Can Perineal Massage During Pregnancy Prevent Perineal Injury During Childbirth?

What is a perineal injury? 

Perineal injury is the most common complication associated with vaginal delivery. This can range from a graze, cut, or first- and second-degree tear around the vagina, perineum, or labia. These are usually minor and heal quickly. Third- and fourth-degree tears involving the anus are rare.

Source: Royal College of Obstetricians & Gynecologists

Although there is no clear reason why this happens, and it is difficult to predict; there are certain non-modifiable risk factors:

• This is your first vaginal birth

• Your baby is over 9lb 

• You have a long second stage of labour (ie. when you are pushing your baby out)

• Your baby’s shoulder gets stuck behind the pubic bone

• You have an instrumental vaginal birth (forceps- or vacuum-assisted)

What are the consequences of perineal injury? 

When identified and repaired immediately after giving birth, most women recover well from perineal injury. But for those women who don’t fully recover, it is associated with significant maternal morbidity, including 

• Chronic pain

• Difficulty controlling the urge to urinate or defecate

• Psychological impairment, like feelings of low mood and anxiety

What is perineal massage? 

The perineum is a small patch of skin and muscle between your vaginal opening and anus (refer to the diagram above). It functions to cradle the pelvic floor muscles, which are internal to the perineum. 

During childbirth, this area needs to stretch and expand to accommodate the head of the baby. In theory, massaging it before childbirth and during delivery may potentially lessen the severity of the tear. But as discussed above, there are many risk factors that are beyond your control, and therefore cannot fully prevent injury from occurring.  

What is the scientific evidence supporting the role of perineal massage in preventing perineal injury? 

There is currently very limited data on effective measures against perineal injury during childbirth, including perineal massage. Various published studies suggest perineal massage, warm compresses, use of birth pools, and avoidance of the upright position during labour. A Cochrane review published in 2011 showed that only the use of warm compresses during the second stage of labour could significantly reduce third- and fourth-degree tears. 

What is the bottom line?

Based on the current science, there is no significant evidence to support the role of perineal massage during pregnancy to prevent perineal injury. Some studies suggest a benefit, while others showed no significant difference. There are no studies that suggest it will do any harm. 

Overall, it’s up to you and your healthcare team if you want to include perineal massage into your birth planning. Talk to your doctor and Pelvic Health Physio to help you make an informed decision. Based on your specific objective findings, your Physio might suggest trying other evidence-informed strategies, such as breathing exercises that help relax the pelvic floor. 

How to do a perineal massage:

If you choose to include perineal massage into your birth planning, here is a guide based on studies that support its role:

It is recommended to complete the massage starting four to six weeks before your anticipated due date. It should be done regularly three to four times weekly, for five minutes each time. 

Source: Royal College of Obstetricians & Gynecologists

• Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.

• Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for one to two minutes.

• Move both thumbs slowly in a U-like motion so you feel a gentle stretch.

Reference list

Kavvadias T, Hoesli I. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor—Implications for Future Research. Obstet Gynecol Int. 2016;2016:3818240. https://pmc.ncbi.nlm.nih.gov/articles/PMC4769774. Accessed Dec 10, 2025

Royal College of Obstetricians & Gynecologists. Reducing your risk of perineal tears. https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/reducing-your-risk-of-perineal-tears. Accessed Dec 10, 2025

Cleveland Clinic. Will Perineal Massage Keep You From Tearing During Childbirth? https://health.clevelandclinic.org/perineal-massage. Published June 12, 2024. Accessed Dec 10, 2025