Tearing during childbirth is common (more than 70% of women experience perineal trauma in childbirth) especially for first time vaginal births, and in vacuum or forceps assisted deliveries (Beckman and Stock, 2014; Aashiem, Nilsen et al. 2011). Studies have found that perineal massage before birth has a positive effect on the incidence of perineal trauma at birth among first time moms. Second time moms experience a significant reduction in pain three months postpartum.
What is perineal massage?
Perineal massage stretches the inner tissue of the lower vagina. Perineal massage teaches you to respond to pressure in your vagina by relaxing your pelvic floor, and can increase muscle and tissue elasticity. It is also thought to enhance the hormonal changes that soften the connective tissue in late pregnancy. I include instructions on how to massage your perineum later in this post.
How do I go about it?
Typically, women start massaging around 34-35 weeks of pregnancy, and are encouraged to spend 5 – 10 minutes 1-2 times a week. Recent studies indicate that the more frequently women use perineal massage, the less likely they are to experience the benefits. Specifically, women who did perineal massage 1.5 times a week experienced a 17% reduction in perineal trauma and a 17% reduction in episiotomy. In contrast, women who massaged between 1.5-3.4 times a week experienced only an 8% reduced risk of perineal trauma. So, the less frequent the massage, the more beneficial the outcomes.
In a Cochrane Review, women who massaged their perineum once or twice a week beginning at thirty-five weeks of pregnancy were compared to women who did nothing. Researchers found that women who were assigned to do perineal massage experienced a 10% decrease in risk of tears requiring stitches (aka perineal trauma), and a 16% decrease in the risk of episiotomy, however these findings were only significant for first time moms.
Although second time mothers did not experience the same reduction in risk of stitches and episiotomy in childbirth, second time mothers reported a significant reduction (32%) in the incidence of pain at three months postpartum. More frequent massage in second time moms was associated with a reduction in perineal pain postpartum.
So, for first time moms only, perineal massage 1.5 times a week during pregnancy has been found to decrease the risk of episiotomy, as well as a decrease the risk of trauma requiring stitches.
For second time moms, frequent perineal massage (between 1.5-3.4 times a week) is associated with a reduction in pain postpartum.
How to do a perineal massage:
- Find a comfortable position (legs bent outward while lying on the bed, standing with one foot on the edge of a bathtub or counter, sitting on the toilet)
- Use unscented oil such as olive, sunflower, or sweet almond oil. Insert one or both thumbs in the entrance of the vagina.
- Pressing towards the back of your vaginal wall, move your thumbs back and forth in a U-shape, focusing on relaxing your muscles at the same time. First downward for 2 minutes, and then sideways for 2 minutes.
- Massage for around 5 minutes each time. Remember your breath as you do this – count to four on your inhales, hold, and count to four on your exhale.
- You can try pushing harder each time you do a perineal massage.
Or if you prefer, a medical explanation how-to: “Digitally stretch perineal tissues by inserting lubricated fingers 1.5 inches into the lower portion of the vagina and slowly massaging downward in a U-shaped movement” (Beckmann and Stock, 2014).
Questions? Feel free to check out any of these sources:
- 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.
- 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.
- Beckmann and Stock (2014). “Antenatal Perineal Massage Decreases Risk of Perineal Trauma During Birth.” Evidence Based Nursing:17(3): CD005123
- Soong, B. and M. Barnes (2005). “Maternal position at midwife-attended birth and perineal trauma: is there an association?” Birth 32(3): 164-169.
- Rebecca Dekker of Evidence Based Birth: What is the evidence for Perineal Massage during pregnancy to prevent tearing?
- Linda Geddes of Bumpology (2014)