• Emily Reul, PT, DPT

Perineal Massage

Updated: Oct 18, 2020

you ask any woman what they are worried about when it comes to giving birth the first thing she will say is that she is worried that she is going to tear!


How likely are you to tear?

It is difficult to estimate rates of tearing because different countries have different practices when it comes to whether they routinely give episiotomies.


Around 50-75% of women who have a vaginal birth will have tear sufficiently extensive to require stitches (meaning 2nd degree or higher)


If you consider any type of tear, this number increases to around 90% of women experiencing some form of trauma which is a very scary statistic!


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Reducing the risk of tearing during childbirth

Antenatal digital perineal massage reduces the likelihood of either tearing or having an episiotomy by around 9%.


Women who practised perineal massage were 16% less likely to have an episiotomy.


Perineal massage also reduces the reporting of ongoing perineal pain, and is generally well accepted by women, although it is mainly women who have previously given birth vaginally. Perineal massage may also be helpful for overactive pelvic floor muscles, pain with sex, and mobilizing scar tissue after perineal tearing or episiotomy.


Whats the evidence?

All the statistics quoted above were taken from this Cochrane review from 2013:


It included four trials (2497 women) comparing digital perineal massage with control. All the trials were of good quality. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (four trials, 2480 women, risk ratio (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat to benefit (NNTB) 15 (10 to 36)).


Women practicing perineal massage were less likely to have an episiotomy (four trials, 2480 women, RR 0.84 (95% CI 0.74 to 0.95), NNTB 21 (12 to 75)). These findings were significant for women without previous vaginal birth only.


Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.45 (95% CI 0.24 to 0.87) NNTB 13 (7 to 60)).


Whats the technique?

Here are the top tips for doing perineal massage by a pelvic therapist, Jeanice Mitchell. You can find her on Instagram @mypelvicfloormuscles


Caution

During pregnancy do not practice perineal massage if you have vaginal bleeding, an active infection or a ruptured membrane.


In general, do not practice perineal massage if you have abnormal vaginal bleeding, open wounds or an active infection. Wait for your doctor’s approval before massaging over new scars to ensure they are fully healed. If the skin around the vagina is red or painful to touch, check with your doctor first to make sure there are no other issues.