75% of women giving birth will experience some degree of tearing. Learn how to prepare for labor and delivery and reduce your likelihood of tearing during childbirth.

 

By Dr. Anna McMaster, PT, DPT

Tearing is incredibly common during labor and delivery, which can create challenges for women postpartum, from painful sex to incontinence. Only 25% of women delivering vaginally will come out with an intact perineum. That means the other 75% of women will experience some degree of tearing. These numbers make sense: the vaginal opening stretches 170% side to side and 40-60% top to bottom during childbirth.

75% of women giving childbirth will experience some degree of perineal tearing.

The following is an overview of the perineum, types of tearing, and massage techniques you can use to help you prepare for labor and delivery and reduce your likelihood of tearing.

What is the perineum?

The perineum is the area between the vagina and the anus. It consists of skin, connective tissue, and also happens to be where many pelvic floor muscles attach.

What happens when the perineum tears?

There are 4 grades of perineal tears that can occur during vaginal childbirth. 

  • Grade 1 tear: just the superficial skin and vaginal mucosa
  • Grade 2 tear: superficial skin, vaginal mucosa, and some pelvic floor muscles
  • Grade 3 tear: superficial skin, vaginal mucosa, pelvic floor muscles, and anal sphincter
  • Grade 4 tear: superficial skin, vaginal mucosa, pelvic floor muscles, anal sphincter, and rectal mucosa

Grades 3 and 4 tears are considered severe and women who sustain these tears are more likely to have more postpartum pain and rectal and/or flatal incontinence postpartum.

An episiotomy is a cut the doctor makes to the perineum during delivery. It is generally not standard practice unless medically necessary because it can actually increase the chance of a severe tear.

With any level of tear, there is still a risk of urinary incontinence, fecal incontinence, pain with sex, and perineal pain.

What is perineal massage?

Perineal massage is a manual technique you can perform at home by yourself or with your partner to help stretch and prepare the tissues of the perineum for a vaginal delivery.

What are the benefits of perineal massage?

The main goal and benefit of perineal massage is to decrease the severity of perineal tearing and/or avoid tearing altogether during a vaginal delivery. It can do this by increasing the flexibility of the tissues and desensitize women to the burning and discomfort they will feel during delivery. 

What is the evidence for perineal massage? 

It has been shown that perineal massage:

Unfortunately, the vast majority of studies on perineal massage are done on women who are delivering their first baby. So, for pregnant women who already have delivered at least one baby, we can’t for certain know if perineal massage has the same protective effects. However, this doesn’t mean they shouldn’t do perineal massage. I would argue that the potential benefits of perineal massage for multiparous women outweigh the lack of knowledge we have, so I’d recommend it for my second, third, and fourth time mamas too!

How do you do perineal massage?

There are a few different ways you can perform perineal massage at home. Regardless of which way you end up choosing, you must: 

The One-Thumb Approach:  

  1. Laying on your back or with one leg propped up in the shower, insert one thumb 1-1.5 inches, about to your first knuckle, into your vaginal opening and apply moderate pressure directly downwards to the perineum (6 o’clock position). 
  2. Perform a series of 1 minute holds at 5, 6, and 7o’clock positions. 
  3. You can also glide your thumb from 5-7o’clock in a “U” shaped motion using moderate pressure.
  4. Use a water based lubricant for comfort. A slight burning or stretching sensation is normal. 
  5. Perform for about 10 min total.

The Two-Thumb Approach:

  1. Laying on your back, place both thumbs 1-1.5 inches, about to your first knuckle, into your vaginal opening. 
  2. Apply moderate pressure directly downwards to the perineum (6o’clock position) with both thumbs for 1-2 minutes. 
  3. Separate the thumbs so one is pressing on 5’oclock and one is pressing on 7’oclock and hold this position for 1-2 minutes. 
  4. Repeat this series of pressing and holding or massage the lower half of your vagina using a "U" shaped movement. 
  5. Again, use a water based lubricant for comfort. 
  6. Perform for about 10 min total.  

The Partner Approach:

  1. Laying on your back, instruct your partner to insert his/her finger 1-1.5 inches into your vaginal opening. 
  2. Instruct them to press down (gently at first!) towards the perineum/6 o’clock position until you feel a stretching and/or burning sensation. 
  3. Hold for 1 minute. 
  4. Repeat at 5 o’clock and 7 o’clock positions. 
  5. You may also instruct them to glide their finger along the lower half of your vagina in a “U” shaped movement between 5 and 7 o’clock. 
  6. Use a water based lubricant for comfort. 
  7. Ensure you are communicating often with your partner so they know how much pressure they should be using. 
  8. Perform for about 10 minutes total.
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Perineal massage should be performed 4-7x per week starting at 35 weeks of pregnancy. The more often perineal massage is performed, the more protective it is. However, it has been shown that even less frequent perineal massage is more protective than no perineal massage.

Need more support?

If you have questions about perineal massage or want to better understand how to prepare your body for labor and delivery, I also recommend working with a pelvic floor physical therapist as early as possible in your pregnancy. That way, you can get to know your body and muscles before it has fully changed, which can help you understand what’s “normal” for you. Origin can help or you can also find a local provider.

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