Evidence Based Birth® REPLAY: EBB 218 – The Evidence on Perineal Massage during Labor with Dr. Rebecca Dekker
Oct 29, 2025
Can perineal massage really reduce tearing during labor? Dr. Rebecca Dekker reviews the research, revealing mixed results. She highlights how the technique is performed, the impact of biases, and the significance of skilled care. Key studies show varying benefits, with some trials suggesting no advantage at all. The discussion includes ethical concerns around consent and aggressive practices. Ultimately, the evidence points to little benefit from massage in preventing severe tears, especially in well-supported settings.
AI Snips
Chapters
Books
Transcript
Episode notes
What Perineal Massage Actually Is
- Perineal massage during the second stage aims to gently stretch tissue so the head can pass without tearing.
- In studies it was usually done with two fingers and water-soluble lubricant, but real-world practice varies widely.
Meta-Analyses Showed Large Risk Reduction
- Two meta-analyses (Aquino 2020, Cochrane 2017) reported ~50% reduction in severe tears with massage.
- Both reviews relied on only five RCTs and noted applicability limits due to high episiotomy rates.
Largest RCT Found No Clear Benefit
- The Stamp et al. (2001) trial was large, well-conducted, and found no statistically significant benefit.
- High episiotomy rates (25–27%) and underpowering for rare severe tears limit its conclusions.
