Reducing perineal tearing

Research on perineal trauma looks at techniques that might lower the chance or severity of tearing at birth. The most studied are perineal massage and warm compresses. Randomized trials test each technique alone and combined during the second stage of labor, and meta-analyses pool the trial results for massage and for warm compresses.

Outcomes vary across papers. Some look at perineal trauma, pain, hemorrhage, or the length of episiotomy. Others follow postpartum pelvic floor function, including a secondary analysis of a randomized trial. Broader reviews, including an overview of systematic reviews and a review of interventions for preventing perineal trauma, compare different second stage techniques. Some analyses focus on first-time mothers or on massage at different stages.

Parents often ask whether anything can be done to avoid tearing and whether massage ahead of time helps. An educator may want slides that describe which techniques have been studied, and the outcomes measured, without promising that any technique prevents tearing. The papers below are the ones the Hub tracks on this topic.