It is common for women to experience trauma to the perineum (the area between the anus and vagina) during childbirth. This perineal trauma can result from an episiotomy (incision to enlarge the vaginal opening) or spontaneous tears. Perineal trauma is most common in women having a vaginal birth for the first time. It can cause pain and discomfort in the weeks and months after childbirth, and can negatively affect sexual functioning.

A new review article in the January 25, 2006 issue of The Cochrane Library found that women who practiced perineal massage during the last month of pregnancy experienced significantly less perineal trauma during birth and less pain afterwards.

About the Study

The researchers analyzed the results of three randomized trials involving 2,434 pregnant women. The women were randomly assigned either to perform perineal massage or not from 34 weeks of pregnancy until childbirth. The massage involved having the woman or her partner insert 1-2 fingers into the vagina and apply downward and sideward pressure. The participants were instructed to practice the massage 3-7 times a week for 4-10 minutes each session. The women were told not to inform their birth attendant whether they were practicing the massage.

Perineal massage reduced the likelihood of an episiotomy or other trauma that required suturing by 9% and 15%, respectively. Both of these findings were significant in women having their first vaginal birth, but not significant in those who had given birth vaginally before. The women who reported massaging 1.5 times a week or less were more likely to experience trauma or have an episiotomy than those who massaged more.

How Does This Affect You?

These findings suggest that practicing perineal massage during the last month or so of pregnancy may reduce the risk of perineal trauma and episiotomy. The authors calculate that for every 16 women who practice massage, one fewer will experience trauma that requires suturing. The authors also note that the reduction in trauma requiring suturing is almost entirely due to the fact that the women were less likely to have an episiotomy.

How does perineal massage reduce the risk of trauma and episiotomy? Theoretically, the massage increases flexibility of the perineal muscles, making them less likely to resist the forces of childbirth, thus helping to protect the perineum from tearing. But since more frequent massage was not associated with a greater benefit in this review, there may be another explanation: women who practice perineal massage are more motivated to achieve a vaginal birth, and may be more likely to keep pushing longer and oppose an episiotomy.