Perineal massage: a few minutes a day to prepare for birth


Most of us are told to pack a hospital bag. Far fewer are told how to prepare the part of the body that does so much of the work. Here is what perineal massage is, what the research says, and how to start.

What is the perineum?

The perineum is the area of skin and muscle between the vaginal opening and the anus. During a vaginal birth it stretches a great deal to make room for your baby, which is why it is so often where tears and soreness happen.

Perineal massage means massaging and stretching this area in the final weeks of pregnancy, to help the tissue become more used to the feeling of stretching before birth.

Why it's worth knowing about

Perineal tears are not rare. They are the norm, and most women are never told how common they are.

  • Up to 9 in 10 first-time mothers who have a vaginal birth have a tear, graze or episiotomy.1
  • 80% of women who give birth vaginally in the UK experience some perineal trauma, around 450,000 women every year.2

Most tears are small and recover well. Knowing this in advance means you can prepare, ask the right questions and plan for recovery, not just for birth.

What the research says

Perineal massage is one of the few things you can do yourself before birth that has been studied in clinical trials. Here is what the evidence shows, plainly.

It can reduce the chance of tears that need stitches.
A Cochrane review of four trials and almost 2,500 women found that massage in the final weeks of pregnancy reduced the likelihood of perineal trauma needing stitches, mainly by reducing episiotomies. The benefit was seen in women having their first vaginal birth.3

It may help after birth too.
In the same review, women who had given birth vaginally before reported less ongoing perineal pain three months after birth.3 A 2024 analysis of 10 trials found that massage during pregnancy was linked to better pelvic floor function at three months, including less bowel and wind leakage.4

Regular practice appears to matter.
A 2025 study of more than 1,800 first-time mothers found fewer episiotomies among women who had perineal massage from 36 weeks, two to three times a week. More sessions were linked to better outcomes, and the study found no increase in preterm birth.5

During labour, ask about warm compresses.
A 2024 Cochrane review found that a warm compress held on the perineum while pushing likely reduces severe tears. The evidence for massage during labour itself is less certain.6 It's worth adding to your birth plan conversation with your midwife.

The evidence is strongest for women having their first vaginal birth. Perineal massage can't guarantee you won't tear, but it is a simple, low-risk way to prepare.

When to start and how often

  • When: in the final weeks of pregnancy. In the research, women typically started from around 36 weeks. Your midwife can tell you what's right for you.
  • How often: two to three times a week or more. The NHS notes the greatest benefit in women who massaged every day.1
  • How long: around 5 to 10 minutes each time.


How to do it

  1. Get ready. Wash your hands and check your nails are short and smooth. Empty your bladder.
  2. Get comfortable. Sit propped up on cushions, lie on your side, or stand with one foot raised on a low step. A warm bath beforehand can help you relax.
  3. Apply a moisturising gel. Smooth a little BloomCalma™ over the perineum and the skin around the vaginal opening.
  4. Massage and stretch. Using one or two fingers, press slowly down towards the anus, then sweep in a U shape from side to side. Hold a light stretch for a minute or two, until you feel a mild tingling or warmth.
  5. Breathe and relax. Slow breathing helps the muscles soften. Many women find this a useful rehearsal for birth.
  6. Stop if it hurts. You should feel stretching, not pain.


Later in pregnancy, when reaching becomes harder, a partner can help.

Before you start

Check with your midwife or doctor first if you:

  • have a vaginal infection, such as thrush, or any unusual discharge
  • have any bleeding, or your waters have broken
  • have been advised to avoid penetration or internal examinations during your pregnancy

What to use

Many women are told to use olive oil or aloe vera. They are easy to find, but they weren't designed for intimate skin, and oils can feel greasy and transfer to clothing.

BloomCalma™ is a pH-balanced intimate moisturising gel for pregnancy and postpartum, designed for perineal massage. It helps protect against perineal soreness, micro-tears and local itchiness.

  • Gel, not oil: non-greasy, residue-free and won't stain underwear
  • Cooling on application, fragrance-free and odour-free
  • Microbiome-friendly and pH-balanced for intimate skin
  • Developed with King's College London and UCL
  • Developed from the research behind our patented DuoBalance technology
  • Made in the UK

Discover BloomCalma™

After birth: the fourth trimester

The perineum often feels sore, dry and tender in the weeks after birth, whether or not you tore. BloomCalma™ is designed for intimate comfort during recovery too, so the gel you used to prepare can stay with you afterwards.

If pain gets worse instead of better, or you notice a high temperature or unusual discharge, contact your midwife or GP.



Frequently asked questions

Does perineal massage hurt?
Perineal massage should feel like stretching, often with a mild tingling or warmth, but it shouldn't be painful. It can feel unfamiliar at first and usually becomes easier with practice. If you feel sharp pain, stop and try a lighter pressure next time, or ask your midwife to talk you through the technique.

How often should I do perineal massage?
Research on perineal massage has typically used two to three sessions a week from around 36 weeks of pregnancy, and the NHS notes the greatest benefit in women who massaged every day. Each session usually lasts around 5 to 10 minutes. Regular practice appears to matter more than doing a long session occasionally.

Is perineal massage safe in pregnancy?
For most women, perineal massage in the final weeks of pregnancy is considered low risk. A 2025 study of more than 1,800 first-time mothers found no increase in preterm birth. Check with your midwife first if you have a vaginal infection, bleeding, broken waters, or have been advised to avoid internal examinations.

Is perineal massage worth doing if I've given birth before?
Yes, it can still help. A Cochrane review found that women who had given birth vaginally before reported less ongoing perineal pain three months after birth when they used perineal massage in pregnancy. The reduction in stitches and episiotomies was seen mainly in first births.

Can my partner do perineal massage?
Yes. Many women find it easier with a partner's help, especially later in pregnancy when reaching becomes harder. The technique is the same: slow, steady pressure downwards and to the sides, stopping if it becomes uncomfortable. It can also be a way to involve a partner in preparing for birth.

What should I use for perineal massage?
Use a product made for intimate skin. Oils such as olive oil are often suggested, but they can feel greasy and transfer to clothing. BloomCalma™ is a pH-balanced intimate moisturising gel designed for perineal massage: fragrance-free, non-greasy, cooling on application and residue-free.

Can I use BloomCalma after giving birth?
Yes. BloomCalma™ is designed for pregnancy and postpartum, so it can be used for intimate comfort during the weeks of recovery after birth. If your perineum is healing from stitches, ask your midwife when it's comfortable to start applying any product to the area.

Is it too late to start perineal massage?
It's rarely too late to start. Research suggests that more sessions are linked to better outcomes, so starting from around 36 weeks gives you the most time. Even if you begin later, a few weeks of regular practice can help you get familiar with the stretching sensation before birth.

References

  1. NHS. Episiotomy and perineal tears. nhs.uk
  2. University of Birmingham. The CHAPTER study. birmingham.ac.uk
  3. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews. 2013;(4):CD005123. doi.org/10.1002/14651858.CD005123.pub3
  4. Yin J, Chen Y, Huang M, et al. Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2024;24:405. doi.org/10.1186/s12884-024-06586-w
  5. Zhang J, Cai F, Li Y, Xu M. Impact and safety of perineal massage in late pregnancy on delivery outcomes among primiparous women: a propensity score matching analysis. BMC Pregnancy and Childbirth. 2025;25:1270. doi.org/10.1186/s12884-025-08452-9
  6. Dwan K, Fox T, Lutje V, Lavender T, Mills TA. Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications. Cochrane Database of Systematic Reviews. 2024;10:CD016148. doi.org/10.1002/14651858.CD016148


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This guide is for information only and does not replace advice from your midwife or doctor.