Prenatal Perineal health and wellness with Annemarie Everett Lepe, PT, DPT

ASK the EXPERT  – Annemarie Everett Lepe; Specializing in Pelvic awareness

PRENATAL: Perineal stretching and injury/tear prevention

Stretching Where?  

Annemarie:” When I suggest perineal massage for my clients as they enter the later stages of

pregnancy, I get a lot of puzzled looks. While a common practice in other cultures for

women preparing for vaginal birth, the technique is still gaining traction in the

United States.

The principle of perineal massage is simple: gradually teach the perineum (the

muscle spanning between the vagina and anus, between the sit bones) to stretch

and accommodate a baby’s birth with greater ease. As the day of your baby’s birth

approaches, your perineal tissues will naturally become softer along with the cervix.

For this reason, some practitioners may not believe that perineal “stretching” is

necessary. However, these sensations are new to first time mothers, and learning

how to relax into the natural opening of the vagina during childbirth and becoming

accustomed to these sensations will help your body react positively during birth.

*Systematic reviews have shown that in first-time mothers, perineal massage

significant reduces the risk of trauma requiring sutures (“tearing”), and decreases

the incidence of episiotomies. Even for second-time mothers, perineal massage

showed a correlation with reduced postpartum perineal pain.

For most women, starting perineal massage around 34 weeks of pregnancy is

appropriate. However, women with a history of pelvic pain, or pain with intercourse

or speculum exams, may want to begin earlier. In my practice, I frequently teach

women and their partners how to perform perineal preparation techniques at

home; I also see many women for weekly appointments in clinic if they are unable to

do it at home. Our clinic (Miracle Physical Therapy) is a great resource if you are

looking for more information. Tutorials for perineal massage exist online – as with

all information online, it is always best to check with your care team before


We always recommend discussing perineal massage with your OB-GYN or midwife

to ensure that all members of your care team are on board with your plans. If you

are having vaginal bleeding, your bag of waters is open, or you have been put on

pelvic rest, do not perform perineal massage.”


*Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal

trauma. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005123.

DOI: 10.1002/14651858.CD005123.pub3.


Courtesy of Annemarie Evert Lepe, PT DPT

Annemarie Evertt Lepe PTAnnemarie Everett Lepe joined Miracle Physical Therapy in 2014, and is excited and honored to be a part of the clinic’s efforts to bring outstanding care and information to women at all stages of life. She earned her Doctorate of Physical Therapy from UC San Francisco, and brings experience and knowledge of orthopedic physical therapy to her women’s health practice. 

She is currently completing her Certificates of Achievement in Pelvic and Obstetrics Physical Therapy, with the goal of a clinical specialization in women’s health (WCS). Whether she is helping women prepare their pelvis for birth or treating pelvic girdle pain or pelvic floor dysfunction, Annemarie loves to empower her patients through education and develop a relationship that lasts beyond their plan of care.

Outside of the clinic, Annemarie is an avid yoga and Pilates student and enjoys spending her weekends exploring the Bay Area with her husband.