Learn how to do a perineal massage during pregnancy to prevent tearing and minimize the risk of having an episiotomy during labor and delivery. Instructional video with helpful tips for pregnant moms.

This post contains affiliate links. For more information, see my disclosures here.

Have you heard about perineal massage and perineal stretching to help reduce the risk of tearing during childbirth but you’re not quite sure what it is or how to do it? It’s the topic that no one really talks about when it comes to childbirth but every woman wants to know. 

Perineal massage is a preventive measure that many women choose to do in order to experience a more tolerable childbirth that reduces the risk of tears and episiotomies.  In this article you will have the “what, why, where, when and how’s” answered in regards to perineal massage. You’ll have a better understanding of what perineal massage is, where it is to be performed on your body, when to do it, what oil is safe to use and how to properly do a perineal massage during your pregnancy. 

Perineal Massage Video

*Warning: Do not use coconut oil as stated in the video but rather prenatal massage gel (continue reading further down to learn what the safest recommend massage gel is during pregnancy). All other content in this video is recommended.

Physical Therapist’s Perspective of Perineal Massage

I am a strong advocate of perineal massage and have done it with all 4 of my pregnancies. Two of my 4 pregnancies I did not have any tearing at all and the other two I had mild grade 0.5-1 tearing that was so small that I only needed a couple stitches (I could barely feel it). 

Any constant stretch of a tissue will cause it to become more elastic and flexible, regardless of what muscle you are stretching (quads, calves, hamstrings, etc). The same goes for the perineum. Stretching the perineum for prolonged durations, consistently over longer periods of time will result in a more flexible birth canal!

Related: Do You Know The 7 P’s For Successful Childbirth

The most significant benefit for me from performing perineal massage regularly the last 3-4 weeks of my pregnancy was that it prepared me to develop a tolerance to the stretching sensation that I was going to feel during natural delivery. 

The stretching sensation that causes a stinging and tingling feeling is extremely similar to the feeling you have as your baby’s head begins to crown. Being prepared and less fearful of the pain that might occur makes a world of difference when it comes to natural childbirth. Start with the perineal stretches to get a better idea of what you’re going to feel on delivery day. 

What Is Perineal Massage?

Perineal massage during pregnancy involves the gentle, manual stretching of the tissues that stretch the birth canal.

Some know it as “birth canal widening” as this is a very old practice and has been around for decades.

“If done daily, this technique softens the skin, improves elasticity, and increases the ability of the perineum—the area between the anus and the lower aspect of the vagina—to stretch, leading to less tearing and less need for an episiotomy during a vaginal delivery.” Kecia Gaither, M.D.

Why Do A Perineal Massage? – The Benefits

1. Reduce the pain that could be experienced during the crowning phase of delivery (also known as the “ring of fire”)
2. Prepare you mentally for the sensation of childbirth
3. Reduce risk of tear
4. Reduce risk of episiotomy
5. Improve the flexibility and the ease of stretch of the perineum when the baby’s head comes out
6. Baby’s head to come out quicker

Where Is The Perineum?

The perineal massage will take place in your perineum. The definition of perineum is…

per·i·ne·um

/ˌperəˈnēəm/

1. the area between the anus and the vulva.

2. an area of tissue that marks externally the approximate boundary of the pelvic outlet and gives passage to the urogenital ducts and rectum also : the area between the anus and the posterior part of the external genitalia especially in the female.

The specific area that the perineal massage is performed on is the bottom region of your vagina, the area closest to your anus. The lower right and left sides of your vagina are also an area of focus for perineal massage during pregnancy. The perineum is also known as  the lower portion of the birth canal.

Related: 6 Physical Therapy Recommended Exercises For An Easier Labor And Delivery

This is an area that is at high risk of tearing during childbirth because even though it is strong, it is not very flexible. The inability to stretch very well during childbirth results in many cases of tears and episiotomies.

What Are The 4 Types Of Tears During Childbirth: Classification of Stages

Episiotomies are performed in 20% of childbirths. Though this is high, the rate continues to decrease year after year. Tearing is more likely to occur in women who are giving birth vaginally for the first time, who need forceps and/or vacuum assistance. 

There are 4 degrees to tearing: 

1. First Degree Tear-superficial

2. Second Degree Tear-vaginal lining and deeper (submucosal) tissues of the vagina

3. Third Degree Tear-tears go into the deeper layers of the vagina and the muscles that make up the anal sphincter

 4. Fourth Degree Tear-encompasses all of the above and extends right through to the rectal lining.

If you need more information on perineal tearing that occurs during childbirth, definitely check out Parents.com for more information.

“Though the national average remains too high, the significant decline in the rate of episiotomies is an encouraging sign. We salute the clinicians and national and regional health care organizations across the country who have led the way in these improvement efforts. More is needed to meet the standard for quality, but progress so far has made a real difference in the health and well-being of women in the United States.” – Leapfrog President and CEO Leah Binder.

When Should You Start Perineal Massage During Pregnancy and How Often?

This is only to be done during the last trimester, specifically during the last 4-6 weeks of pregnancy (34-36 weeks pregnant) because the sole purpose is to prepare for childbirth.

There is no reason to start in your first or second trimester. It’s not the most comfortable thing to experience, so why put yourself through it that early if you don’t have to? What’s most important is that you prep your body before you are to possibly go into labor.

Related: How To Be Fearless During Natural Childbirth

It doesn’t matter what time of day you do it, but you definitely want it to be a time when you are relaxed and comfortable. It only takes 5-10 minutes (at most 15 if you can tolerate that long) and most women prefer to do it at night before going to bed.

How To Do A Perineal Massage During Pregnancy

1. Prepare a place for you to do the perineal massage, whether it be a comfortable chair or your bed with both knees bent. You may even want to do it standing in a shower with one leg propped up.

2. Have massage gel near by. The only safe gel that is recommended for perineal massage during pregnancy is BabyIt Perineal Massage and Postpartum Comfort Gel  (one of the APA’s corporate sponsors). Avoid using coconut oils and other lubricants (pure vegetable oil or vitamin E oil) as this could be harmful to a pregnant woman’s body and cause infections.

BabyIt Perineal Massage and Postpartum Comfort Gel

“Avoid using natural oils, like coconut or almond oil, as these products contain oxidative, inflammatory chemicals and are linked to an increase in vaginal infections” – American Pregnancy Association 

3. Get a towel to sit or lie on

4. Wash your hands with soap and water, dry thoroughly

5. Apply massage gel to thumbs, use a liberal amount initially so that your skin is covered and reapply as needed so that you are comfortable throughout the massage

6. You may want to try using different fingers, start with 1 thumb and then use both thumbs. You may also want to try using your index or middle fingers. Whatever is most comfortable for you.

7. Insert your thumbs about 1 inch into your vagina. Typically this is the length from the tip of your thumb to your first knuckle. Your thumb pads will face down and your palms will be resting on your thighs

8. Focus on massaging the back/bottom part of your perineum which is the area closest to your anus. Massaging this part of your birth canal will help the tissue to stretch and expand more easily during childbirth.

9. There are various ways to stretch this area but the goal is to gradually increase the amount of pressure through your fingers over time. 

10. Push down towards your anus

11. Push down and sideways to the right and left with both thumbs

12. Hold the position for 20-30 seconds and as long as 2 minutes and focus on relaxing. 

13. You may also want to continuously massage back and forth from bottom to sides without stopping, making a U-shaped movement for 2 minutes.

14. Readjust and repeat, performing for a total of 10 minutes (minimum of 5, maximum of 15 minutes) 

15. You may feel discomfort, but if the pain is intolerable, stop and try again tomorrow. Remember to gradually increase the pressure each day you attempt to do the perineal massage. 

A Common Question From The Husbands: “How To Give My Wife A Perineal Massage During Pregnancy?” 

Partners can do the same technique and assist you by doing the massage himself. He would sit in front of you and use his index finger instead of his thumbs for the massage. Be sure to follow all the steps above (especially hand washing prior).

Be sure to communicate with one another about the amount of pressure that is tolerable. Be sure that both of you are relaxed and comfortable.

Does Perineal Massage Prevent Tearing? What’s The Evidence?

There seems to be conflicting evidence floating around the internet. Some articles say the evidence is non-existent, and, therefore, perineal massage is not proven to work when it comes to preventing tearing. However, there have been reports of some studies stating there has been a decrease in the risk of tearing and episiotomies during childbirth.

“Beckmann and Garrett found that women who were randomly assigned to do perineal massage had a 10% decrease in the risk of tears that required stitches (aka ‘perineal trauma’), and a 16% decrease in the risk of episiotomy – but these findings were only true for first-time moms.”

–Lamaze.org 

Just because there is conflicting evidence, it doesn’t mean that there’s no reason to try anyways. Why not try with the possibility that it might help you during your delivery of your baby. 

The bottom line is, there is little to no risk in performing perineal massage and every little bit can help in some way or another. The stretching that you do during the massage prepares your skin to be more flexible during the stretching that occurs during the crowning phase. 

And most of all, keep in mind that the sensation that you feel during the perineal massage is extremely similar to the sensation you feel during childbirth. So the simple fact that your mind and body are more prepared and know what to expect when the time comes to deliver will just help you to be more relaxed and less fearful. Being in the know is better than not, so go ahead and give it a try and know what it’s like to feel the stretch of your perineum during childbirth.

If fear is something that you are facing as you near the end of your pregnancy, take a moment to read this post How To Be Fearless During Natural Childbirth.

And do you know the 7 P’s of A Successful Childbirth? If not, you’ll definitely want to read all about it before the last few weeks of pregnancy slip on by in a flash. 

Keep Smiling,

Dr. Jena Bradley, DPT

This post contains affiliate links. For more information, see my disclosures here.

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