Perineal Massage and Episiotomy

Old vs. New Theories


Maite emailed and asked: Will perineal massage help me avoid a tear during delivery? Will the doctor do an episiotomy even if I don't want one? Let me start with reassurance: While episiotomies are still performed, they're not done routinely anymore.

What's better: a tear or an episiotomy? The best choice is neither. Back in the olden days routine episiotomies were considered safer, cleaner and easier to repair. Nowadays, we know better.

A study published in May 2005 in the Journal of the American Medical Association, concluded that the benefits traditionally attributed to routine episiotomy don't exist and that episiotomy actually increases risk of severe tearing, pain with intercourse, incontinence and other pelvic problems following delivery. The researchers determined that routine episiotomies were unnecessary, though they still occur in approximately 25% of deliveries.

An article in Women's eNews reports on a study published last year in the Journal of Reproductive Medicine showing physicians in practice 15 years or more perform episiotomies 50% more often than those in practice less than 15 years.

Younger practitioners often take a "wait and see" approach before they get out any tools. If the perineum tears, it's usually a small injury and repairs are fairly simple. There are definitely times when an episiotomy is necessary however, like when there's fetal distress. Sometimes baby needs a bit more room – fast.

There are a few theories about preparing your perineum for delivery:

1. Do nothing. Your body will prepare itself. Gravity, hormones and labor will stretch your perineum adequately. Most women use this theory.

2. Work it: Do Kegel exercises and perineal massage. Personally, I'm not a fan of pre-delivery Kegels. Labor nurses spend a lot of time pushing with patients. We like nice, relaxed, soft perineums with lots of stretch and "give." Many of us think Kegels are better after delivery to tighten everything back up. Ask your practitioner. The jury's out.

Perineal massage involves gently rubbing and stretching the pereneum with natural vegetable oils or a personal lubricant (like KY Jelly) for a few minutes daily starting around 34 weeks. Don't use mineral oil, baby oil or petroleum jellies like Vaseline. Some studies say this helps reduce tears. Others say it doesn't. As long as you're not being rough, it doesn't cause any harm and might keep you occupied during those long, last weeks. If you get your partner to do it'll be extra entertaining.

3. Demand control. Some women demand their practitioner not to do an episiotomy under any circumstances. This one always brings out the devil's advocate in me. I'm not an episiotomy fan but I have to ask, "Really? Under no circumstances? What if your baby's in trouble? What if he has your husband's giant head? What if she's stuck and all the massage in the world isn't going to create the extra inch needed for delivery? What if your other choice is a c-section? Would it be OK then? During birth, most of us are willing to do whatever it takes.

Most of us who sit at the bottom of the bed during pushing stage, use warm compresses and gentle massage to help ease baby's head through. Most of the time, an episiotomy isn't necessary even if there's a possibility of a tear.

Which theory to choose? That's up to you and your practitioner. Nobody wants to tear or get an episiotomy but once you're in the "tail end" of labor and your baby's head is barreling through your vagina en route to your arms, you'll be ready for whatever happens.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.