If you’ve ever watched a gymnast, dancer, or cheerleader prepare for a split, you know they don’t just walk into the gym and force their bodies into that position. They work on mobility, gradually introduce their tissues to the movement, and give their bodies time to adapt.
Childbirth asks the body to do something pretty remarkable, too. As your baby moves through the birth canal, the tissues around the vaginal opening and the pelvic floor need to stretch and accommodate the baby’s head. So, it makes sense that you may have heard about perineal massage or stretching during pregnancy as a way to prepare for delivery.
But does it actually help? And does everyone need to do it?
What Is Perineal Massage?
The perineum is the area of tissue between the vaginal opening and the anus. During vaginal delivery, this area stretches as your baby moves through the birth canal.
Antenatal perineal massage is a technique that can be performed during the final weeks of pregnancy, often beginning around 35 weeks. It involves gently massaging and stretching the tissues around the vaginal opening to help familiarize them with the sensation of lengthening.
Think of it as introducing the tissues to a stretch gradually, rather than waiting until delivery for them to experience that level of demand.
Does It Actually Reduce the Risk of Tearing?
The research suggests that it can help with some types of perineal trauma, but the benefits are more specific than you might think.
A 2022 Cochrane review found that antenatal perineal massage was associated with a reduction in both perineal trauma that could require stitches and a reduction in need for an episiotomy. The benefits were also most noticeable for women having their first vaginal birth.
However, the research did not find a significant reduction in first or second degree tears or more severe third and fourth degree tears.
So, while perineal massage may be a helpful tool for some people, it is not a guarantee that tearing won’t happen. And skipping it does not mean you’ve done anything wrong or failed to prepare your body.
Does Everyone Need to Do Perineal Massage?
No! And this is an important point.
Just as every pregnancy and birth experience is different, everyone’s pelvic floor and perineal tissues are different, too.
Some individuals may benefit from working on tissue mobility and their ability to relax and lengthen the pelvic floor. Others may already have good tissue mobility and coordination and may not need additional stretching.
In fact, if the pelvic floor is already sensitive, painful, or overly tense, simply adding more stretching may not be the best approach.
This is where a pelvic health physical therapist can help. An individualized assessment can look at how well the pelvic floor muscles relax and lengthen, tissue mobility, tenderness, sensitivity, and any previous scars or injuries. From there, a therapist can help determine whether perineal massage may be useful and, if so, how to approach it comfortably.
The goal isn’t to force a stretch. It’s to understand what your body needs and help you feel more prepared.
What About Warm Compresses During Labor?
Here’s another piece of the conversation that often gets overlooked: what happens during delivery matters, too.
Warm compresses applied to the perineum during the second stage of labor, when the baby’s head is stretching the tissues, have been shown to reduce the likelihood of combined third and fourth degree tears. They may also help reduce perineal pain after delivery.
This is different from antenatal perineal massage. One is performed during the final weeks of pregnancy, while the other is used by the birth team during labor.
Both approaches have research behind them, but they serve different purposes, and we can’t say that one is universally better than the other. If this is something you’d like to include in your birth preferences, it’s worth discussing with your OB-GYN or midwife ahead of time.
How Can Pelvic Floor Physical Therapy Help?
Preparing for childbirth isn’t just about strengthening your pelvic floor. It’s also about knowing how to relax it, coordinate your breathing, and allow the tissues to lengthen when needed.
A pelvic health physical therapist can help you: Understand how your pelvic floor muscles contract, relax, and lengthen, assess perineal tissue mobility and identify areas of tenderness or sensitivity, determine whether antenatal perineal massage may be appropriate for you, learn how to perform perineal massage comfortably, if indicated, and practice breathing and pelvic floor coordination strategies that may be helpful during labor.
An internal assessment is not automatically necessary. Any examination or treatment should be discussed with you beforehand and performed only with your informed consent.
The Takeaway
Your body doesn’t need to be forced into flexibility to prepare for childbirth. Perineal massage may offer some benefits, particularly for individuals preparing for their first vaginal birth, but it isn’t a requirement for a healthy delivery.
There are also strategies that can be used during labor, including warm perineal compresses, that may help reduce certain types of birth-related trauma.
The best preparation is individualized. Understanding how your pelvic floor moves, learning how to relax and lengthen it, and knowing what options are available can help you feel more informed and confident heading into delivery.
And remember, tearing is not a sign that you didn’t prepare enough. Birth is complex, and there is no single technique that can guarantee a particular outcome.
Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at [email protected]. We are in-network with several insurance plans and can help you confirm your benefits before your evaluation.
