How to Do Perineal Massage (and Why You’ll Want To)

One of the many mysteries around childbirth is: How will I push something the size of a small watermelon out of my body without breaking into two?

The short answer is, your body can do miraculous things. One way or another, you will deliver that beautiful baby of yours.

But sometimes this comes at a cost. During my first childbirth, I got a second-degree tear. Tearing is fairly common, especially among first-time moms. Less common these days though (thankfully) is episiotomy, a surgical cut between the vagina and anus to aid in delivery.

Is it possible to avoid tearing or episiotomy? Is there a way to prepare your body for that great biiiiig stretch during childbirth?

Yes.

Probably.

Okay, maybe.

Read on for everything you need to know about perineal massage.

What is the perineum?

The perineum is the soft skin between the anus and the vagina. Because of its proximity to where the baby exits the vaginal canal, as well as the pressure put on it while pushing, this delicate area is prone to tearing—especially for women having their first vaginal birth.

But not all tears are the same. Some are tiny, heal quickly, and require no special treatment. While others may end up on the other end of the spectrum, with deep lacerations requiring stitches and weeks of healing and discomfort.

If only there was something we could do to help prep this area for the flexibility and stretching required for baby to come into the world with your perineum intact… enter, perineal massage.

What is perineal massage?

Perineal massage is exactly what it sounds like: massaging the perineum. Some women do it for themselves, and others will ask their partners to help. Often, it is done throughout pregnancy.

What for? Perineal massage is done to stretch and increase flexibility in the perineum in preparation for birth, in hopes of keeping the area intact—or at least minimizing perineal trauma during delivery.

Perineal massage video

Okay, it’s an animated gif, but same difference?

Perineal massage video illustrated guides.

You’ll find more detailed instructions on how to do perineal massage below.

Benefits of prenatal perineal massage

Though there don’t seem to be any benefits to perineal massage done during the pushing stages of labor (and it may even cause trouble), perineal massage done throughout pregnancy has many potential benefits.

Easing pain during crowning

It’s said that perineal massage can ease the “ring of fire” so often experienced while baby’s head is crowning. The idea is that gently stretching the perineum regularly will allow it to stretch more easily when baby is crowning, causing less pain.

Helping the baby’s head come out easier and/or quicker

Again, if the perineum stretches more easily, baby’s head may come out more easily or quickly. It may also mentally prepare you for the feeling of pressure and stretching, and may help you become more comfortable with it. If you know what to expect, you may be less tense and more able to stretch.

Avoid tearing

In four trials of nearly 2,500 women, researchers found that perineal massage before birth reduced the incidences of perineal trauma requiring suturing in first-time moms. The study also found that women who practiced perineal massage were less likely to have episiotomies  What’s more? experienced moms who practiced perineal massaging reported less pain at three months postpartum.

Avoiding an episiotomy

The same researchers found that perineal massage throughout pregnancy also helped reduced episiotomies by 16% for first-time mothers, though it didn’t reduce the risk of episiotomy for experienced moms.

Is perineal massage worth a try?

Absolutely! Provided that you’re comfortable trying it, that is.

While there does seem to be some benefit to perineal massage, the difference hasn’t proven to be huge. So if you’re not comfortable with it, don’t stress.

If you are comfortable with giving it a try, perineal massage can only help!

How to do prenatal perineal massage

Here are the step-by-step instructions for getting started with perineal massage at home. As always, check with your healthcare provider about whether perineal massage or any vaginal massage is safe for you.

When to start perineal massage, and how often?

It’s best to start the prenatal perineal massage around 34 weeks. Any earlier, and you may just be wasting your time.

As far as how often you should do the perineal massage, the evidence is not clear. In the Beckmann and Garret review mentioned earlier, the data surprisingly suggests that less-often perineum massage (1–2 times a week) resulted in fewer perineal traumas. However, the largest study in their review showed that the more often women did perineum massage (3–4 times per week), the more likely they were to have an intact perineum.

The simple answer would be to do this vaginal massage at least once a week—and up to as often as you like.

What you’ll need to get started

  • Clean hands (yours or your partners) with neatly trimmed nails
  • Safe, non-toxic and non-irritating massage oil like almond oil, vitamin e oil, or coconut oil
  • A clean towel
  • A mirror (optional)

How to do the perineal massage yourself

First, get your body prepared.

  • Take a warm bath or use a warm washcloth compress to soften the area (10 minutes).
  • Lay in a comfortable position on a clean towel. Try propping your back up with pillows. Position mirror if needed. Keep yourself relaxed and calm so that your bottom can be relaxed and calm too.
  • Apply massage oil to the perineum.

Next, follow these three steps.

1. Insert your one or two thumbs about an inch into your vagina (about to your thumb’s knuckle), and put firm but gentle pressure straight down on the perineum. Allow the perineum to stretch for a minute or two. After it stretches for a few minutes, you may be able to get the second thumb in more easily. Slight burning or stretching is OK, but if you experience pain, use more gentle pressure, or stop the massage.

Perineal massage may help you avoid pain and tears to your perineum during childbirth. Here's how to do it, step by step, with video and photo guides.

2. Once the perineum has been stretched for a couple of minutes, gently move your thumb up along the sides of the vagina, stretching it from side to side. Think about it like running your thumb on the inside of a bowl from one side to the other.

Perineal massage may help you avoid pain and tears to your perineum during childbirth. Here's how to do it, step by step, with video and photo guides.

3.If you are using two thumbs, you can run them from the bottom up to each side, like you’re starting with your thumbs at the bottom of the bowl and running them up opposite sides.

Perineal massage may help you avoid pain and tears to your perineum during childbirth. Here's how to do it, step by step, with video and photo guides. Continue for 3–5 minutes, or as long as is comfortable.

Tip: If you’re having trouble reaching but still want to do the massage yourself, you can prop one foot up onto a chair or toilet seat (so that you’re in a lunge position) and perform the massage as described above.

How to have your partner do the perineal massage

  • Make sure you’re asking a trusted person to help you with this. It doesn’t work as well if you are feeling uncomfortable or tense.
  • Follow the directions above, except have your partner use their index fingers instead of thumbs. They will insert their fingers about an inch into your vagina, about to the knuckle.

Perineal massage bottom line

  • There isn’t a ton of research to support prenatal perineal massage just yet
  • But the info we do have shows that it can be moderately beneficial
  • If you’re comfortable with the idea, then go for it. It can only help!

Did you do perineal massage?

Do you think it was helpful? Share with us in the comments!

 

References

  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590696/
  • http://www.ncbi.nlm.nih.gov/pubmed?term=16437520

About the Author

Genevieve Howland is a childbirth educator and breastfeeding advocate. She is the bestselling author of The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth and creator of the Mama Natural Birth Course. A mother of three, graduate of the University of Colorado, and YouTuber with over 75,000,000 views, she helps mothers and moms-to-be lead healthier and more natural lives.

Cynthia Mason, CNM, APN, MSN medical reviewer at Mama Natural

Reviewed By
Cynthia Mason, CNM, APN, MSN

Cynthia Mason, CNM, APN, MSN is a Certified Nurse Midwife who has attended more than five hundred births. She works in Regional Obstetrics and Gynecology for Cleveland Clinic .

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22 Comments

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  1. I am on week 6 with my second baby and got a second degree year with my first, I asked my doctor during my first baby and she said it’s not required but this time I am planning to go ahead with it around week 34.
    My only question is if you are doing it on your own around week 34, how do you manage it with your stomach out and hanging ?

  2. I’m 7 weeks pregnant with my first and am absolutely terrified of tearing in any degree. I know it says to start in the mid-30s but I really want to start now Haha

  3. I have given birth to 5 babies and am pregnant with my 6th. For my first 4 perineal massage with evening primrose oil gel caps inserted into the vagina was a nighttime ritual starting at 36 weeks. With my 5th we had moved, I had a new midwife who didn’t recommend perineal massage, plus a fall (more like a split) that left me very tender in that area, I gladly went along with the no massage advice. It wasn’t until delivering my 5th baby that I understood what my midwife meant by “ring of fire” during my 1st delivery. The burning was excruciating. I was in tears and annoyed that my husband was wiping my tears instead of he or the midwife massaging around the crowning head. She just kept dousing oil on me which felt about like spraying a mist of water in someone’s face while the room around them is engulfed in flames! I had very small tears with my first 2 babies that did not require stitches. Needless to say with this baby I am doing perineal massage nightly until delivery. I highly recommend it!

      • 10cm diameter is the goal of perineal massage or birth canal widening; as this is the diameter of the opening in the bony pelvis, which allows the back of baby’s head to exit mum’s pelvis. The walls of the bony pelvis limit the opening of the birth canal for baby. Please see Wikipedia Perineal massage page and YouTube video ‘Epi-no massage’. For us, it saved our baby from forceps.

        • Ina May Gaskin, effectively a Nobel prize winner, in her talk ‘Reducing the fear of birth, in US culture’ at 14.58 minutes on YouTube, shows Peruvian birth educational figures, using all four fingers of both hands to achieve10cm diameter opening for baby’s head.

  4. I performed perineal massage with my first starting at 36 weeks, about 3 times a week and had no tearing whatsoever! I feel it also helped that I took my time pushing (a little over an hour) and my daughter’s head was on the smaller side. I assume it was a combo of all those factors that kept me from tearing bur I am certainly going to do the massage again this time!

  5. Hi there,
    Giving birth to a child is beautiful and painful at the same time.
    Perineal massage may be uncomfortable for most of the mothers but it has a lot of benefits. It relaxes and eases the pain at the time of delivery.
    Not only that, it also helps in post delivery as well, to reduce the tension of the muscles after delivery…
    A great piece of information.

    Great Day Ahead!

  6. I did the massage during the last month of my first pregnancy . Did it every 3 to 4 days (not 3-4 days a week…more like 1-2 times a week). I did tear but not as much as I thought. I think this time around I will start earlier and keep at it everyday to prepare myself for it.

  7. With my first I was given an episiotomy but my son also came out with his elbow out, tearing me even further, so that I ended up with not only a cut but 3rd degree lacerations. I was healed after a week but I still get phantom pains from that every time my period shows up. I’m about to have my 5th in a few months and I don’t care if there isn’t any proof that this helps women who have already had children. My hubby is gonna rub the daylights out of my perineal for the next few months if it gives me peace of mind lol!

  8. I had a fourth degree tear with my first born as well as tearing into my rectal muscle. I healed up perfectly and have zero problems with fistulas and do not suffer from incontinence.
    However, with my second birth they highly suggested a cesarean birth in preventing a possible tear again. I didn’t want to have a cesarean but felt at the time that that was probably the right decision for me. I hated every minute of the delivery process except the part of hearing my baby cry and seeing him for the first time. My recovery was an easier and quicker heaing process than my first birth. I’m pregnant with my third and want to have a natural VBAC birth. I’m not fully confident in my decision though. I really want to do what is best for ne and baby. I’m sure the perennial massage would help from tearing but I’m a tad nervous about other complications that can go along with VBAC’s as well.

    • Perineal* you got to love spell check lol 🙂

      • well, let’s not be TOO hard on her…she may have meant that she had a massage that lasted “throughout the year”…now THAT”S the kind of massage I’D like to have…a “perennial” massage…anyone?

        • She was the one that corrected herself :-/

  9. With my first baby, I had a 4th degree laceration. I healed really well and despite being offered a c section for this next baby (I’m 20 weeks), I declined and want to have another natural birth. I’m guessing this will be beneficial for me to do leading up to my next birth to help prevent another bad tear?

  10. I started to do this about 6mo into my pregnancy. My boyfriend thought I was crazy. But he eventually helped too. I was TERRIFIED that I was going to rip and tear. I did this about 3-4x a week. It was my first time giving birth and when the time came, I didn’t tear enough to to need any stitches at all. I got some small lesions that they said would heal on their own. I did feel the “ring of fire” but I know if I hadn’t of done this it would have been far worse. So glad I found this info when I did. Everyone should know about this.

  11. Great info. I am sure this is not a well-discussed topic even though it is so important. Not tearing sounds like a great plan to me.

  12. Thanks for the great info! Question- will doing this also make sex feel different with your partner since you are stretching out the vaginal area? I just feel like sex wouldn’t be as satisfying!

    • No, it won’t make a difference in that way 🙂

    • I did this 3-4x a week and had sex often with my partner. Never felt better 🙂

    • I’m on my first, so can’t say from experience. But I’ve found some good information about kegel exercises that also help prevent tearing as well as in recovery in tightening everything up. I’m at 38 weeks and just found the information, but I plan on combining the stretches with the exercises to improve my chances of preventing tears as well as in the healing process

    • These stretches stretch the perineum which is the entrance to the vagina, basically. Thankfully the vaginal vault is already highly elastic muscular tissue made to expand and contract back down. 🙂

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