Perineal massage for birth: the evidence and how to do it

Third trimester · Pregnancy · Updated July 2026 · All articles

Perineal massage is one of the most searched third-trimester topics, and for good reason: it is one of the few birth-preparation techniques with a solid evidence base behind it. If you have heard about it but are not sure exactly what it involves, when to start, or whether it is worth doing, this article covers everything you need to know.

What the perineum is

The perineum is the area of soft tissue between the vaginal opening and the anus. During a vaginal birth, this tissue needs to stretch significantly as your baby's head passes through the birth canal. In some births the perineum stretches without tearing; in others it tears to some degree, or a midwife may make a small cut (called an episiotomy) if more space is needed. Both outcomes are common and both heal, but many people understandably want to give their perineum the best preparation possible before birth.

What perineal massage is

Perineal massage is a technique of gently and repeatedly stretching the perineum in the weeks before birth. The goal is to gradually increase the elasticity of the tissue so that it is better prepared for the stretching that happens during delivery. You apply steady pressure with your thumbs (or your partner uses their fingers) against the lower vaginal wall, working the tissue in a slow sweeping movement.

It is not complicated, it does not require any special equipment beyond a clean lubricant, and most people can fit it into a weekly routine with a few minutes per session.

What the evidence says

The evidence base for perineal massage is substantial. A Cochrane systematic review by Beckmann and Stock (2013) analysed the results of multiple randomised controlled trials and found that perineal massage practised from around 34 to 35 weeks of pregnancy significantly reduced the likelihood of perineal trauma requiring stitches for first-time parents giving birth vaginally. In practical terms, this meant a lower rate of episiotomy and a lower rate of serious (third- and fourth-degree) tears in people who practised it regularly.

The benefit was less clear for people who have given birth vaginally before. This is thought to be because a previous vaginal birth has already stretched the perineal tissue, making it more elastic to begin with.

NICE (the National Institute for Health and Care Excellence) recommends that antenatal perineal massage be offered to women planning a vaginal birth, citing this evidence. The NHS also supports it. This is not an alternative therapy: it is a technique recommended by mainstream clinical guidelines.

When to start and how often

The evidence is based on perineal massage started at around 34 to 35 weeks of pregnancy, practised once or twice a week. That is the schedule with the most evidence behind it, so it is the one to follow. Starting earlier has not been shown to produce extra benefit, so there is no need to begin before 34 weeks.

If you are reading this at 37 or 38 weeks and have not started yet, it is not too late. Even a handful of sessions before your due date is worth doing, and there is no harm in trying at any point in the third trimester.

How to do it: step by step

Here is how to do perineal massage in practice.

  1. Wash your hands thoroughly with soap and warm water. Clean hands are all you need: there is no clinical evidence that perineal massage increases infection risk when basic hygiene is followed.
  2. Choose a lubricant. Pure vegetable oil, almond oil, olive oil, or a purpose-made perineal massage oil all work well. The key is to use something plain and body-safe. Avoid mineral oil, petroleum jelly (Vaseline), or baby oil, which are not suitable for the vaginal area. If you have a nut allergy, use sunflower or vegetable oil rather than almond oil.
  3. Get comfortable. A semi-reclined position on your bed works well for most people: lie back with your knees bent, feet flat, and your back propped on pillows. Alternatively, try standing with one foot resting on a bath edge or a low step, or try a supported squat leaning against a wall. Choose whatever position lets you reach comfortably and lets your body relax.
  4. Apply a little oil to your thumbs and to the perineal area.
  5. Place your thumbs inside the vaginal opening to roughly the depth of the second knuckle. Point them toward your back passage. Apply a gentle, steady downward and sideward pressure until you feel a stretching or burning sensation. When you feel that sensation, hold the pressure steadily for one to two minutes, breathing slowly, until the feeling eases a little. If you do not feel a stretching sensation, you may need slightly more pressure.
  6. Sweep in a U-shape, moving from one side across to the other and back again, maintaining gentle but firm pressure against the lower vaginal wall. Continue for around three to five minutes in total per session.
  7. Listen to the sensations. A stretching, burning, or tingling feeling is exactly what you are working toward: it tells you the tissue is being worked. The sensation should not feel sharp or acutely painful. If you feel sharp pain at any point, ease the pressure or stop and try again another day.

If reaching comfortably has become difficult in the later weeks of pregnancy, a partner can help. They use their index fingers rather than thumbs, apply the same technique, and follow your lead on pressure and comfort throughout.

What to expect when you start

The first few sessions are often the most uncomfortable. The stretching and burning sensation can be stronger than you expect, and it may take a few minutes to find a position that works well for you. That is completely normal.

Most people find that with weekly practice the sensation becomes noticeably easier to manage over two to three weeks, which is itself a sign that the technique is working. Some sessions will feel more uncomfortable than others depending on how you are feeling on a given day, and that variability is normal too.

Do not feel you have to push through sharp pain to make it work. Steady, sustained pressure at the point of stretching is what matters: you do not need to push harder than that.

Is it safe?

Yes, for most people. Perineal massage does not increase the risk of vaginal infection when clean hands and a suitable oil are used. It does not affect the baby.

There are two situations where you should check with your midwife before starting:

Outside of those two situations, perineal massage is safe to start without needing explicit clearance from a clinician.

Will it definitely prevent tearing?

No. No technique can guarantee you will not tear during birth. Perineal massage reduces the risk of perineal trauma in first-time births, but many factors affect what happens during delivery: the speed of the second stage, the baby's head size and position, your birth position, and the support available from your midwife all play a role.

The goal of perineal massage is to give your tissue the best preparation possible, not to guarantee a specific outcome. If you do experience a tear or need an episiotomy despite doing the massage regularly, that does not mean you did anything wrong. Perineal trauma is not a failure: it is a common part of birth that is treated and heals.

Other approaches with evidence behind them

Perineal massage is not the only technique that can help. There are two others worth knowing about.

Warm perineal compresses during labour: A Cochrane review (Aasheim et al.) found that warm compresses applied to the perineum during the pushing phase of labour reduced the rate of serious perineal tears. If this interests you, note it in your birth plan and discuss it with your midwife beforehand so they can have a warm compress available.

Hands-on support from your midwife: Active support from the midwife or birth attendant during the pushing phase, sometimes called the hands-on technique, is also associated with reduced perineal trauma. Your midwife will use their clinical judgment during labour about the best approach, but you can ask about this in your antenatal appointments if you want to understand more.

Perineal massage before birth and warm compresses or hands-on support during labour are complementary: they work through different mechanisms at different stages, and there is no reason you cannot plan for both.

Frequently asked questions

Does perineal massage actually work?

The evidence is strongest for first-time parents. A Cochrane systematic review (Beckmann and Stock, 2013) found that perineal massage from around 34 to 35 weeks significantly reduced the rate of perineal trauma requiring stitches in first-time vaginal births, including lower rates of episiotomy and serious tears. For people who have given birth vaginally before, the evidence of benefit is less clear. NICE recommends that antenatal perineal massage be offered to women planning a vaginal birth.

When should I start perineal massage?

Around 34 to 35 weeks of pregnancy is when the Cochrane evidence base begins. That is the recommended starting point. If you are already past 35 weeks, start now: even a few sessions before your due date is better than none, and there is no harm in starting at any point in the third trimester.

How often should I do it?

Once or twice a week is the frequency used in the research, with sessions of around five minutes. You do not need to do it every day. More frequent practice has not been shown to produce additional benefit, so once or twice weekly is enough.

What oil should I use?

Pure vegetable oil, almond oil, olive oil, or a purpose-made perineal massage oil are all suitable. Avoid mineral oil, petroleum jelly, and baby oil. If you have a nut allergy, stick to sunflower or vegetable oil rather than almond oil. Fragrance-free and additive-free is the principle to follow.

What does it feel like?

A stretching, burning, or tingling sensation is normal and is what you are aiming for: it tells you the tissue is being worked. The first few sessions tend to be the most uncomfortable. With regular practice the sensation typically becomes more manageable over two to three weeks. If you feel sharp pain at any point, ease the pressure or stop.

Can my partner do it?

Yes. If reaching comfortably becomes difficult in the later weeks of pregnancy, a partner can help. They use their index fingers rather than thumbs, apply the same technique, and follow your guidance on pressure and pace throughout. Good communication matters more than technique perfection.

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Sources

Informational only. Always follow the advice of your midwife or obstetric team. Browse all articles.