Perineal massage eases the pain of childbirth

April 18, 2000
Web posted at: 2:14 PM EDT (1814 GMT)

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(WebMD) -- Like many pregnant women, Dana Martin knew very little about perineal massage until about two months before giving birth. "That's when my doctor and midwife taught me the basic techniques," says the New York mother. Martin's caregivers explained that perineal massage involves gently stretching the tissues that surround the opening to the vagina.

Not only can massage reduce the risk of severe trauma to the perineum (the area between the vagina and the rectum) during labor, it may even help a woman avoid an episiotomy, where an incision is made near the vagina to ease delivery of the baby. Although practicing perineal massage during her third trimester of pregnancy didn't allow Martin to avoid an episiotomy entirely, it still made a big difference when her daughter was delivered. "(It) helped the tissues around my vaginal opening to stretch, so when it was time to give birth, my incision ended up being very minor and quick to heal," she says.

Research -- including a recent study published in the March 2000 issue of Obstetrics and Gynecology -- has demonstrated quite conclusively that perineal massage can help avoid episiotomies and severe tearing in women giving birth vaginally for the first time.

While research on the benefits of perineal massage to women who already have a child remains less clear-cut (the same study found no benefit to women giving birth for the second or subsequent time) many obstetricians and gynecologists say it's worth a try. "I tell my patients that it won't hurt, and it just might help," says John R. Sussman, M.D., co-author of The Unofficial Guide to Having A Baby.

Both those for and against perineal massage agree that there are many good reasons to avoid an episiotomy. Lacerations to the perineal area are more likely to be superficial and not involve muscle tissue if a spontaneous tear occurs during birth. On the other hand, the tearing that accompanies an episiotomy tends to be more severe, notes Kim Updegrove, a practicing nurse-midwife and a faculty member in the Yale School of Nursing.

Women who can avoid an episiotomy are less likely to experience complications such as blood loss, infection, pain during the postpartum period, pain during intercourse and the involuntary passage of gas or fecal matter after delivery -- all of which are more common in women who have had an episiotomy, says Jessica Arluck, M.D., a clinical instructor in the department of gynecology and obstetrics at Emory University School of Medicine in Atlanta.

Arluck adds that, despite what some pregnancy books tell you, there's no such thing as a perfect episiotomy. Midline episiotomies, where the incision goes straight up and down, are associated with a high rate of anal incontinence and flatus incontinence (the involuntary release of gas from the bowel) following the delivery, while mediolateral episiotomies, where the incision veers slightly to the right or left, are more likely to result in painful intercourse when the couple resumes sexual relations.

Still, not all caregivers are convinced that perineal massage can help women avoid episiotomies and the difficulties related to them. "I have not found perineal massage to make a difference in my own practice," says Arluck.

But Updegrove remains a strong proponent of the method. "It's a nonmedical intervention that women have within their control," she explains. "They can choose when and how to do it."

If you do decide to give perineal massage a try, don't assume that doing so will guarantee you an episiotomy-free delivery -- even if you are giving birth vaginally for the very first time. Remember that it's not possible to predict how a particular delivery will go. "There are emergency situations where episiotomies simply have to be done," Arluck explains.

But if you've practiced perineal massage, there's always the chance that you'll luck out like Dana Martin did and get away with the world's tiniest incision -- or perhaps no episiotomy or tear at all. "Needless to say, I'm a big fan of perineal massage," Martin says.

Ann Douglas specializes in writing about pregnancy, birth, and parenting. She is co-author of The Unofficial Guide to Having A Baby and the author of both The Unofficial Guide to Childcare and Baby Science: How Babies Really Work, a recent Book of the Month Club selection.

© 2000 Healtheon/WebMD. All rights reserved.

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American College of Obstetricians and Gynecologists
U.C. Davis Health System Wellness Center -- Episiotomy

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