Perineal Massage: Worth a Try or a Waste of Time?

If you're moving into your last trimester of pregnancy, chances are you've heard something about perineal massage—the practice of gently stretching the skin between the vagina and the anus in order to "condition" the tissues for birth. The theory is that having a more stretchable perineum lessens your chances of tearing during delivery, and that it may even help you avoid an episiotomy.

Does it Work?

Perineal massage during late pregnancy has long been supported by anecdotal evidence, but clinical research has been less conclusive; however, a recent review of randomized, controlled studies of complementary and alternative medicine practices used during pregnancy showed that perineal massage may truly be helpful, says Frank Anderson, MD, MPH, an assistant professor of Obstetrics and Gynecology at the University of Michigan Medical School.

Dr. Anderson, who co-authored the review, notes that while more research is needed, the three studies of perineal massage examined in the review showed that it does seem to result in a greater likelihood that the perineum will be intact at the time of delivery.

The studies also showed that perineal massage is most effective in women having their first baby. If you've had an episiotomy or tearing in a previous delivery, perineal massage may not work as well for you. "In multiparous women who have had previous episiotomies, the perineum contains scar tissue that is weaker than normal tissue, so the perineum will be more likely to tear at subsequent deliveries and will be less likely to respond to massage," says Dr. Anderson.

Perineal massage also seems more helpful to first-time moms over the age of 30, says Dr. Anderson, noting that this could be due to older tissues being stiffer than younger tissues.

Should You Try It?

Proponents of perineal massage point out that it may have other benefits besides helping the perineum stretch. Practiced regularly, perineal massage may also help you cope with the stinging sensation you'll feel as your baby's head crowns.

In addition, perineal massage may have the effect of focusing the mother's determination, says Peg Plumbo, CNM, a certified nurse-midwife and instructor at the University of Minnesota School of Nursing. "The type of woman who wants to do perineal massage is the same one who is motivated to find a care provider who blends with her birth philosophy and who will work with her for the extra time it takes to deliver baby gently and slowly," notes Plumbo.