
Does the evidence show perineal massage is effective at preventing tearing? We are going to review the research and share if it’s worth it to spend time to do perineal massage to reduce tearing.
In this episode, we dive into the following:
An overview of the tear types and recovery
What is perineal massage
Whether perineal massage reduces the chances of tearing
Listen to the episode now:
Perineal Massage During Pregnancy: Does It Really Help Prevent Tearing During Labor?
In the latest episode of The Mindful Womb Podcast, we dive into one of the most talked-about prenatal practices: perineal massage. If you're pregnant, you've probably heard about it from friends, in childbirth classes, or through social media influencers who claim it’s a miracle solution to prevent tearing during labor. But does the science really back up the hype?
What Is Perineal Massage?
Perineal massage during pregnancy is a practice often introduced to birthing people around the 34-35 week mark. This technique is usually performed by the pregnant person or their partner and aims to increase the elasticity of the perineal tissue in preparation for birth. Perineal massage involves inserting one to two fingers into the vagina—about two inches deep—and applying pressure downward for two minutes, then sideways for another two minutes on each side. A safe lubricant or sweet almond oil is often encouraged to reduce friction and enhance comfort during the massage.
Some educators recommend starting with once a week, gradually increasing to three to four times a week as you near your due date. Each session typically lasts a five minutes. Advocates of perineal massage believe that it boosts blood flow to the perineum, promoting circulation and enhancing tissue elasticity, which may help the area stretch more easily during labor as the baby passes through.
Many birthing people and birth workers recommend perineal massage, often sharing their personal experiences or those of others who have had positive outcomes. The practice is frequently discussed in childbirth education classes and among friends and family who have gone through pregnancy.
Supporters argue that perineal massage may reduce the risk of tearing during labor, particularly for first-time birthing people. Some birth workers also mention that perineal massage might benefit individuals who are survivors of sexual assault, allowing them to become more comfortable with the sensations they might experience during labor.
However, not everyone is convinced of its benefits. Critics worry that perineal massage may lead to micro-tears or damage to the tissue, possibly increasing the risk of complications rather than preventing them.
Many in the childbirth community reference studies touting significant benefits of perineal massage without closely scrutinizing the validity of the studies. As a result, birthing people are often encouraged to try perineal massage without understanding the full context of the available evidence. While perineal massage is widely discussed, what does the research actually say?
The Fear of Tearing – What’s Normal?
Many expecting parents fear tearing during childbirth. It’s a common concern, but not all tears are created equal. Tearing ranges from first-degree (small, skin-deep tears that often heal without stitches) to fourth-degree tears, which involve the muscles around the anus and may require surgery.
The most severe tears, called Obstetric Anal Sphincter Injuries (OASIs), affect the anal sphincter and can lead to a longer recovery. Preventing these serious tears, also known as third and fourth-degree tears is a top priority for many.
Does Perineal Massage Help?
In this episode, we dig into the available research on perineal massage. The results? They’re not as clear-cut as you might expect.
The reality is that just because research is published doesn’t necessarily mean it’s credible. There is an overall lack of quality research on the effectiveness of perineal massage during pregnancy and the reviews of high quality studies have been very mixed.
A high quality meta-analysis examining the effectiveness of perineal massage that combined the results from four randomized, controlled trials that enrolled 2,497 pregnant women, mostly first time moms (Beckmann and Garrett, 2006). While the study found that participants who were randomly assigned to practice perineal massage during pregnancy had a 10% decrease in the risk of experiencing a tear that required stitches, and a reduced risk of episiotomy of 16%, these results were only true for first-time parents. This study showed that perineal massage did not reduce the risk of perineal trauma for those who had given birth vaginally before but it did decrease ongoing perineal pain at 3-months postpartum by 32%.
This meta-analysis also found that the more frequently a participant practiced perineal massage in pregnancy, the less likely they were to experience any benefits. Other studies, like Labrecque et al. (1999) found the opposite results.
It's important to understand that the percentages mentioned are relative risk which is different from absolute risk. Let me explain with an example. If you're a first-time parent and your absolute risk of perineal trauma is 50%, a 10% reduction in relative risk means your absolute risk decreases by 5% (since 50% x 10% = 5%). So, perineal massage would reduce your absolute risk of perineal trauma from 50% to 45%.
The Bottom Line: Is Perineal Massage Worth It?
While it’s not harmful, perineal massage might not be the magic solution many hope for, especially for those who are not first-time birthing people or are in low-intervention birth environments. More effective strategies, like choosing the right birth setting and advocating for a provider with low episiotomy rates, may make a bigger difference in protecting your perineum during childbirth.
For first-time birthing people, some evidence suggests that perineal massage may provide benefits, but these benefits seem to be largely associated with birth settings where episiotomies are common and are not necessarily generalizable. If you’re giving birth in an environment where the rate of episiotomy is below 1%, the need for perineal massage may be minimal. Avoiding an episiotomy altogether, as discussed earlier, is one of the most effective ways to protect the perineum, and this largely depends on your healthcare provider's approach to birth rather than the elasticity of your tissues.
For those who have already had a vaginal birth, research indicates that perineal massage offers little to no additional benefit. In these cases, other methods for reducing the risk of tearing—such as finding a provider with low episiotomy rates and focusing on controlled and slow pushing—might be more effective than relying on perineal massage. Ultimately, while perineal massage may not be harmful, its necessity varies depending on individual circumstances and birth environments.
If you’re eager to dive deeper into ways to reduce tearing, I’ve created an ebook packed with evidence-based strategies used by midwives and childbirth professionals. It’s available for purchase in instant download at: How to Prevent Tearing During Childbirth eBook
If you’re interested in learning more, check out the episode and the ebook to get all the details on protecting your perineum during childbirth. Have you tried or are you considering perineal massage? Let me know in the comments!
For more in-depth tips on childbirth preparation, head to clearlightbirth.com. Wishing you a gentle, empowered, and confident birth experience!
Citations:
Aasheim, V., A. B. Nilsen, et al. (2011). 'Perineal techniques during the second stage of labour for reducing perineal trauma.' Cochrane Database Syst Rev(12): CD006672.
Beckmann, M. M. and A. J. Garrett (2006). 'Antenatal perineal massage for reducing perineal trauma.' Cochrane Database Syst Rev(1): CD005123.
Byrd, L. M., J. Hobbiss, et al. (2005). 'Is it possible to predict or prevent third degree tears?'Colorectal Dis 7(4): 311-318.
Christianson, L. M., V. E. Bovbjerg, et al. (2003). 'Risk factors for perineal injury during delivery.' Am J Obstet Gynecol 189(1): 255-260.
Dahlen, H. G., C. S. Homer, et al. (2007). 'Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.' Birth34(4): 282-290.
Declercq, E. R., C. Sakala, et al. (2007). 'Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.' J Perinat Educ16(4): 9-14.
Groutz, A., J. Hasson, et al. (2011). 'Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.' Am J Obstet Gynecol 204(4): 347 e341-344.
Hirayama, F., A. Koyanagi, et al. (2012). 'Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study.' BJOG 119(3): 340-347.
Labrecque, M., E. Eason, et al. (1999). 'Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.' Am J Obstet Gynecol 180(3 Pt 1): 593-600.
Soong, B. and M. Barnes (2005). 'Maternal position at midwife-attended birth and perineal trauma: is there an association?' Birth 32(3): 164-169.
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