotti says the research is mixed on whether a perineal massage during pregnancy prevents you from perineal trauma during vaginal delivery, but if it’s something you want to try, it’s not likely to do any harm.

What is perineal massage?

Your perineum is the small patch of skin and muscle between your vaginal opening and anus. Your perineum is only about 1.5 inches long, but it’s got a big job to do. It’s essentially the cradle for your pelvic floor — the muscles that help control your ability to do the three Ps: poop, pee and pass gas.

As your body prepares for delivery, the skin of your vagina stretches to allow your baby to pass through. But it doesn’t always stretch enough, and something’s gotta give.

According to the American College of Obstetricians and Gynecologists (ACOG), between 53% and 79% of people experience lacerations during vaginal childbirth. Those lacerations are usually called vaginal tears or perineal lacerations.

This is where the idea of a perineal massage comes in — massaging the area at least a few times a week toward the end of your pregnancy may help your perineum stretch instead of tear.

What are the benefits of perineal massage?

Vaginal and perineal tears are common and more likely to happen if:

• You deliver a baby larger than 8 pounds.
• Your delivery progresses quickly.
• Your provider needs to use forceps to help deliver your baby.
• Your baby is delivered face up.
• It’s your first delivery.

Tears to your perineum are graded by severity. Some don’t need any intervention. Others will require stitches (which dissolve on their own over time). A first-degree tear is a small injury in the first layer of tissue around the vagina’s perineal area. A fourth-degree tear is the most severe and extends from your vagina through your rectum.

While you can’t outright prevent your perineum from tearing, massaging it before childbirth and during delivery may potentially lessen the severity of the tear.

“The perineum can be very rigid and the muscles can be tight, particularly if you’ve never delivered a baby vaginally before,” Dr. Zanotti explains. “So, in theory, the idea is that massaging the area can help stretch the muscles and skin and reduce your chances of tearing.”

But Dr. Zanotti reiterates that whether a perineal massage will help is debatable.

“Over the years, people have done studies to look at whether perineal massage reduces tears, and you can find studies to back both sides. There’s no consistent answer to the question,” she says.

“There are studies that show that if you do consistent perineal massage, you may reduce the risks of some advanced tears (third and fourth degree). And you have other studies that show that it doesn’t make a difference.”

When to start?

Dr. Zanotti says if you choose to do perineal massage, you should start four to six weeks before your anticipated due date.

How to do perineal massage

Dr. Zanotti recommends talking to your healthcare provider before trying perineal massage to make sure you understand the anatomy of your perineum. You’ll want to make sure you’re pressing in the right places and with the right amount of pressure.

Typically, a perineal massage will follow these steps:

Step 1: Wash your hands

Before you begin, wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.

Step 2: Get in position

Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.

Step 3: Use a lubricant

Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant (like Astroglide® or K-Y Jelly®) to your fingers, thumbs and perineum.

Step 4: Begin massage

Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.

Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.

Move both thumbs slowly in a U-like motion so you feel a gentle stretch.

The research studies that show benefits of perineal massage suggest it’s important to massage the area regularly — at least three to four times a week, for at least five minutes at a time.

Are there other ways to prevent tearing during birth?

If perineal massage during your pregnancy isn’t a sure-fire way to prevent vaginal tearing, is there a better solution?

Unfortunately, Dr. Zanotti says there isn’t much that you can do during your pregnancy that’s been proven to lower your risk of perineal lacerations. (Or think of it this way: One less thing for you to do in the final weeks before birth!)

“At the end of the day, your best bet for avoiding a tear during vaginal birth is a controlled delivery,” she continues. And to that end, there are some methods providers use during your delivery that aim to reduce your risk of tears.

Research shows that perineal massage during delivery by your provider can help stretch your perineal tissue to lower your risk of significant tears. Dr. Zanotti says that’s a practice many providers commonly use during childbirth.

“Other methods, like applying a warm compress to the perineum during delivery can help loosen up the tissue as well,” she adds.

Also, the ACOG recommends providers can consider episiotomy (a small cut to widen the opening of the vagina) during delivery when necessary, such as when birth is progressing quickly and the risk for a more severe tear is likely. They’re not as common as they used to be, but in some cases, an episiotomy can reduce the risk of a higher-degree natural tear.

Bottom line?

As you think about your birthing experience, it’s natural to worry about tearing. It’s not a possibility anyone wants to consider happening.

But know that perineal tears are something your provider sees often. They know how to help reduce your risk. And if you do have a tear, they’ll know how to treat it.