Perineal massage during pregnancy: what it is, when to start, and does it really help?

There’s an old saying, “a stitch in time saves nine.” But when it comes to perineal massage, the hope is often to skip the stitches altogether. Perineal massage during pregnancy is a gentle way of stretching the perineum, the area that supports the birth canal, in the weeks leading up to birth. It’s one of those topics that tends to come up late at night, usually after a provider mentions tearing, stitches, or “stretching,” and it can sound a lot scarier than it actually is.

So let’s slow it down and talk it through. Below, we’ll walk you through what perineal massage is, when to start perineal massage, how to do it safely, and whether it really works, with evidence, expert guidance, and reassurance.

What is a perineal massage?

The perineum is the area of tissue between the vaginal opening and the anus. During a vaginal birth, this area stretches significantly to allow your baby to pass through.

Perineal massage involves gently stretching and massaging this tissue in the weeks leading up to labor. The goal is to improve flexibility and help the perineum gradually get used to stretching, rather than being asked to stretch suddenly during delivery.

According to the American Pregnancy Association (APA), perineal massage may help reduce the likelihood of tearing and the need for an episiotomy, especially for first-time vaginal births. The goal isn’t to force the body, but to support it through gradual preparation, much like other prenatal practices such as stretching or pelvic floor awareness.

Why perineal massage?

If you’re planning a vaginal birth, it’s normal to worry about tearing,  especially if this is your first time. Studies show that some amount of tearing is common in vaginal births, particularly for first-time moms or when extra help like forceps or a vacuum is needed. The good news is that most tears are small and heal well. More serious tears are much less common, but they can take longer to recover from.

Perineal massage is one way some parents choose to prepare for birth. By gently stretching the skin and muscles at the opening of the vagina in the weeks before birth, perineal massage may help that area relax and stretch more easily during labor. It’s not a guarantee, but for many parents, it’s a simple, low-pressure way to support their body ahead of birth.

The CDC notes that recovery after a vaginal birth, including healing from tearing or episiotomy,  varies from person to person, and emphasizes the importance of postpartum care, pain management, and knowing when to seek medical help. Birth outcomes are influenced by many factors, such as the baby’s position, pushing technique, provider practices, and individual anatomy.

Think of perineal massage as one supportive tool, not a promise or a pass/fail task.

Did you know?

Episiotomies used to be extremely common in the U.S. in 1979; nearly 2 out of 3 vaginal births included one, especially for first-time moms. But as evidence grew showing no long-term benefit and higher risks, the American College of Obstetricians and Gynecologists ACOG advised against routine episiotomies. Today, rates have dropped dramatically to around 7%, reflecting a shift toward more evidence-based, tissue-protective birth practices.

When should you start doing perineal massage?

One of the most common questions parents ask is when to start perineal massage.

Most experts recommend starting around 34–35 weeks of pregnancy, practicing a few times per week. This timing allows enough opportunity for the tissue to adapt, without adding unnecessary pressure earlier in pregnancy.

The American Pregnancy Association suggests:

• Starting in the last 4–6 weeks of pregnancy
• Practicing 3–4 times per week
• Spending 5–10 minutes per session

If you have complications such as placenta previa, active vaginal infections, or have been advised to avoid vaginal exams or intercourse, always check with your OB-GYN or midwife before starting.

Is perineal massage painful?

Short answer: It shouldn’t be painful,  but it may feel uncomfortable at first.

Most people describe early sessions as:

• A stretching or burning sensation
• Mild tenderness
• Pressure rather than pain

That discomfort usually eases as the tissue adapts over time. Pain is a signal to stop. Using enough lubrication, like a safe massage gel, staying relaxed, and starting gently makes a big difference. Warm compresses beforehand can also help soften the area.

If the experience feels sharp, intensely painful, or emotionally distressing, it’s okay to pause or skip it entirely. Perineal massage is optional, not mandatory.

Conclusion

Pregnancy advice can come at you fast, and not all of it needs to stick. Perineal massage isn’t a must-do, and it’s not meant to add pressure or another box to check. Think of it as an option you can learn about, not an assignment you have to complete.

Before trying it, it’s always a good idea to talk it through with your midwife or OB-GYN. They can help you understand what it is, how to do it safely, and whether it makes sense for your body and birth plan. If it feels gentle, doable, and reassuring, it may be something you choose to try. If it doesn’t feel right, that’s completely okay too. Your body already knows how to do this, and it deserves care, trust, and support, with or without this practice.

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Sources: 

1. Perineal massage guidance during pregnancy. American Pregnancy Association. “Perineal Massage During Pregnancy.” Perineal Massage During Pregnancy – American Pregnancy Association
2. Information on episiotomy procedure and considerations. American Pregnancy Association. “Episiotomy.” Episiotomy – American Pregnancy Association
3. Review of strategies to prevent perineal trauma in vaginal birth. American Journal of Obstetrics and Gynecology. 2024. “The prevention of perineal trauma during vaginal birth.” (Linked to PubMed) Prevention of Perineal Trauma During Vaginal Birth (PubMed)
4. Systematic review and meta-analysis on antenatal perineal massage effects. Systematic Review & Meta-Analysis of RCTs. 2020. “Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.” (Linked to PubMed) Antenatal Perineal Massage Benefits — PubMed
5. Cochrane evidence summary on perineal massage for birth. Cochrane Database of Systematic Reviews. n.d. “Antenatal perineal massage for reducing perineal trauma.” Cochrane: Antenatal Perineal Massage for Reducing Trauma
6. CDC information on postpartum recovery and care needs. Centers for Disease Control and Prevention (CDC). n.d. “Pregnancy and postpartum care.” (Note: CDC pages on postpartum recovery address physical and emotional recovery, common symptoms, and care guidance after childbirth.) CDC – Pregnant and Postpartum Women Resources
7. Reduction in episiotomy rates through education and feedback. Obstetrics & Gynecology. 2017. “An Initiative to Reduce the Episiotomy Rate: Association of Feedback and the Hawthorne Effect With Leapfrog Goals