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Can Perineal Massage Help Prevent Tears During Delivery?

As you approach the big day of bringing your baby into the world, you’ve likely got a laundry list of things to do. You’re finishing the last-minute touches to your baby’s room, finalizing your birth plan and getting your hospital bag ready to go

Aside from these preparations, you may also have some thoughts and worries about childbirth. For many pregnant people, one of the most common questions is: “Will I tear down there?”

Studies show that about 85% of pregnant people who have vaginal birth will experience some tearing to their perineum (the area between your vaginal opening and anus). While this stat may be shocking, trying techniques like perineal massage may help reduce your risk of tearing “down there.”

Read on to understand more about perineal massage and some tips on how to get started.

What is perineal massage?

Perineal massage is a manual technique using the pad of one or two fingers where you massage and stretch the tissue of your perineum. 

“The perineum connects with your pelvic floor muscles, the muscles that support your pelvic organs,” said Tricia Nast, CNM, a midwife with Banner Health. 

These muscles hold in pee and poop until you are ready to empty, and they have a role in sexual activity. 

During birth, the perineum thins out and stretches over your baby’s head and body during vaginal delivery. The idea behind perineal massage is to slowly soften and stretch the vagina and tissues of your perineum to allow for an easier delivery.  

Can perineal massage help me avoid a tear or an episiotomy?

By its nature, vaginal childbirth can lead to tearing. Many factors, like the baby’s size, the speed of delivery and the use of forceps or vacuums during delivery can influence if you tear. Age and previous childbirth experiences also play a role.

While there is no 100% guarantee against tearing, strong evidence shows that perineal massage may help. 

“There is research that shows perineal massage in the weeks leading up to birth may decrease the chances of tearing or needing an episiotomy (a small cut into the perineum),” Nast said. “It can be especially helpful for those who are having their first vaginal delivery or who have had a previous episiotomy.”

Perineal massage may help you get more comfortable with the sensations of birth and how to use your pelvic floor muscles. It may also help with healing, scar tissue and discomfort after the baby arrives (postpartum).

Every pregnancy and childbirth experience is unique. If you’ve had a previous episiotomy or tear and/or have concerns, talk to your health care provider. They can help you understand your risk and develop a plan to minimize the chances of tearing.

Is there any reason I should not practice perineal massage?

You should not perform perineal massage if you have any of the following:

When is the best time to start perineal massage?

It’s best to wait until you are closer to your due date(about 36 weeks pregnant), but check with your health care provider about when you should start.

“A good time to discuss perineal massage with your provider is sometime in the third trimester of pregnancy,” Nast said. “See if they are familiar with perineal massage and if they have experience with patients performing it before giving birth.”

How do you perform perineal massage?

You can massage your perineum by yourself or with your partner, if you prefer. However, it’s important to speak with your health care provider before starting. 

Once you get the all-clear from your provider, here are some basic steps to follow:

  1. Prepare for the massage: Before starting, use the bathroom and ensure your hands and fingernails are clean. It’s best if your fingernails are clipped short so you don’t scratch yourself. You can also take a warm bath or shower or use a warm compress on your perineum to increase blood flow to the area
  2. Find a comfortable position: Sit in a comfortable spot on your bed or sofa with your back supported. Bend your legs and spread your knees open.
  3. Use a lubricant: Apply a water-based lubricant,  olive oil or coconut oil onto one or two fingers or on your thumbs and perineum.
  4. Gently stretch: Place your thumbs just inside the vaginal opening. Gently press your fingers down toward your anus and outward to the sides of the vagina. Hold this stretch for a few minutes. You may feel a very slight burning, stinging or tingling sensation. The pressure should be firm enough to feel a stretch, but not so hard that it is painful or causes bleeding
  5. Massage in a U-shape: Massage from a 6 o’clock to a 3 o’clock position, then from a 6 o’clock to a 9 o’clock position. Continue to apply downward and outward pressure.
  6. Pay attention to scar tissue: If you had a previous tear or episiotomy, the area will not stretch as easily and may need extra stretching.
  7. Remember to breathe: Take slow, deep breaths while massaging. This will help to relax your muscles.
  8. Repeat: You can perform the massage as often as one to two times a day for about two to three minutes at a time. 

Figuring out perineal massage can feel a bit weird or awkward at first. It’s normal to feel that way. Don’t stress about doing it perfectly or feeling a bit uncomfortable with the process in the beginning.

“The practice of perineal massage allows you to understand your body better and prepare for the sensations of giving birth before the actual experience,” she said. “You don’t have to do it ‘right’ for it to be helpful. What matters most is your comfort and well-being.” 

Bottom line

If you are a little nervous about tearing “down there” during childbirth, perineal massage may be a good method to try. While it does not guarantee you won’t tear or need other procedures like an episiotomy, it can help you understand your body and begin to prepare for childbirth.

Talk to your health care provider or a Banner Health specialist about perineal massage and if this technique is right for you.

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