Can This Massage Technique Really Prevent Tearing During Labor?

Although medical opinions differ about how effective perineal massage is in preventing tears during vaginal childbirth, there is evidence that first-time moms who receive perineal massage are less likely to tear and less likely to require an episiotomy, reports the International Urogynecology Journal. They healed faster, as well. "Perineal massages may also decrease the burning and perineal pain during labor," Dr. Pero adds.

Another study in the Journal of Maternal-Fetal & Neonatal Medicine found that perineal massage during labor also helped reduce the risk of severe tearing.

As for how it works: "Perineal massage — [performed] before labor, called antenatal, or during the second stage of labor — is intended to decrease perineal muscular resistance and reduce the likelihood of laceration at delivery," Dr. Pero says. "The physiological explanation is that a perineal massage increases the elasticity of the tissue that would naturally be stretched and at risk of tearing during labor."

But perineal massage isn't the only effective method to prevent tearing. "Putting warm compresses on the vulva and perineum during pushing has been shown to reduce the incidence of third-degree and fourth-degree tears during labor, which both involve the tissue extending from the vagina to the anus and the tissue involving the anus," Dr. Pero says.

Birthing position may also make a difference, she says. In one 2012 study, "lateral birthing position with delayed pushing (meaning laying on your side instead of your back and waiting to push until you feel pressure, not just when you are fully dilated) was compared with lithotomy (back) positions and pushing at complete dilatation (being 10 cm dilated)," Dr. Pero says. The result? People in the lateral position with delayed pushing were more likely to deliver with no tears. Again, this doesn't mean this will work for everyone — but it could be something to discuss with your care team prior to giving birth.

The good news is that perineal massage can be performed at home. "There are at-home perineal massage devices to help you get to hard-to-reach places," Dr. Pero adds. "But I really encourage pregnant women to see a pelvic-floor therapist at least to get educated about their pelvic floor and how to most effectively perform these massages and optimally prepare for childbirth," she stresses, saying: "Pelvic-floor PTs are not expensive, and most are covered under your insurance."

Typically, a perineal massage works like this, according to information from Lamaze International: you or your partner can begin by inserting their lubricated thumbs and index fingers about two inches into the vagina and applying pressure. Experts recommend applying pressure downward for two minutes first, and then sideways for two minutes in each direction. Under no circumstances should pregnant people use any object other than a pair of clean hands.

But again, it's worth setting up a visit with a pelvic-floor therapist to get instructions tailored to you. While Dr. Pero says there are few risks associated with perineal massage, you don't want to apply too little pressure (which would be ineffective) or too much (which could hurt you) or massage the area for too long each day.

Princess Lock, a nurse practitioner and nursing educator at Orlando Health's Winnie Palmer Hospital for Women & Babies, suggests giving yourself a perineal massage for 10 minutes per day, three to four times per week, starting at around 35 weeks gestation to decrease your chances of tearing while in labor.

"Any earlier than this could possibly increase chances of preterm labor due to muscle contractility and hormone release. Statistically, there hasn't been a significant benefit if done prior to six weeks before delivery. Keep in mind that a little discomfort or tingling is normal, but burning is not," Lock says.

And it can be used during delivery, too. Make sure to speak with your medical team ahead of time if this is something you're interested in including in your birth plan.

There are perineal-massage-specific lubricants, Dr. Pero says. But some oils may also work, she says: "Studies have used almond oil, but olive or coconut oil can work as well."

One thing to be aware of: "Reactions to the lubricant can happen, so test it on your skin before putting a large amount in your vaginal area," Dr. Pero says.

Although perineal massages may help prevent tears, they're definitely not for everyone. But as long as you're planning on delivering your child vaginally, perineal massages are fair game. "[A misconception is that] the utilization of perineal massage is only for patients who want a 'natural childbirth,' meaning no epidural or delivery at a birthing center," Lock says. "This misconception sometimes prohibits a pregnant woman's desire to explore ways to enhance her birth experience."

Michaela Ward, a midwife at the Ohio State University Wexner Medical Center, adds that perineal massage shouldn't be looked at as a cure-all. "A common misconception is that all pregnant moms should perform perineal massage and that if you do so, you will not have any type of tear or require episiotomy," she says.

Dr. Pero agrees. "There are clear benefits at helping to reduce major tearing, but there is still a likelihood that you could have minor tearing even with doing perineal massage daily." But again, there are few downsides or risks to the technique, as long as you take care to ensure you're doing it correctly — so it's worth a try.