Should You Do Perineal Massage During Pregnancy? Insights from PT Hayley Kava

Birth Preparation, Podcast

One of the most common concerns many pregnant people have is tearing during birth. The thought of pushing a baby out and then potentially needing stitches—especially without an epidural—can bring up a lot of anxiety. A popular question we hear is: Should I be doing perineal massage to prevent tearing?

In a recent MamasteFit Podcast episode, I sat down with our in-house pelvic floor physical therapist, Hayley Kava, to dive into the research, benefits, risks, and practical considerations around perineal massage. Here’s what we uncovered.

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What Is Perineal Massage?

Perineal massage is a technique that involves gently stretching the tissues between the vaginal opening and anus in the final weeks (typically between 34-35 weeks) of pregnancy. The goal is to prepare these tissues for birth and ideally reduce the risk of tearing.

What Does the Evidence Say?

The research on perineal massage is mixed, but here’s the summary:

Most effective for first-time birthing people: Studies show that perineal massage may reduce the risk of severe tearing (third- or fourth-degree) during a first vaginal birth.
Not a guarantee: The overall risk of severe tears is already very low (around 4–5% for first births), so perineal massage isn’t a magic solution.
Confidence booster: For some, it helps ease anxiety and provides a sense of control going into birth.

As Hayley said: “It’s your vulva—you can do whatever you want. If it makes you feel more confident, go for it. If it stresses you out, it’s not necessary.”

The Mental Benefits of Perineal Stretching

Beyond the physical, perineal stretching can serve as mental training for labor.

It introduces you to the sensation of stretching or discomfort in a safe environment.
You can practice yielding to the sensation instead of resisting it—similar to what you’ll need to do during crowning.
Breathwork, softening, and letting go are skills that can transfer directly into birth.

Think of it as practicing your response to discomfort rather than “pre-stretching” tissue.

Other Key Factors That Influence Tearing

Perineal massage isn’t the only piece of the puzzle. Other, often bigger, factors include:

Your provider’s approach: Do they believe tearing is inevitable, or do they actively work to minimize it? Asking how they support crowning can tell you a lot.
Slowing down during crowning: Using touch, mirrors, or feedback from your provider can help you ease your baby out more gently.
Relaxing your legs and pelvic floor: Tension makes tissues less stretchy. Positions that feel comfortable (not extreme) are more supportive.
Breathwork and sounds: Techniques like low tones, humming, or horse-lip exhales can help keep tissues relaxed as your baby emerges.

Practical Alternatives to Massage

If perineal massage doesn’t feel right for you, there are other ways to prepare:

Pelvic floor release with a wand: Helps you practice relaxing tight spots.
Foam roller or lacrosse ball drills: Sitting on these can mimic the sensation of pressure and allow you to practice softening into discomfort.
Simply looking at your vulva: Having a reference point before birth can reduce fear and confusion in postpartum recovery.

Are There Risks to Perineal Massage?

Generally, perineal massage is safe, but there are a few cautions:

Avoid if on pelvic rest (e.g., for placenta previa, preterm labor, or other medical reasons).
Avoid if prone to infections: Pregnancy can make the vaginal microbiome more sensitive, so introducing new bacteria may increase risk of yeast infections or BV.
Be gentle: Devices like the now-discontinued EpiNo balloon caused harm when overused.

Remember: your perineum is designed to stretch and heal. Small tears (first or second degree) are very common and often heal well—sometimes without stitches.

Top Takeaways from Hayley

If the long list of “things to do” during pregnancy feels overwhelming, here are her top two recommendations for reducing tearing anxiety:

Get to know your vulva: Look at it before birth so you have a frame of reference.
Create safety for your nervous system: Whether through environment, supportive people, or relaxation techniques, feeling safe is far more effective than any single stretch.

Final Thoughts

Perineal massage is optional. If it makes you feel empowered, it may help—especially for first-time vaginal births. But if it feels stressful, it’s okay to skip. Focus instead on building confidence, practicing relaxation, and choosing a provider who actively supports minimizing tearing.

Remember, your body is designed to give birth. Small tears are common and usually heal well, and even in cases of more significant tearing, recovery is possible with the right support.

Gina Conley, MS