If you’re moving into your last trimester of pregnancy, chances are you’ve heard something about perineal massage—the practice of gently stretching the skin between the vagina and the anus in order to “condition” the tissues for birth. The theory is that having a more stretchable perineum lessens your chances of tearing during delivery, and that it may even help you avoid an episiotomy.
Does It Work?
Perineal massage during late pregnancy has long been supported by anecdotal evidence, but clinical research has been less conclusive; however, a recent review of randomized, controlled studies of complementary and alternative medicine practices used during pregnancy showed that perineal massage may truly be helpful, says Frank Anderson, MD, MPH, an assistant professor of Obstetrics and Gynecology at the University of Michigan Medical School.
Dr. Anderson, who co-authored the review, notes that while more research is needed, the three studies of perineal massage examined in the review showed that it does seem to result in a greater likelihood that the perineum will be intact at the time of delivery.
The studies also showed that perineal massage is most effective in women having their first baby. If you’ve had an episiotomy or tearing in a previous delivery, perineal massage may not work as well for you. “In multiparous women who have had previous episiotomies, the perineum contains scar tissue that is weaker than normal tissue, so the perineum will be more likely to tear at subsequent deliveries and will be less likely to respond to massage,” says Dr. Anderson.
Perineal massage also seems more helpful to first-time moms over the age of 30, says Dr. Anderson, noting that this could be due to older tissues being stiffer than younger tissues.
Should You Try It?
Proponents of perineal massage point out that it may have other benefits besides helping the perineum stretch. Practiced regularly, perineal massage may also help you cope with the stinging sensation you’ll feel as your baby’s head crowns.
In addition, perineal massage may have the effect of focusing the mother’s determination, says Peg Plumbo, CNM, a certified nurse-midwife and instructor at the University of Minnesota School of Nursing. “The type of woman who wants to do perineal massage is the same one who is motivated to find a care provider who blends with her birth philosophy and who will work with her for the extra time it takes to deliver baby gently and slowly,” notes Plumbo.
Is perineal massage safe? As with any complementary or alternative therapy you try during pregnancy, it’s best to check with your healthcare provider before beginning perineal massage. According to Dr. Anderson, perineal massage could be harmful if done improperly, and it’s important to use adequate lubrication and avoid excessive force.
Plumbo adds that she would caution a woman against perineal massage if she has a history of preterm labor, premature rupture of membranes, a vaginal infection, if the massage induces contractions, or even if the procedure simply makes her sore or uncomfortable.
Finally, if you do try perineal massage, keep in mind that birth is unpredictable by nature. Tears do often happen, and episiotomies sometimes become necessary, even during highly prepared-for births.
I tried perineal massage during my first pregnancy. I was happy to be doing something proactive as I waited—endlessly, it seemed—for the birth of my son. His delivery was easy, and afterwards, I would have recommended perineal massage to anyone.
At around the same time as I was expecting my little boy, Amy Kameda-Smith* was expecting a girl. She didn’t try perineal massage. “For exercise, I stuck to water aerobics—and night time aerobics!” laughs Kameda-Smith, an Atlanta-area mom of one. She, too, had a happy birth experience and wouldn’t change a thing.
In the end, both approaches were fine. “Perineal integrity has more to do with race, parity, age, and overall state of health than it does to perineal massage,” says Plumbo.
*Name and location changed by request.
A How-To Guide
When to start: Begin perineal massage around 34 to 35 weeks into your pregnancy. Be sure to check with your healthcare provider first, in case there is something in your medical history that would make perineal massage inadvisable for you.
What you’ll need:
- A pair of thoroughly scrubbed hands (yours or your partner’s), with the nails neatly trimmed.
- An edible oil (many practitioners recommend vitamin E oil, olive oil, or other pure vegetable oil). A water-soluble lubricant such as K-Y Jelly will also work.
- A clean towel.
- A mirror for the first few massages, if you are unfamiliar with your perineal area (floor-to-ceiling may work best).
What to do: After your bath, find a private place and sit back on a towel in a comfortable position. Apply the oil or lubricant to your hands and around the perineum. Put your thumbs (or have your partner put both index fingers) about one to one-and-one-half inches (three to four centimeters) into your vagina.
Next, press firmly but gently downward towards your rectum. A little tingling is okay, discomfort or burning is not. These tissues are sensitive, especially during pregnancy. Being too vigorous could lead to swelling or bruising. Hold this stretch until the area begins to feel a little numb (around two minutes).
Then, maintaining steady pressure, gently move the fingers or thumbs back and forth upward along the sides of the vagina. Continue for around three to four minutes, being careful to avoid the urethra (urinary opening).
Perineal massage can be repeated daily, and in about a week, you’ll probably notice increased “stretchiness” in your perineal area.