What Is an Episiotomy?
To aid with vaginal delivery, an incision may be made to the pregnant person’s perineum, the skin between their vagina and rectum. The surgical procedure, known as an episiotomy, has its risks, so there are only very specific circumstances under which it is performed. Experts including the American College of Obstetricians and Gynecologists (ACOG) recommend against routine episiotomy going as far as laying out steps for providers to take to avoid it and advising that the procedure only be done when absolutely necessary, such as when the baby is in distress and needs to be delivered quickly or to prevent much larger tears. An episiotomy may be recommended if:
There is a need for a vacuum or forceps delivery. The baby experiences a lack of oxygen or decreased heart rate while crowning. The baby’s shoulders won’t emerge (known as shoulder dystocia).
Benefits and Risks of Episiotomy
Between 53% and 79% of vaginal deliveries include some degree of laceration or “tearing.” Most of these lacerations heal well and don’t result in long-term complications. But severe lacerations, though less common, are associated with an increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction. In cases where there is a clear risk of severe tearing, providers may recommend an episiotomy. But there are risks associated with episiotomy. Episiotomy incisions may cause tears beyond the skin’s surface involving the muscles and rectal sphincter as well as the anal wall and increased maternal blood loss. Post-surgery, there is the risk of infection, narrowing of the vaginal canal, skin tags, development of a hole in the vaginal canal, and increased pain. Some people also experience anal sphincter dysfunction, anal incontinence, and dyspareunia (painful intercourse) long after the episiotomy incision heals. There is also an increase in the risk of perineal tearing in a future delivery.
Why Perineal Massage?
Perineal massage involves massaging and stretching the skin of the perineum (the area of skin between the vaginal opening and rectum). The technique can be performed during late pregnancy and during the pushing stage of labor to decrease muscular resistance and reduce the risk of severe perineal tearing during delivery. Though there is limited research on the effectiveness of prenatal perineal massage for decreasing tearing during delivery, there is stronger evidence supporting its use during labor. A 2013 review concluded that prenatal perineal massage can reduce the likelihood of perineal trauma during birth. While the use of perineal massage during pregnancy was associated with a reduction in trauma requiring stitches, this was mainly a result of the reduction in the need for episiotomy, not the overall reduction of tearing. A 2017 review found that perineal massage and support during the second stage of labor, however, was linked with a reduced risk of third- and fourth-degree tears when compared to an unsupported or “hands-off” second stage. That said, the review did not uncover a significant difference in the incidence of first- and second-degree tears. A 2019 study of 99 cases also found that there was a significant reduction in episiotomies when perineal massage was performed during labor. Perineal massage during labor was also associated with a shorter second stage. In addition to potentially reducing the likelihood of episiotomy, prenatal perineal massage may also familiarize you with some of the sensations of birth and how to control your pelvic floor muscles. The knowledge of what you are feeling can help you relax more during birth.
How to Do Prenatal Perineal Massage
Before you try prenatal perineal massage, consult with your healthcare provider to ensure the technique is right for you. Once cleared to try, these are the basic steps: You can do this massage as often as once a day during late pregnancy to prepare for delivery.
A Word From Verywell
There are many factors to consider when it comes time for your baby’s birth, and there is little control to be had over most of them. Still, there are ways that you can prepare for the experience in advance, including reducing the risk of severe tearing and episiotomy during delivery. Perineal massage alone will not protect your perineum, but it can be one part of your birthing plan, especially if you wish for perineal support from your provider during delivery.
