Even though celebrity moms like Chrissy Teigen have made talking about the not-so-glamorous side of pregnancy [1] more commonplace, the topic of tearing during childbirth isn't discussed as much as it should be. In studies where the use of episiotomies [2] (a surgical cut made at the opening of the vagina during childbirth to aid a difficult delivery and prevent rupture of tissues) was restricted, the rate of spontaneous tearing was recorded to be anywhere from 53 to 79 percent [3]. Thankfully, there is a practice called perineal massage that could decrease the chance of tearing for first-time moms — and it's less involved than you think.
Does perineal massage actually work?
Although medical opinions on how effective perineal massage is in preventing tears during vaginal childbirth [4] differ, there is evidence that first-time moms who receive perineal massage are 10 percent less likely to suffer a tear [5] that would require stitches and 16 percent less likely to require an episiotomy.
It's also worth noting that perineal massage isn't the only effective method to prevent tearing. Princess Lock, a nurse practitioner and nursing educator at Orlando Health's Winnie Palmer Hospital for Women & Babies [6], points out that the use of a warm compress during the second stage of labor can reduce the likelihood of secondary perineal trauma.
How exactly do you perform a perineal massage?
In order to adequately engage in perineal massage, women or their partners should begin by inserting their lubricated thumbs and index fingers [7] about two inches into the vagina and apply pressure. Experts recommend applying pressure downward for two minutes first, and then sideways for two minutes in each direction. Under no circumstances should women use any other object other than a pair of clean hands.
Still not exactly sure where to begin? Your best bet is to look it up on YouTube for a visual demonstration.
When should you start perineal massage?
Princess Lock suggests giving yourself a perineal massage for 10 minutes per day, three to four times per week, starting at around 35 weeks gestation to decrease your chances of tearing while in labor.
"Any earlier than this could possibly increase chances of preterm labor due to muscle contractility and hormone release. Statistically, there hasn't been a significant benefit if done prior to six weeks before delivery. Keep in mind that a little discomfort or tingling is normal but burning is not," she explained.
What oil should you use for perineal massage?
Michaela Ward, a midwife at the Ohio State University Wexner Medical Centre, says that soon-to-be moms can use vitamin E oil, coconut oil, almond oil, or any vegetable oil used for cooking, like olive oil. You can also go the water-based lubricant route and opt for K-Y Jelly or your body's natural vaginal lubricant.
Are there any misconceptions about perineal massage?
Although perineal massages may prevent tears, they're definitely not for everyone. But as long as you're planning on delivering your child vaginally, perineal massages are fair game. "[A misconception is that] the utilization of perineal massage is only for patients who want a 'natural childbirth,' meaning no epidural [8] or delivery at a birthing centre," Princess Lock said. "This misconception sometimes prohibits a pregnant woman's desire to explore ways to enhance her birth experience [9]."
Michaela Ward agrees, emphasizing that while not every soon-to-be mom will walk out of the delivery room tear-free, it could still be worth exploring.
"A common misconception is that all pregnant moms should perform perineal massage and that if you do so, you will not have any type of tear or require episiotomy," she explained. "Again, perineal massage may have some benefit, but only with moms who are delivering vaginally for the first time."