Tearing is common during vaginal birth, with spontaneous tearing reported in 25% to 90% of cases. It is more likely with a first vaginal birth or when forceps or vacuum assistance is used. Tears are classified as first through fourth degree: first-degree tears affect the perineal skin, second-degree tears include the perineal muscle, third-degree tears reach the anal sphincter, and fourth-degree tears extend to nearby tissues. Among first-time birthers, third- and fourth-degree tears occur in about 3% to 6.5% of vaginal births. Risk is higher with a first vaginal birth, a baby in a posterior position or with higher birth weight, and births involving forceps, vacuum assistance, or episiotomy.
What is perineal massage?
Research suggests perineal massage may improve blood flow, increase tissue flexibility, widen the vaginal opening, and reduce episiotomy and perineal trauma during birth. It is usually started 4–8 weeks before the due date, around 34–35 weeks’ gestation. Massage can be done daily for 5–10 minutes while sitting or lying down, by the birther or their partner.
How does one perform perineal massage?
Before beginning perineal massage, the pregnant person should discuss it with their healthcare provider, for example, conditions such as a vaginal infection make it contraindicated prior to treatment. Start with clean hands and trimmed nails. Some people find massage easier after a warm bath, which can soften and relax the tissues. Perineal massage may be done in several positions, including sitting on the toilet, standing with one foot raised, supported squatting, or sitting while leaning back. Lubricate the fingers with gel or organic oil, such as sweet almond, olive, or coconut oil. Avoid baby oil, petroleum jelly, and mineral oil in the vaginal area because they may increase the risk of yeast or other vaginal infections. To begin, use two fingers or the thumbs to apply gentle downward pressure just inside the vaginal opening until a mild stretching sensation is felt, without pain. Hold this pressure for about one minute, then gently massage the lower part of the vaginal opening in a U-shape for 2–3 minutes. Repeat the process for a total of 10 minutes. After about two weeks, the birther may notice greater tissue elasticity. Eventually, they may be able to apply slightly more pressure without pain, allowing for increased stretching of the tissue.
What is the evidence for perineal massage?
One pilot study and three different systematic reviews, one of which as a meta-analysis of the data, reported on the benefits of antenatal perineal massage starting between 32 and 35 weeks gestation. The results were as follows:
- Reduced risk of perineal trauma (including more intact perineum at birth)
- Reduced risk of episiotomy
- Reduced perineal edema in the first 10 days postpartum
- Reduced risk of perineal pain up to 3 months postpartum and reduced need for analgesics
- Reduced risk of third- and fourth-degree tears (with perineal massage and exercise)
- Reduced risk of involuntary passing of gas in the first 45 days postpartum
Other results:
There were no differences between women who did prenatal perineal massage and those who did not regarding the following:
- Spontaneous vaginal birth
- First- and second-degree tearing
- Urinary incontinence at 3 months postpartum
- Fecal incontinence at 3 months postpartum
Wait, I'm confused. You say that there was a decrease in perineal trauma and intact perineum but there was no difference in first- or second-degree tears. How can this be?
Perineal trauma includes injuries that may require stitches, such as episiotomies. Perineal massage lowered the overall risk, but not enough to show clear differences in specific outcomes like first- or second-degree tears. The reduction may be linked to fewer episiotomies in the massage group. In addition, the researchers found evidence of publication bias in the findings showing no significant difference in first- or second-degree tearing and in the reported reduction of third- and fourth-degree tears, but not in other results. So, some results may be more reliable than others because bias may have affected the findings.
Why would perineal massage during pregnancy reduce the rate of episiotomies?
Researchers suggest that birthers taught perineal massage may have been especially motivated to avoid perineal tearing and therefore more likely to decline an episiotomy. With fewer episiotomies, fewer people would have trauma that required stitches.
So, what can we learn from the evidence?
During pregnancy, perineal massage may reduce tearing, including tears that need stitches, but this benefit appears mainly for people having their first vaginal birth. There are other benefits also linked with prenatal perineal massage. The lower risk of perineal trauma is likely tied to fewer episiotomies. In the United States, 25% of people who gave birth vaginally had an episiotomy in 2007, compared with 16% in 2026. These findings may apply less in settings where episiotomies are already uncommon. Asking your healthcare provider their thoughts about episiotomy would be beneficial during a prenatal visit.
Second time moms who use perineal massage will not see any decrease in their risk of tearing, but they may reduce their risk of ongoing perineal pain at 3 months postpartum or see other benefits.
Have you learned about perineal massage? Have you tried it or do you plan to? If you have already had a baby, do you feel it helped you?
References
Beckmann, M. M., & Stock, O. M. (2013). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews, 4, CD005123. https://doi.org/10.1002/14651858.cd005123.pub3
Chen., Q., Qui, X., Fu, A., & Han, Y. (2022). Effect of prenatal perineal massage on postpartum perineal injury and postpartum complications: A meta-analysis. Computational and Mathematical Methods in Medicine, 2022, 3315638, 1-10. https://doi.org/10.1155/2022/3315638
Cohen, W. R. & Friedman, E. A. (2024). The second stage labor. American Journal of Obstetrics and Gynecology, 230, S865-S875. https://doi.org/10.1016/j.ajog.2022.06.014
da Costa Monguilhott, J. J., Bruggemann, O. M., Velho, M. B., Knobel, R., & Costa, R. (2022). Antenatal perineal massage for trauma prevention: A pilot randomized clinical trial. Acta Paulista de Enfermagem, 35, eAPE0381345. http://dx.doi.org/10.37689/acta-ape/2022AOO3813459
Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S. (2007). Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. The Journal of Perinatal Education, 16(4): 9-14. https://doi.org/10.1624/105812407x244769
He, R., Wang, X. X., Nian, S., Wang, X. Q., Zhang, L., & Lu, Y. (2023). The effect of pelvic floor muscle training and perineal massage in late pregnancy on postpartum pelvic floor function in nulliparas: A randomized controlled clinical trial. Complementary Therapies in Medicine, 77, 102982. https://doi.org/10.1016/j.ctim.2023.102982
Hossein-Pour, P., Rajasingham, M., & Muraca (2025). Risk of cervical laceration in forceps versus vacuum delivery: A systematic review and meta-analysis. Acta Obstetrica et Gynecologica Scandinavica, 104, 29-38. https://doi.org/10.1111/aogs.14969
Imperial College Healthcare NHS Foundation Trust (2023), [reviewed 2026]. Antenatal Perineal Massage. https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/physiotherapy/antenatal-perineal-massage.pdf?rev=0344c02dc3a94823bfe690b6885e2ec1
Kunkel, M. E., Picanco, C. P., Santos, M. V., Schor, P., & Zanetti, M. R. D. (2024). Preventative approaches to perineal trauma in vaginal delivery: Systematic literature review. Brazilian Journal of Motor Behavior, 18(1), 1-11. https://doi.org/10.20338/bjmb.v18i1.407
Okeahialam, N. A., Sultan, A. H., & Thakar, R. (2024). The prevention of perineal trauma during vaginal birth. American Journal of Obstetrics and Gynecology, 203. https://doi.org/10.1016/j.ajog.2022.06.021
Sakala, C., Strauss, N., Barnard-Mayers, R., Hernández-Cancio, S., & Declercq, E. R. (2026). Listening to Mothers IV: New mothers' views and experiences of childbearing. First questionnaire report. National Partnership for Women & Families. https://nationalpartnership.org/wp-content/uploads/listening-to-mothers-iv-first-questionnaire-report.pdf
Published: July 21, 2026
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