Perineal Massage and Epi-No: What You Need to Know in Pregnancy
Many women hear about perineal massage or devices such as Epi-No during pregnancy and wonder whether they actually help prepare the body for birth or reduce the risk of perineal tearing.
With mixed opinions online and strong marketing claims around some products, it can be difficult to know what is evidence-based and what is not. This article explores what perineal massage and Epi-No are, what the research shows, and how they may fit into birth preparation.
If you’d like personalised guidance on perineal preparation or pelvic floor health during pregnancy, a women’s health physiotherapist can provide individualised advice based on your body and birth goals.
What Is Perineal Massage?
Perineal massage is a technique used during late pregnancy to gently stretch and prepare the tissues of the perineum — the area of skin and muscle between the vagina and anus — in preparation for vaginal birth.
The aim of perineal massage is to help these tissues become more flexible and tolerant to stretching, which may reduce the likelihood of significant tearing during delivery. It can also help women become more familiar with the sensations of stretching in this area, which may support relaxation during the pushing stage of labour.
Perineal massage is usually performed using clean fingers and a natural lubricant or oil. It can be done by the pregnant woman herself or with the help of a partner, depending on comfort and preference.
Some women may have difficulty relaxing due to an overactive pelvic floor.
When is perineal massage usually started?
Perineal massage is commonly recommended from around 34 weeks of pregnancy, although this may vary depending on individual circumstances. It is typically performed for a maximum of 5 minutes a couple of times per week.
What does perineal massage involve?
Perineal massage involves applying gentle pressure to the lower vaginal tissues and slowly stretching them in a downward and outward direction. The stretch should feel firm but comfortable. Over time, this may help improve tissue flexibility and confidence with the sensations associated with birth.
Why is perineal massage recommended?
Research suggests that perineal massage may:
reduce the risk of perineal trauma, particularly for first-time vaginal births
decrease the likelihood of needing stitches
support awareness and relaxation of the pelvic floor muscles
help some women feel more prepared for vaginal birth
It’s important to note that perineal massage is not a guarantee against tearing, and many women have positive birth outcomes without doing it. It is simply one optional tool that may be helpful for some.
Is perineal massage right for everyone?
Perineal massage is generally safe for uncomplicated pregnancies, but it may not be appropriate for everyone. Women with certain conditions, discomfort, or concerns should seek individual advice before starting.
Note- What is the perineum!?
The perineum is the area of skin between the vagina and the rectum. During childbirth, your perineum and pelvic floor muscles will be greatly stretched and can tear, or you may be cut in a procedure called an episiotomy (to enlarge the space for the head to come through). The risk with any tearing or episiotomy is that it can lead to pelvic floor defects, reduced sensation, urinary incontinence, or incontinence of stool or flatus.
Does Perineal Massage Reduce Tearing?
The research on perineal massage is quite strong, and there are no known negative effects, which is why most midwives and obstetricians will recommend that you do this if you are planning a first-time vaginal delivery. The premise of doing perineal massage or using an EPI-NO in the lead up to delivery is to increase blood flow to the perineum and help the tissues and skin stretch with more ease and with less pain during childbirth and lower the risk and severity of tearing. It has been shown to have a significant impact on the reduction of the need for episiotomies and the duration of the second stage of labour (pushing baby out). In addition, if you perform perineal massage during pregnancy, and your midwife uses a warm compress on the perineum during crowning, this may further reduce serious perineal trauma.
What Is the Epi-No Device?
Epi-No is a silicone balloon device designed to be inserted into the vagina in late pregnancy, then gradually inflated to stretch the perineal tissues. The theory is that regular, gradual stretching may help the perineum adapt to the stretching forces of childbirth.
In the last three weeks of pregnancy, you slowly inflate the balloon to stretch your perineum, helping to prepare these tissues for birth. By stretching the perineum and learning to yield against the discomfort, you will become familiar with the sensation of birthing your baby.
At the time of writing this blog purchasing an Epi-No costs $189.
What Does the Evidence Say About Epi-No?
Perineal massage and devices like Epi-No are both aimed at preparing the perineum for the stress of birth, but the scientific evidence on their effectiveness is mixed — and it’s important to interpret it accurately.
The majority of studies on Epi-No tend to focus on whether it can reduce perineal tearing or the need for episiotomy during vaginal birth.
Here’s a summary of the evidence:
Limited or Inconsistent Impact on Tearing
Several trials have compared women who used Epi-No to those who didn’t. Most do not show a strong or consistent reduction in overall perineal trauma (tears or episiotomy rates) compared with women who used manual perineal massage or no intervention.
Some small studies suggested possible reductions in superficial tears, but not in more severe tears.
Other research found no significant difference in perineal outcomes compared with control groups.
In other words:
Epi-No does not consistently reduce the overall risk of perineal tearing in a way that is clearly superior to standard care or manual massage.
Symptom and Comfort Outcomes
In some studies, women using Epi-No reported:
increased confidence about stretching
feeling more aware of perineal sensations
…but these subjective outcomes do not necessarily translate into measurable clinical benefit.
This is important when managing expectations:
feeling more prepared is valid, but preparation doesn’t guarantee tearing won’t occur.
Technique and Consistency Matter
Where benefits do appear, they’re often linked to:
consistent and correct use
starting at an appropriate time in pregnancy
gentle technique without pain
But this is true of manual perineal massage too — and manual methods don’t require a device.
Perineal Massage vs Epi-No: Is One Better?
Perineal preparation during pregnancy can be done either through manual perineal massage or with the assistance of a device such as Epi-No. While both approaches aim to help the perineal tissues tolerate stretching during birth, they work in different ways and suit different women.
Perineal massage involves gently stretching the perineal tissues using fingers (your own or a partner’s), usually from around 34 weeks of pregnancy. It allows you to control pressure, speed and comfort, and can be adjusted based on how your body feels on the day.
Epi-No is a balloon-based device designed to be inserted into the vagina and gradually inflated to stretch the perineal tissues. The idea is to simulate the stretching that occurs during the later stages of vaginal birth.
What does the evidence suggest?
Research suggests that manual perineal massage may reduce the risk of perineal trauma, particularly for women having their first vaginal birth. The evidence for devices such as Epi-No is more mixed. Some studies suggest possible benefits for certain women, while others show no clear advantage over manual techniques.
Importantly, there is no strong evidence that Epi-No is superior to manual perineal massage in preventing tearing. Outcomes vary depending on individual anatomy, comfort, technique, and how consistently the approach is used.
Practical considerations
When choosing between perineal massage and Epi-No, it can help to consider:
Comfort: Some women prefer the hands-on control of manual massage, while others feel more comfortable using a device.
Cost and access: Perineal massage requires no equipment, whereas Epi-No is a purchased device.
Body awareness: Manual massage allows you to feel tissue response directly, which can help with relaxation and confidence.
Consistency: Whichever method is used, regular and gentle practice matters more than the tool itself.
Is one safer than the other?
Both approaches are generally considered safe when used gently and appropriately in uncomplicated pregnancies. Neither should cause pain. Discomfort, sharp sensations, or anxiety are signs to stop and reassess. Perineal preparation should always be optional — many women have healthy vaginal births without using either method.
If you’re unsure which approach — if any — is right for you, individual guidance can help ensure that perineal preparation is appropriate, gentle and tailored to your body. If you live in Canberra then you can book an appointment with our Women’s Health Physiotherapist.
Other Ways to Support Perineal Health During Birth
While perineal massage and devices such as Epi-No focus on preparing tissues during pregnancy, it’s important to recognise that perineal outcomes during birth are influenced by many factors — many of which are not fully within your control.
Pelvic Floor Relaxation and Perineal Health
A factor that is sometimes overlooked in perineal preparation is pelvic floor muscle relaxation. While strength and control of the pelvic floor are important, the pelvic floor must also be able to fully relax and lengthen to allow a baby to pass through the birth canal.
Some women carry increased tension or tightness in their pelvic floor muscles without realising it. This tension can make stretching during birth more challenging and may contribute to discomfort or difficulty during the pushing phase.
A consultation with a women’s health physiotherapist, including an internal assessment when appropriate, can help identify pelvic floor tension and guide strategies to improve relaxation and coordination. Ideally, pelvic floor function is assessed during pregnancy — often in the second trimester — so that any tension can be addressed well before birth.
Learning to Relax Your Pelvic Floor
Pelvic floor exercises are commonly recommended during pregnancy, but it’s equally important to focus on full relaxation between contractions.
When practising pelvic floor exercises:
gently contract the pelvic floor
then consciously relax the muscles completely
allow the relaxation phase to last at least as long as the contraction
For example, if you hold a pelvic floor contraction for five breaths, aim to fully relax the muscles for five breaths before starting the next contraction. This helps prevent unnecessary tension from building up and supports better muscle coordination.
Learning how to relax the pelvic floor can be just as important as strengthening it, particularly when preparing for vaginal birth.
The bottom line
Perineal massage and Epi-No are tools, not guarantees. Neither can completely prevent tearing, and neither is essential for a positive birth outcome. For many women, manual perineal massage offers a simple, low-cost and evidence-supported option, while Epi-No may be something some women choose to explore based on personal preference.
References
Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews. 2013;(4):CD005123.
Leon-Larios F, Corrales-Gutierrez I, Casado-Mejía R, Suarez-Serrano C. Influence of a perineal massage programme on perineal tears. Midwifery. 2017;47:62–67.
Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy. American Journal of Obstetrics and Gynecology. 1999;180(3):593–600.
Kok J, Tan KH, Koh S, et al. Use of the Epi-No device in pregnancy for prevention of perineal trauma: a randomized controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2004;111(4): 394–399.
Ruckhäberle E, Jundt K, Bäuerle M, et al. Prospective randomized controlled study evaluating the Epi-No birth trainer. Journal of Perinatal Medicine. 2009;37(5):520–523.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Perineal care during childbirth. Clinical guidance statement.
National Institute for Health and Care Excellence (NICE). Intrapartum care for healthy women and babies. NICE Guideline CG190.
Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on pelvic floor muscle training. Neurourology and Urodynamics. 2017;36(2): 232–244.