Perineal Massage in the Third Trimester to Reduce Tears

If you’re looking for a simple, at-home practice that may lower your chance of tearing in birth, perineal massage is worth considering. This gentle technique—done in the late third trimester—helps the tissues around the vaginal opening stretch more comfortably during labor. While no approach can guarantee a tear-free birth, research suggests perineal massage can reduce severe tears and episiotomy, particularly for first-time births, and may ease postpartum recovery (Mayo Clinic; ACOG; Cleveland Clinic).

Key takeaway: Perineal massage to reduce tearing is a low-cost, low-risk tool that can make a meaningful difference—especially when started around 34–37 weeks and practiced consistently.

1) Perineal massage in pregnancy: what it is and why it helps

The perineum is the area between the vaginal opening and the anus. During a vaginal birth, it stretches to accommodate your baby’s head. Perineal tears range from:

First-degree: skin only
Second-degree: skin and muscle
Third-degree: extends into the anal sphincter
Fourth-degree: extends into the rectal mucosa

Perineal massage is the practice of gently stretching the lower vaginal opening and perineal tissues with the thumbs or fingers. The goal is to increase tissue flexibility, improve awareness of stretching sensations, and help the pelvic floor relax during birth. Studies report that regular, gentle stretching may decrease muscular resistance and improve tissue elasticity, which in turn may reduce severe lacerations and the need for episiotomy (ACOG; Cleveland Clinic; Abdelhakim 2020; Venugopal 2022).

Expectation setting matters: Perineal massage is not a guarantee against tearing. Baby’s position, birth speed, genetics, and other factors still play a role. But it is one of the few at-home, evidence-informed strategies within your control.

2) When to start perineal massage (34–37 weeks) and how often

Evidence and clinical guidance suggest starting perineal massage in the late third trimester—most often between 34 and 37 weeks—and continuing until birth (Cleveland Clinic; American Pregnancy Association; RCOG).

Frequency: 3–4 times per week
Session length: 5–10 minutes
Who benefits most: People preparing for their first vaginal birth tend to see the biggest benefit, but anyone hoping to prevent perineal tears or episiotomy may find it helpful (ACOG; RCOG; Abdelhakim 2020)
How long to continue: From the time you start until you go into labor, adjusting frequency to what feels sustainable and comfortable

Key takeaway: Consistency—short, frequent sessions—is more helpful than occasional long or intense sessions.

3) Proven benefits: does perineal massage reduce tearing?

Multiple studies and clinical bodies suggest meaningful benefits:

Reduced severe tears and episiotomy: Systematic reviews and meta-analyses show antenatal perineal massage is associated with lower rates of third- and fourth-degree tears and fewer episiotomies, especially in first-time births (Abdelhakim 2020; Venugopal 2022; Butler 2023).
Less postpartum pain: People who practiced perineal massage report less perineal pain in the early postpartum period and up to three months after birth (Abdelhakim 2020; Yin 2024).
Better birth experience: Familiarity with the sensation of stretching can support relaxation and more controlled pushing, which many find empowering and reassuring (Mayo Clinic; Cleveland Clinic).

Professional guidance aligns with these findings:

ACOG notes that perineal massage (antenatal or during second-stage labor) can decrease muscular resistance and reduce obstetric lacerations.
RCOG provides public guidance on reducing perineal tears, including massage and in-labor techniques like warm compresses and hands-on support.
The Cleveland Clinic and Mayo Clinic both describe potential benefits and offer practical how-to tips.

Key takeaway: The evidence is strongest for reducing severe tears and episiotomy rates, with added potential for easing postpartum discomfort.

4) Safety first: risks, contraindications, and when to skip

Perineal massage is generally safe when done gently and hygienically. However, avoid or pause massage and ask your clinician if you have:

Active infections (e.g., herpes outbreak, yeast infection, bacterial vaginosis)
Placenta previa or low-lying placenta
A cerclage, preterm labor symptoms, ruptured membranes, or any reason you’ve been advised pelvic rest
Unexplained vaginal bleeding or severe pain

Hygiene and nail care matter:

Wash hands thoroughly; keep nails short and smooth
Use clean, body-safe lubricant
Stop if you have bleeding more than spotting, severe pain, foul-smelling discharge, or fever, and call your clinician

Key takeaway: If your provider has recommended pelvic rest or you have an active infection, skip perineal massage and ask about alternatives.

5) How to do perineal massage: step-by-step technique

Use this inclusive guide for self- or partner-performed massage.

1. Set up and relax

Choose a private, warm space and a time you won’t be rushed.
A warm bath or shower beforehand can help the tissues relax.
Consider pillows for support, soft lighting, and slow breathing.

2. Positioning options

Semi-reclined with knees bent and legs comfortably apart
Side-lying with the top knee supported by pillows
Standing with one foot on a low stool
Use a mirror for visibility if helpful

3. Lubrication

Apply a generous amount of unscented, body-safe oil (e.g., coconut, sweet almond, olive, grapeseed) or a water-based personal lubricant.
Avoid irritating or petroleum-based products.

4. Thumb/finger placement

With clean hands, insert one or both thumbs (or a partner’s index/middle fingers) 1–1.5 inches inside the vagina, resting on the back vaginal wall (toward the anus).

5. Gentle downward stretch

Press downward toward the rectum until you feel a gentle stretch or mild stinging/burning—not sharp pain.
Hold 30–60 seconds while breathing slowly.

6. U-shaped motion

Sweep in a slow “U” from the center downward and outward toward the sides (4–5 o’clock to 7–8 o’clock), then back to the center.
Continue 2–3 minutes, adjusting pressure so it’s comfortably intense but not painful.

7. External perineal skin

Use fingertips to gently massage the skin between the vaginal opening and anus in small circles.

8. Duration and pacing

Aim for 5–10 minutes total, 3–4 times per week.
Stop sooner if you feel discomfort beyond a gentle stretch.

9. Finish and aftercare

Gently wipe away excess lubricant. No need to rinse.
Take a few breaths to relax and re-center.

Pressure cue: You’re looking for a “deep stretch” sensation, not pain. If you can’t relax your jaw or breathing, the pressure is likely too strong.

6) Partner-assisted perineal massage: communication and consent

A supportive partner can make massage easier in late pregnancy. Keep it collaborative, respectful, and guided by your comfort.

Consent first: Agree on boundaries, preferred positions, and lubrication.
Comfort check-ins: Use simple hand signals or a “stop word.” Pause immediately if requested.
Go slow: Warm, clean hands; gentle, steady pressure; constant feedback.
Support relaxation: Soft lighting, calm music, slow breathing cues, and privacy.
Stay flexible: If a certain angle is uncomfortable, adjust fingers, pressure, or position.

Key takeaway: Your comfort is the priority. If partner-assisted massage doesn’t feel right, skip it or try a different approach.

7) Tips for comfort and success (positions, lubricants, tools)

Warm-up: Try a warm bath/shower or warm compress over the perineum for a few minutes.
Breathing: Inhale through the nose, exhale slowly through the mouth to relax pelvic floor muscles.
Props: Pillows under knees or behind the back, a mirror for visibility, and a towel under the hips for comfort.
Lubricants: Choose unscented, body-safe oils or a water-based lubricant. Patch test if you have sensitive skin.
Tools: A simple, smooth, body-safe silicone perineal massage tool or wand can help if reaching is difficult. Avoid anything rigid, sharp, vibrating, or not designed for perineal use.
Consistency: Short sessions, several times per week, beat occasional long sessions.
Late pregnancy tweaks: Side-lying with pillows often feels best as your belly grows.

8) Common mistakes and how to troubleshoot

Too much pressure: Pain, bruising, or lingering soreness means you’re pressing too hard. Back off to a gentle stretch.
Poor hygiene: Always use clean hands and short nails. If you have an infection, skip massage until treated.
Wrong direction: Focus on the lower half of the vaginal opening (toward the anus), moving in a U-shape from side to side.
Infrequent practice: Aim for 3–4 times per week for 5–10 minutes to see potential benefits.
Irritating products: Avoid fragranced or petroleum-based products; switch to a simple, body-safe lubricant.
Hard to reach: Try side-lying, use a mirror, enlist a partner, or consider a body-safe tool designed for perineal massage.
Feels tense or uncomfortable: Add warmth, slow your breath, soften your jaw, and reduce pressure. Try again another day.

9) Myths vs facts about perineal massage

Myth: Perineal massage guarantees no tears.

- Fact: It lowers the risk of severe tears and episiotomy but can’t eliminate all tearing (Abdelhakim 2020; Venugopal 2022).

Myth: Perineal massage induces labor.

- Fact: There’s no evidence it triggers contractions; it’s a local tissue-stretching technique (Cleveland Clinic).

Myth: It’s only for first-time births.

- Fact: Benefits are greatest in first-time births, but anyone planning a vaginal birth may benefit, especially if they had prior perineal trauma (ACOG; RCOG).

Myth: Any oil works.

- Fact: Use unscented, body-safe oils or water-based lubricants. Avoid petroleum-based or fragranced products which can irritate.

Myth: It should hurt to be effective.

- Fact: You’re aiming for a comfortable stretch, not pain. Pain can trigger muscle guarding and defeat the purpose.

10) More ways to reduce tearing during labor and birth

Perineal massage pairs well with in-labor strategies shown to reduce severe tears:

Warm compresses to the perineum during pushing: Associated with fewer third- and fourth-degree tears (RCOG guidance).
Hands-on perineal support: Skilled, gentle support of the perineum and controlled delivery of the head can reduce severe lacerations (ACOG; RCOG).
Positions that slow crowning: Side-lying, hands-and-knees, or semi-sitting may help control the pace as baby’s head emerges (RCOG).
Slow, controlled pushing: Following your body’s urge to push and pausing as the head crowns can minimize rapid stretching (Mayo Clinic; RCOG).
Avoid routine episiotomy: Major organizations discourage routine episiotomy; it’s reserved for specific clinical indications (ACOG; WHO). Discuss preferences and indications with your care team.
Hydrated tissues and good communication: Sips of water/ice chips as allowed, and continuous check-ins with your midwife or obstetrician during second stage can optimize perineal protection.

Key takeaway: Ask your team about warm compresses and hands-on perineal support—these are among the most effective in-labor measures for severe tear reduction.

11) Talk with your care team and add it to your birth plan

Bring up perineal massage at a prenatal visit around 32–36 weeks. Ask:

Based on my history (e.g., prior tears, episiotomy, pelvic floor concerns), do you recommend perineal massage?
Are there any reasons I should avoid it or modify the technique?
What in-labor strategies do you use to prevent perineal tears (warm compresses, hands-on support, position changes)?
How do you approach episiotomy? In what situations might it be necessary?

Include preferences in your birth plan:

I plan to practice perineal massage in the third trimester.
I’d like warm compresses and hands-on perineal support during pushing.
Please guide me to slow/stop pushing as the head crowns.
Episiotomy only if medically indicated; discuss with me if time allows.

Credible resources to explore and share:

ACOG: Prevention and Management of Obstetric Lacerations at Vaginal Delivery — https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/09/prevention-and-management-of-obstetric-lacerations-at-vaginal-delivery
RCOG: 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/
Mayo Clinic: Can vaginal tears be prevented? — https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/preventing-vaginal-tearing-during-childbirth/faq-20416226
Cleveland Clinic: Perineal Massage in Pregnancy — https://health.clevelandclinic.org/perineal-massage

Conclusion: A small habit with meaningful benefits

Perineal massage in the third trimester is a gentle, practical way to prepare your body for birth. While it can’t guarantee a tear-free delivery, evidence suggests it lowers the risk of severe tears and episiotomy, and may ease postpartum discomfort—especially for first-time births. With simple tools, a few minutes of practice, and good communication with your care team, this is a manageable routine that can pay off on birth day.

Call to action: If perineal massage aligns with your goals, add it to your weekly routine starting around 34–37 weeks, talk with your clinician about safety and technique, and include perineal protection strategies in your birth plan.

References

Mayo Clinic. Can vaginal tears during childbirth be prevented? https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/preventing-vaginal-tearing-during-childbirth/faq-20416226
American College of Obstetricians and Gynecologists (ACOG). Prevention and Management of Obstetric Lacerations at Vaginal Delivery. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/09/prevention-and-management-of-obstetric-lacerations-at-vaginal-delivery
Cleveland Clinic. Perineal Massage In Pregnancy: Benefits and How To. https://health.clevelandclinic.org/perineal-massage
Royal College of Obstetricians and Gynaecologists (RCOG). 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/
Abdelhakim AM, et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis. 2020. https://link.springer.com/article/10.1007/s00192-020-04302-8
Venugopal V, et al. Perineal Massage for Prevention of Perineal Trauma and Episiotomy During Labor: A Systematic Review and Meta-Analysis. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9759438/
Yin J, et al. Effects of perineal massage at different stages on perineal outcomes. BMC Pregnancy and Childbirth, 2024. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06586-w
American Pregnancy Association. Perineal Massage During Pregnancy. https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/perineal-massage-pregnancy/
WHO. Recommendations to reduce harms from routine episiotomy and improve perineal protection (summary context). https://www.who.int/news/item/05-10-2025-global-health-agencies-issue-new-recommendations-to-help-end-deaths-from-postpartum-haemorrhage