Perineal Massage During Pregnancy: What It Is, How to Do It & Why It Matters

You may have heard your grandmother or mother talk about massaging the area below your belly during the final trimester to help ease delivery. This is called perineal massage - a research-backed technique that reduces the risk of tearing and the need for an episiotomy during vaginal delivery. Read on to learn everything you need to know about it.

Key Takeaways

• The perineum is the tissue between the vaginal opening and anus that stretches during birth
• Start perineal massage during pregnancy from 34 weeks onwards
• Proven to reduce episiotomy rates, especially in first-time mothers
• Can be done by yourself or your partner using a natural oil
• Once or twice a week for 4–5 minutes is enough
• Avoid if you have infections, placenta praevia, or preterm labour risk

What is Perineal Massage?

Perineal massage is a gentle technique used in the final weeks of pregnancy to stretch the perineal tissue as a part of birth preparation. Often, women undergo a lot of pain and vaginal tears during the vaginal birthing process. Perineal massage done a few days before delivery helps relax and ease these muscles and stretch the perineal tissues. This practice has shown a reduction in episiotomy rates or suturing during delivery.¹

What is the Perineum?

The perineum is the skin and muscle tissue between the vagina and the anus. ² During vaginal delivery, this tissue stretches to allow the baby to pass through. Many times, this tissue is not flexible enough, leading to a tear or a lot of pain. Doctors perform an episiotomy - a small surgical cut in the perineum to prevent the tearing and trauma.³

A perineal massage is the practice of preparing this tissue beforehand to flex and stretch easily during delivery to avoid the chances of episiotomy or tear. ⁴

When Can I Start Perineal Massage?

A perineal massage can be started from the 34th week of pregnancy. ⁵ 

How Can Perineal Massage Help During Birth?

Regular massaging and stretching of the perineal tissues in the final weeks of pregnancy helps to make these tissues more elastic and flexible. As per research, women who had undergone perineal massage before delivery had significantly lower rates of severe perineal trauma, tear or the need of an episiotomy. ⁶

How Is Perineal Massage Done?

Perineal massage can be done yourself in the following ways:⁷

• Wash your hands thoroughly
• Sit in a comfortable position with back support and place one foot on a raised surface.
• Use a natural oil like coconut, almond or a water-based lubricant.
• Place your thumb or index finger about 3-4 cms inside the vaginal opening and apply this oil.
• Apply gentle downwards pressure towards the anus and hold for 1-2 minutes.
• Then slowly sweep in a U-shaped motion side to side for 4-5 minutes.

These steps, done daily in the final weeks before delivery, help to loosen and stretch the perineal muscles, enabling easier vaginal delivery. 

Important Tips To Keep In Mind

While performing a perineal massage is easy, there are some tips to keep in mind:⁸

• Stop immediately if you feel a sharp pain. While mild stretching is normal, you should not experience any pain
• Trim your nails and wash your hands thoroughly before starting
• Breathe normally
• Try this massage after a warm bath when the tissues are more relaxed

How Often Should I Do Perineal Massage?

A perineal massage should be done once or twice a week for a month. This frequency is enough to reduce the risk of episiotomy. Consistency matters more than frequency here - regular practice from 34 weeks until delivery makes a substantial difference in stretching the perineal tissues. ⁴ 

When Should I Not Do Perineal Massage?

You should avoid doing perineal massage if you have the following issues: ⁸

• A vaginal infection like thrush, bacterial vaginosis, genital herpes, etc.
• Placenta previa
• A history of preterm labour
• If your doctor has advised against vaginal penetration. 
• Stop immediately and call your doctor if you notice any bleeding, pain or unusual discharge.

Conclusion

Perineal massage is a science-backed massage technique to reduce the risk of vaginal tear, trauma and episiotomy during vaginal birth. It is a gentle massaging technique done at the last stages of pregnancy to ease, relax and stretch the perineal tissues to enable an easier delivery.

Ask your doctor if you need guidance on how to do it properly. With consistent practice from 34 weeks, this simple step could make a meaningful difference to your birth experience - and your recovery after it.

FAQs

Q1) Can my husband do my perineal massage?

Yes, many women find it easier to let their partners do this massage for them. This is because it becomes difficult for them to reach down properly in the later weeks. Just ensure your partner’s hands are clean and nails trimmed. Teach them the proper technique of using a natural lubricant and using gentle motions downward and circular pressure. 

Q2) Is 39 weeks too late for a perineal massage?

No, not at all. You can start with perineal massage at 39 weeks. Even a few sessions done at this time can help to soften the tissue and relax your perineal muscles.  

Q3) Why should you not do perineal massage before 34 weeks?

 Perineal massage stimulates the vaginal nerves that can inturn stimulate oxytocin - a hormone that triggers contractions. Performing perineal massage before 34 weeks can lead to an increased risk of preterm labour. ⁹