Sometimes the perineum tears during delivery. Minor tears can be painful but rarely lead to lasting problems. But major tears can mean long-term trouble. That's why doctors sometimes make a cut in the perineum -- an episiotomy. However, there's good evidence that routine episiotomies don't help.
Midwives often recommend massaging the perineum during the last weeks of pregnancy. Can it help?
Yes, find Michael M. Beckmann, MD, and Andrea J. Garrett of the QE2 Jubilee Hospital in Queensland, Australia. They analyzed data from three studies of perineal massage.
"Perineal massage during the last month of pregnancy ... undertaken by the woman or her partner for as little as once or twice a week ... reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain," Beckmann and Garrett write.
They report their findings in the Jan. 25 online issue of The Cochrane Database of Systematic Reviews.
How to Do It
The researchers found that for every 16 women who practice perineal massage, one will avoid needing stitches to repair her perineum after birth. This benefit applied only to women having a first vaginal pregnancy -- although Beckmann and Garrett suggest that women might benefit during later pregnancies, too.
Overall, this group of women who practiced perineal massage had 15% fewer episiotomies than those who did not.
How is it done? The woman herself or her partner can give the massage. These are the instructions given in one of the studies:
"Woman or partner performed daily 5- to 10-minute perineal massage from 34 weeks [of pregnancy]. One or two fingers are introduced 5 centimeters [about 2 inches] into the vagina, applying alternating downward and sideward pressure using sweet almond oil."
Beckmann and Garrett note that there are now "massage devices" for perineal massage. Unfortunately, none of these devices has been studied in clinical trials, so they don't know whether they work as well as manual massage.