Find out what perineal massage is and how it might work to help you avoid a tear or episiotomy when you give birth.
What is the perineum?
The perineum is the area of skin and muscle between the vagina and anus.
What can happen to the perineum?
The pressure of giving birth on your perineum means it may tear or need an episiotomy (surgical cut) when your baby is born.
"Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy (NHS 2020)."
An episiotomy is a non-routine surgical cut to the vaginal opening, which is intended to prevent more serious tears.
Up to one in 10 women experience pain for up to 18 months after a serious perineal tear or episiotomy (Frohlich & Kettle, 2015).
Yet there is something you can do that might help – perineal massage. Research has shown that perineal massage reduces the chance of a perineal tear or episiotomy (Abdelhakim et al, 2020).
Another review showed that pelvic floor exercise and perineal massage reduced perineal trauma, while the EPI-NO perineal dilator (marketed as a childbirth and pelvic floor training device) had no benefit (Schreiner et al, 2018).
What is perineal massage?
Perineal massage is a way of helping to prepare the perineum for childbirth, making it more flexible so it can stretch more easily during labour (Beckmann and Stock, 2013). Massaging the perineum reduces the chances of a tear or an episiotomy during labour and perineal pain afterwards (Abdelhakim et al, 2020). This is particularly the case for women giving birth vaginally for the first time (Beckmann and Stock, 2013).
Perineal massage involves massaging the area between the vagina and anus during late pregnancy. Some women massage their perineum themselves, while others prefer to get their partner to help.
When can I start doing perineal massage?
From when you’re 35 weeks pregnant onwards (RCOG, no date a).
How do I do perineal massage?
Can perineal massage help me avoid a tear or an episiotomy?
It’s possible, although not guaranteed. A number of things can affect whether you tear or have an episiotomy during childbirth.
Is there anything else I can do to prevent a tear or an episiotomy?
- A kneeling, side-lying, or all-fours position may help reduce pressure on the perineum (RCOG, no date a).
- When the baby's head becomes visible, your midwife will suggest you stop pushing and take some quick short breaths and blow out through your mouth. This helps your baby’s head emerge slowly, giving the perineum a chance to stretch gently.
- A warm compress on your perineum, or a 'hands-on' birth where the midwife supports the perineum as the baby is born, may also help reduce tearing (RCOG, no date a).
- Some women like to use a mirror to help guide their pushing gently.
- Some people feel using water in labour helps reduce the chance of tearing, though evidence is mixed.
It’s also a good idea to keep up your pelvic floor exercises throughout pregnancy. This helps ensure your pelvic muscles are supportive during pregnancy, you can release them during labour and they return to being supportive after you give birth.
If you need further information about or support with perineal massage talk to your antenatal teacher, midwife or GP.
This page was last reviewed in March 2021.
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about having a baby, labour and life with a new child.
The Royal College of Obstetricians and Gynaecologists (RCOG) has an information hub for perineal tears and episiotomies in childbirth. You can find out more about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear. It also covers what to do if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.
Abdelhakim, A.M., Eldesouky, E., Elmagd, I.A. et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 31, 1735–1745 (2020). https://doi.org/10.1007/s00192-020-04302-8
Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3… [Accessed 1st September 2018]
Schreiner, L., Crivelatti, I., de Oliveira, J.M., Nygaard, C.C. and dos Santos, T.G. (2018), Systematic review of pelvic floor interventions during pregnancy. Int J Gynecol Obstet, 143: 10-18. https://doi.org/10.1002/ijgo.12513
Frolich J, Kettle C. (2015) Perineal care. BMJ Clin Evid. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356152/
NHS (2020) Episiotomy and perineal tears. Available from: https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/ (Accessed 9 Apr 21)
RCOG (no date a) Reducing your risk of perineal tears. Available at: https://www.rcog.org.uk/en/patients/tears/reducing-risk
RCOG (no date b) Episiotomy. Available at: https://www.rcog.org.uk/en/patients/tears/episiotomy/