When to start perineal massage before birth

What does the evidence say about when to start perineal massage during pregnancy?

1. A systematic review of four trials involving 2,497 women found antenatal perineal massage lowered trauma needing stitches (risk ratio 0.91) and episiotomy (risk ratio 0.84); those findings were significant among women without a previous vaginal birth, not for every tear category. 1
2. In a 450-participant randomized trial, massage during the second stage of labor led to more intact perineums and fewer episiotomies, but the overall tear rate did not differ. This intrapartum intervention is not the same as starting massage at home at 34 to 35 weeks. 2
3. A randomized labor study found fewer episiotomies with perineal massage, while the degree of spontaneous tears did not differ between groups. Its findings concern active labor, not an antenatal schedule. 3
4. In a nonrandomized study of 81 participants, self-massage, physiotherapist massage, and usual-care groups did not differ significantly in postpartum urinary-incontinence incidence or severity. This small study does not establish a urinary benefit from antenatal perineal massage. 4
5. A meta-analysis of 10 studies in 1,057 first-time mothers separated antenatal massage after 34 weeks from second-stage massage. Antenatal massage was linked with lower fecal and flatus incontinence at three months, whereas second-stage massage had lower immediate postpartum pain; urinary-incontinence results were not significant. 5

Is when to start perineal massage safe in each trimester?

• First trimester. Antenatal perineal massage is generally a late-pregnancy practice, not a first-trimester activity. Focus on routine prenatal care and ask before any internal technique if you have bleeding or a pregnancy complication.
• Second trimester. Most evidence begins massage in the final month rather than the second trimester. Ask your maternity team when your individual pregnancy makes the technique appropriate.
• Third trimester. Many protocols begin around 34 to 35 weeks. Stop if it causes pain or bleeding, and ask first if membranes may have ruptured, infection is present, the placenta is low, or a cervical stitch is in place.