How To Do Perineal Massage | BabyCenter

Getting ready to push out a whole human? Perineal massage is one way to prep your body – and it might help you avoid tearing, stitches, and soreness after birth. Here's what to know.

Key Takeaways

• Perineal massage can help reduce tearing during vaginal birth by making the perineum (the area between your vagina and anus) more flexible.
• You can start around 34 weeks pregnant, doing it once or twice a week.
• Benefits of perineal massage include lower chances of needing an episiotomy, less postpartum pain, and fewer stitches.
• It's easy to do at home, with or without a partner, using clean hands and a little oil. Just go slow, be gentle, and stop if it hurts.

What is perineal massage?

Perineal massage is a method of preparing the tissues of the perineum – the area between your vagina and anus – for vaginal delivery. Massaging this pelvic floor area in the weeks before your baby's birth can help soften the tissues that are stretched as your baby is born. 

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You can massage your perineum yourself, or you can ask your partner to do it for you.

Perineal massage can also be done during delivery to keep the area loose so that it will stretch rather than tear.

There's decades of research on the advantages of perineal massage, but it isn't a routine part of childbirth prep, so your healthcare provider might not bring it up. If you're interested in perineal massage, feel free to ask your provider about it.

Benefits of perineal massage

The benefits of perineal massage include potentially reducing damage to the pelvic floor – the muscles that support your reproductive organs, bowels, and bladder. More specifically, perineal massage may help you avoid:

• An episiotomy
• Perineal tearing and stitches
• Scarring

   

• Postpartum urinary or bowel incontinence
• Postpartum perineum pain

Perineal massage has been proven especially helpful if you're getting ready for your first vaginal delivery or if you have very tight pelvic floor muscles (because of a previous episiotomy or tear, for example).

"I have a scar from tearing from my first pregnancy and my physical therapist recommended I do the massage on the scar specifically," says BabyCenter Community member Abermarsh. "I can definitely tell that my scar tissue needed more massaging. It was quite tender, and it's improved a lot."

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If the idea of touching scar tissue makes you wince, you're not alone – but loosening that tightness now can make a real difference later.

When done during the second stage of labor (often together with the application of warm compresses), perineal massage has been shown to significantly reduce the risk of perineal trauma, such as third- and fourth-degree tears.

Practicing perineal massage is also an opportunity to practice your relaxation skills for labor while focusing on the area that will be stretching during delivery. Women who do perineal massage in late pregnancy and during pushing report feeling more in control of their labor.

"I did not [massage] with my first and did tear; did the massage with my second and did not tear," shares Community member EmM15af. "I'm not sure if it was the massage itself that helped or the practice with relaxing down there that helped. It definitely let me feel the difference when I relaxed, and I think that made the biggest difference during labor." (You're also less likely to tear if you've had a vaginal delivery before.)

Curious what else might help with birth prep? The BabyCenter app serves up expert-backed tips right when you need them – including pelvic floor prep, sleep tricks, and more.

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When to start perineal massage

A good time to start perineal massage is in your third trimester, around 34 weeks. Start with just once or twice a week, but you can do it every day if you want. 

It might be uncomfortable at first, and you may even feel a burning or stinging sensation as you stretch skin that isn't used to stretching. That's normal – as you breathe and relax through the stretching, you'll get more comfortable (and it's good practice for labor itself).

"I had heard that the thing that's actually the most useful about doing perineal massages is learning what part of your body to relax to lessen the ring of fire sensation," says another BabyCenter Community member. "If you can learn that before birth, then you can purposely relax the muscle during crowning and help lessen the risk of tearing."

If you try perineal massage and find it uncomfortable, you may want to do it once a week or so and then increase your sessions gradually.

How to do perineal massage

Perineal massage isn't difficult to learn. Your healthcare provider can show you how. Or you might want to visit a pelvic floor physical therapist a couple of months before your baby is due to learn the method. Some insurance companies will cover this visit, and you can get a referral from your usual pregnancy provider. 

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You can also learn to massage your perineum on your own, following these step-by-step directions (prop a mirror nearby so you can see what you're doing):

1. You can skip this step, but taking a warm bath or shower or pressing a warm compress on your perineum can increase blood supply and soften the tissue.
2. Make sure your nails are clipped and filed smooth, and your hands are clean.
3. Sit comfortably in a semi-reclined position in a quiet place. Lean back on pillows, bend your legs, and spread your knees open.
4. Put a drop or two of oil or lube on your thumbs and perineum.
5. Place your thumbs about 1 to 1 1/2 inches (to or just past your first knuckle) inside your vagina. Press down toward the rectum and toward the sides. Gently and firmly continue stretching as much as you can tolerate. It shouldn't hurt, so stop if you feel pain.
6. Hold this position for a minute or two.
7. This part is optional. Slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Massage up and down in a U shape (from 9 o'clock to 3 o'clock, if you imagine a clock face), while gently pressing outward. Keep this up for three to four minutes.
8. Finally, massage the tissue that you're holding between your thumb and forefinger back and forth for about a minute.

Having your partner massage your perineum might be easier than doing it yourself – and you may even enjoy sharing the intimacy. If you want your partner to massage you, have them follow the instructions above, but they'll use their index fingers instead of their thumbs to massage from one side to the other, gently pressing downward.

But you might be more comfortable doing it yourself – that way, you can control how firm or gentle your touch is. Some BabyCenter Community members also recommend using a pelvic wand, since it can give you more reach than your fingers.

"A vibrator can help, too, whether you turn it on or not," advises Layan Alrahmani, M.D., a board-certified ob-gyn and member of the BabyCenter Medical Advisory Board. "Use the wand or vibrator in such a way as to put pressure down on the vagina (toward the rectum, at 6 o'clock) and on the sides, going between 3 and 9 o'clock. You can hold pressure for a few minutes at each area and then move, or it can be constant pressure as you go back and forth. Don't forget to use lubricant or oil."

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Don't:

• Overdo it. Going too hard could cause bruising or swelling.
• Put pressure on the urethra (urinary opening), as this can lead to irritation or infection.
• Massage your perineum if you have any type of vaginal infection, such as a yeast infection, a urinary tract infection, or genital herpes. Talk with your doctor about treatment first.

Perineal massage oils and gels

The right oil can make the massage smoother – and way more comfortable. Here's what's safe to use:

• Vitamin E oil
• Coconut oil
• Sweet almond oil
• Sunflower oil
• Vegetable oils such as olive oil
• Water-based lubricant

Take care with how much and how often you use it, though, as oils and lubes on your most sensitive areas can raise your risk of vaginitis and vaginal irritation. And don't use anything with added dyes or fragrances, since that can irritate your sensitive skin.

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There are also gels made specifically for perineal massage. Ask your healthcare provider for recommendations on what to use.