Does Perineal Massage During Labor Help Prevent Tearing?

Does Perineal Massage During Labor Help Prevent Tearing?

Many expecting parents hope to minimize or avoid tearing during birth. One technique that sometimes gets suggested is perineal massage during the pushing stage of labor. But does it really help—and is it necessary?

Below is a clear, gentle, research-informed explanation to help you understand your options and feel confident discussing them with your care team.

What Is the Perineum?

The perineum is the area of tissue between the vagina and the rectum. During birth, this tissue stretches to make room for your baby’s head and body. Tearing is common and often heals well—but the goal is to avoid severe tears when possible.

What Is Perineal Massage During Labor?

This refers to hands-on stretching of the perineum while you are pushing. A nurse, midwife, or doctor places two fingers inside the vagina and moves the tissues side to side.

This is different from perineal massage during pregnancy, which is done at home.

Some people experience this as gentle and helpful; others may find it uncomfortable or even distressing—especially if it happens without clear explanation or consent.

So, Does It Help Prevent Tearing?

The research is mixed, and results depend on the care environment.

Some studies show:

Gentle perineal massage may slightly reduce the risk of severe tears, especially for first-time parents.

However:

In many of those studies, episiotomies (surgical cuts) were extremely common—sometimes 50–80% of births. In these settings, perineal massage may have simply reduced the likelihood of being cut, rather than preventing natural tearing.

In places or birth settings where episiotomies are rare, massage does not appear to offer a clear benefit.

What Actually Helps More

Research points to several practices that are more protective than massage:

• Warm compresses on the perineum

(helps the tissue soften and expand)

• Slow, gradual pushing

(gives the perineum time to stretch at its own pace)

• Upright or side-lying birthing positions

(reduces pressure on the perineum)

• Avoiding routine episiotomy

(cuts often lead to bigger tears and slower healing)

• A supportive, patient care provider

(rushing pushing increases the chance of tearing)

In fact, when midwives use warm compresses and allow the baby’s head to emerge slowly, many birthing parents have no tears requiring stitches—even without perineal massage.

Consent and Comfort Matter Most

Some parents appreciate perineal massage for relaxation or awareness during pushing.

Others find it uncomfortable, triggering, or simply unnecessary.

You always have the right to choose what happens to your body.

You may say:

> “I prefer no perineal massage during labor. Please offer warm compresses and allow slow crowning.”

or:

> “If massage is used, it must be gentle and stop immediately if I ask.”

Your boundaries are valid.

Bottom Line

Perineal massage during labor may help in some cases, but the evidence is not strong or universal.

Warm compresses, slow pushing, and supportive care are more consistently protective.

Your comfort, consent, and position during pushing matter more than any single technique.

Birth is deeply individual. The goal is not to avoid every tear—it’s to support a safe, respectful, and empowered birth experience.

Giuditta Tornetta