Perineal Massage: What to do Before Delivery to Decrease Your Risk of Tearing
Perineal Massage
Expecting moms often ask me what they can be doing to prepare for labor.
They want to know how to best strengthen their core, pelvic floor, and maintain mobility to feel comfortable going into this physical event.
Most women hear that they should do perineal massage but most are not sure why, how long, how often, or when to start!
Studies conducted over the last decade suggest that perineal massage can significantly influence the childbirth experience, particularly by reducing the likelihood of perineal trauma, such as tears or episiotomies, and by improving recovery times.
What is Perineal Massage?
Perineal massage is a technique in which a woman (or her partner) manually massages the perineum—especially around the lower part of the vaginal opening—in the weeks leading up to labor.
This massage is thought to increase the elasticity of the perineal tissues, reducing the risk of severe tearing during vaginal delivery. The massage is typically performed starting at 33 weeks of pregnancy, for about 5–10 minutes per day, although recommendations may vary.
Some providers recommend starting at 31 weeks, as the massage is recommended for a minimum of 6 weeks for optimal results. Not every woman goes through the full 40 weeks of pregnancy and therefore can start earlier. Starting at 31 weeks ensures that a woman has gone through the appropriate skin preparation even if she goes into labor at 37 or 38 weeks.
The Role of Perineal Massage in Preventing Perineal Trauma
One of the primary benefits of perineal massage is its ability to reduce perineal trauma during vaginal delivery, a significant concern for many pregnant women. Perineal trauma includes vaginal tears, episiotomies (a surgical incision made to enlarge the vaginal opening), and other injuries to the perineum, which can result in discomfort, prolonged healing, and even sexual dysfunction in the postpartum period.
Reduced Risk of Perineal Tearing
Several studies from the last decade have consistently supported the claim that perineal massage can lower the risk of perineal tears, particularly severe third- and fourth-degree tears.
A 2016 meta-analysis published in BMC Pregnancy and Childbirth reviewed 14 randomized controlled trials involving nearly 10,000 women and found that perineal massage decreased the incidence of severe perineal tears (third- and fourth-degree) by about 40%.
The study also indicated that the massage was associated with a reduction in the need for episiotomy. The positive effect is believed to arise from the gradual stretching of the perineal tissues, which allows them to adapt better to the pressures/stretching of delivery.
Decreased Need for Episiotomy
Episiotomies have been a common intervention during vaginal births, particularly for first-time mothers or women experiencing labor complications. However, they have been associated with increased pain and longer recovery times.
Evidence from a 2020 systematic review in The Cochrane Database of Systematic Reviews showed that perineal massage could lower the likelihood of requiring an episiotomy, with a decrease of approximately 10-20%.
This is likely due to the tissue's enhanced elasticity, which can reduce the need for surgical intervention to facilitate the birth process.
Shorter Recovery Time
Research has also shown that perineal massage can reduce recovery time following childbirth.
A 2018 study published in Birth examined the long-term effects of perineal massage and found that women who performed the massage experienced less pain, fewer complications, and healed faster post-delivery compared to those who did not.
Women who had fewer perineal injuries, such as minimal or no tearing, were more likely to return to normal activities quicker and report better postpartum satisfaction.
How Perineal Massage Works
The mechanism behind perineal massage is based on the theory that the tissues of the perineum become more elastic and less likely to tear under pressure.
During the massage, gentle, consistent pressure is applied to the perineum, which may help to stretch and soften the tissues, making them more flexible when the baby’s head moves through the birth canal.
Who Can Benefit from Perineal Massage?
Most research focuses on women giving birth for the first time, as they tend to have a higher risk of perineal trauma.
However, recent studies have shown that even multiparous women (those who have given birth before) can benefit from perineal massage. Although the incidence of severe perineal tears may be lower in women with previous vaginal births, the practice can still reduce the likelihood of other complications and aid in faster recovery.
Potential Risks and Considerations
While perineal massage is generally safe when performed correctly, there are a few risks and considerations to keep in mind.
For instance, excessive pressure or improper technique could lead to discomfort or injury. Women who attempt perineal massage should be cautious and ensure that their hands are clean to reduce the risk of infection.
It's important to note that perineal massage is not recommended for all pregnant women. Women with certain conditions such as placenta previa, vulvar varicosities, active genital herpes, or other complications should avoid perineal massage or consult with their healthcare provider before attempting it.
Proper Technique
A pelvic health physical therapist can play a crucial role in helping expectant mothers perform perineal massage safely and effectively.
They can provide personalized instruction on the correct technique, ensuring that the massage is done gently and in a way that maximizes its benefits. They can teach women how to use the appropriate amount of pressure, where to focus, and how to maintain proper hygiene to avoid the risk of infection.
Additionally, pelvic physical therapists can guide women in understanding their body’s response to the massage, adjusting technique as needed for comfort or effectiveness. This professional guidance ensures that women feel confident and knowledgeable when performing the massage, ultimately optimizing the chances of a smoother labor and delivery.
Looking for pelvic health physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one sessions to address your pelvic health concerns, we provide pelvic health physical therapy services to women in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pelvic concerns, we’ve got you. We’re here to help you if you’re experiencing pelvic pain, pelvic heaviness, leaking, or are pregnant/postpartum and want to continue safely working out/running/lifting during your pregnancy and get back to your sport after birth.
Get started today by booking a discovery call.