Perineal Massage During Pregnancy
Have you heard that doing perineal massage during pregnancy might reduce your risk of tearing?
If so, you aren’t alone. But let’s start at the beginning.
What is a perineal tear? And is it normal to tear during birth?
A perineal tear is a tear of the perineum, in particular, the space between the vagina and rectum and yes, it’s totally normal. In fact, up to 80-90% of first-time vaginal births result in some degree of tearing. The good news is that most tears are minor and heal quickly. And they can often be avoided!
These tears can be rated from first through fourth degree, with fourth degree being the most severe. It’s especially important to avoid 3rd and 4th degree tears because they can have severe health consequences, including Obstetric Anal Sphincter Injury.
One of the most impactful ways to reduce your risk of tearing is to adapt practices that reduce your risk of episiotomy, since that’s one of the strongest risk factors for ending up with 3rd or 4th degree tear, and to choosing a supportive provider.
This includes choosing a provider and hospital with a low rate of episiotomy and educating yourself about birthing positions. Birthing with a midwife and hiring a doula can also reduce your risk of episiotomy.
The idea behind perineal massage is that it’s done to increase tissue elasticity, by increasing blood flow to the area. Starting around 34 or 35 weeks, you’re typically instructed to insert 1 or 2 lubricated fingers into the vagina, up to the first knuckle or so, and apply downward pressure, then sideways, for a few minutes in a U-shaped motion. Instructions for how often and for how long vary.
Worth keeping in mind: there are serious concerns and questions about the quality of many of the studies available on the subject.
According to Evidence Based Birth, “We’re not really sure if the perineal massage works because it increases tissue elasticity or because there’s a greater motivation, you’re constantly thinking about protecting your perineum and avoiding an episiotomy, so that leads you to collaborate better with your care provider to avoid perineal trauma, perhaps by working them to have a slower, more controlled birth of the baby’s head.”
What do you need to know for your best birth?
1) There is evidence that perineal massage during pregnancy may be associated with benefits but only if you’re a first time birthing person.
2) These benefits were seen in birth settings with extremely high rates of episiotomy and may not be generalizable to people where giving birth where rates of episiotomies are less than 20%.
3) Who you choose as a provider is one of the strongest predictors of whether or not you’ll have an intact perineum, meaning 0 tearing. Data supports midwifery care = less likely to need an episiotomy.
4) Birth setting also makes a huge impact - home and birth center settings are associated with a lower risk of tearing.
5) Pushing position matters. Using an epidural? Try side lying positions and labor down to greatly increase your rate of an intact perineum. Laboring unmedicated? Upright positions can lower your risk for an episiotomy and severe tears. Hands and knees is a long-time favorite!
6) Warm compresses increase the rate of having an intact perineum while also reducing the risk of episiotomy and 3rd and 4th degree tears.
Schedule a session to learn more about reducing your risk of tearing and increasing your chance of an intact perineum.
