Perineum massage during pregnancy: Does it help to avoid an episiotomy?

Before you opt for a perineum massage during pregnancy, read this!

Many doctors, holistic healers and antenatal experts advise expectant mothers to do a perineum massage during pregnancy, precisely after the 34th week of pregnancy to make vaginal delivery easy. It is also believed that continuous perineum massage helps the area to stretch adequately during vaginal birth and avoid an episiotomy.

Doing a perineum massage is easy. You have to apply some oil (any oil that is suitable for you, olive oil or coconut oil) on your fingertips and massage the area for few minutes every day. The perineum is the area that stretches from the vagina to the anus which tears during a vaginal birth or a surgical cut is made to facilitate the baby to make the transition from womb to the world. If a surgical cut is made then it needs to be stitched up after the delivery necessitating an episiotomy.

An episiotomy though helps in a vaginal birth, but the process of healing and aftercare needs some attention. If the area is not cared for in the right way it could lead to infections, pain and prolong the healing. But it is wise to know if perineum massage actually helps in reducing chances of episiotomy. We did some research to know if episiotomy actually helps.

A study done almost two decades back in 1999 and published in American Journal of Obstetrics and gynaecology showed that 10 minutes daily perineum massage in expectant mothers who are in the 34th or 35th week of pregnancy were beneficial for women who were having a vaginal delivery for the first time. The study took into account 493 women with previous vaginal delivery and 1035 women who were delivering for the first time. The participants were further subcategorised into massage group and control groups in both the categories. It was seen that among women with a previous vaginal birth, 34.9% and 32.4% in the massage and control groups, respectively, were delivered with an intact perineum. The study concluded that a perineal massage is an effective approach to increasing the chance of delivery with an intact perineum for women with a first vaginal delivery but not for women with a previous vaginal birth [1].

However, since this study seemed dated we tried to find more recent data to understand if perineum massage was useful. We found that another study published in the Israel Medical Association Journal showed that the practice of antenatal perineal massage showed neither a protective nor a detrimental significant effect on the occurrence of perineal trauma. This means the massage neither helped nor made thing worse for the mother. The study included 234 women with a singleton fetus. Women allocated to the study group were instructed to practice a 10-minute perineum massage daily from the 34th week of gestation until delivery. It was seen that episiotomy rates, overall spontaneous tears and intact perineum rates were similar in the study and control groups. Women in the massage group had slightly lower rates of first-degree tears and slightly higher rates of second-degree tears although both of these outcomes did not reach any significant difference [2]. However, it did show that perineum massage did marginally better the outcomes of vaginal delivery.

Our take: If you want to perform perineum massage to avoid an episiotomy or ease the process of vaginal birth then talk to your doctor or antenatal coach about it. Remember, perineum massage isn t for everyone. If you have weak pelvic floor muscles or low lying uterus or have a high-risk pregnancy you should refrain from trying this massage at home. So, before you try to experiment with any kind of massage or therapy, talk to your doctor about it.

Reference:

[1]1: Labrecque M, Eason E, Marcoux S, Lemieux F, Pinault JJ, Feldman P, Laperri re L. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):593-600.PubMed PMID: 10076134.

[2]1: Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008 Jul;10(7):499-502. PubMed PMID: 18751626.

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