50. 3 Ways to Support Your Perineum During Birth for a Smoother Recovery
You’ve probably heard all kinds of advice on how to “protect” your perineum during birth—perineal massage, warm compresses, hands-on support, stretching devices… the list goes on.
But here’s the deal: your perineum isn’t fragile and birth isn’t something you need to “fix” ahead of time. If you really want to reduce your risk of tearing, it’s less about fancy techniques and more about who is catching your baby and how they handle birth.
So let’s talk about what actually makes a difference (and what’s just noise).
1. Perineal Massage: The Research Isn’t That Strong
Maybe you’ve heard that perineal massage during pregnancy can prevent tearing. But here’s what most people aren’t telling you—the research backing this up comes from hospitals where episiotomies were being done left and right.
If you’re birthing in a setting where episiotomies are rare, the data just doesn’t apply. (You can read a full breakdown of the research and its limitations in Evidence Based Birth’s analysis here.)
Does that mean perineal massage is bad? Nope. If it makes you feel good, do it! If it sounds like a chore, skip it. Either way, the biggest factor in whether or not you tear isn’t massage—it’s your provider’s habits during birth.
If you want to try it:
✅ Start around 34–35 weeks.
✅ Use clean hands and a little natural oil (like coconut or olive oil).
✅ Gently press and stretch the area using a U-shaped motion.
Some people swear by it, others find it awkward. Bottom line? It’s optional, not essential.
2. Warm Compress: Meh on the Research, But Some Swear By It
A warm compress on the perineum during pushing might help increase blood flow and reduce the risk of tearing. But here’s the thing—the research on this isn’t rock solid. Some studies suggest it helps, others are kind of “meh” about it.
What is solid? If warmth and comfort sound good to you, go for it. If not, skip it. Your birth, your call.
If you do want to try it:
✅ Have your birth team use a warm, damp cloth and hold it against your perineum as you push.
✅ Communicate what feels good (or doesn’t) in the moment.
And if you’re more of a hands-off kind of person? That’s totally fine too. No one has to be touching you down there if you don’t want them to. Period.
3. Hands-On vs. Hands-Off: Who’s Catching Your Baby Matters More
This is where things get interesting. There’s a lot of debate about whether a provider should use a “hands-on” approach (applying pressure to the perineum) or “hands-off” (letting your body do its thing).
Here’s what the research leans toward:
✅ Hands-off is linked to lower episiotomy rates and higher chances of keeping your perineum intact.
🚩 Hands-on has been linked to higher rates of episiotomy and severe tearing.
That said, if a provider is going to use their hands, they better know what they’re doing—because done wrong, it can actually increase trauma.
At the end of the day, this is your call. If you want a hands-off approach? Say it. Your body is fully capable of handling birth without extra hands all up in your space.
So What Actually Protects Your Perineum?
Forget the gimmicks, the best ways to protect your perineum have nothing to do with massage or compresses. Instead, focus on:
✅ Avoiding episiotomies (this comes down to choosing a provider who doesn’t do them unless medically necessary).
✅ Birth positions that reduce perineal pressure (upright, side-lying, hands-and-knees. Basically, not flat on your back).
✅ Breathing your baby out instead of forced pushing.
Your body was designed for this. The real work isn’t about stretching your perineum in pregnancy and during labor. It’s about making sure you have a provider who actually trusts birth and your body.
Want to dive deeper into the research and learn more about making empowered, informed choices during your pregnancy? Download my free research guide or join my email list for regular tips and resources to support your journey.
What about you?
Have you thought about what kind of support you want during birth—or how you want your provider to handle those final moments as your baby arrives? I’d love to hear your thoughts or experiences in the comments.
