Perineal massage - what it is, and how to do it
Can massaging the perineum help avoid tearing or episiotomy during childbirth? How does it work - and how can you do it yourself? Here's all you need to know...
The perineum is the area of the skin and muscle stretching between your vaginal opening and your anus.
You’ve probably not given it much thought until now, let alone considered massaging it ?
But it does undergo a lot of pressure during childbirth, and massaging it beforehand may improve its strength and elasticity – which could help reduce your risk of tearing
So, how do you do it? Does it hurt? And how exactly does massaging the perineum help you in labour?
Here’s everything you need to know about perineal massage…
What is perineal massage?
Perineal massage is a way of preparing the tissues of the perineum, the area between your vagina and anus, for the stretching that is necessary during childbirth.
It’s not so much a ‘massage’ in the traditional sense. It basically involves you or your partner inserting (lubricated) fingers into your vagina, and exerting downward and sideways pressure to stretch the skin and muscle.
How does perineal massage help in labour?
It’s good prep for the perineum, as during labour the tissues need to stretch a good deal to allow your baby to pass through the birthing canal. If the tissue doesn't stretch enough, then it can tear.
(We should add here that slight tearing is pretty common, regardless.)
Perineal massage 'trains' the perineal tissues to stretch - not only helping to avoid tearing, but also episiotomies (a cut to widen the vaginal entrance). It also helps reduce the stinging sensation you experience when your baby crowns.
Perineal massage is most effective if practised every day for the last 6 weeks of pregnancy, so from around week 34, for between 5 - 10 minutes at a time.
The theory is that a stronger, more elastic perineum should expand more easily when you give birth – but is there any scientific evidence behind it?
Well, a review of studies has confirmed that women who use a simple massage technique in the last 4 to 5 weeks of pregnancy can reduce their chances of needing an episiotomy when they give birth.
According to the review, published in the Cochrane Library Journal, the group of women who practiced the massage had 15% fewer episiotomies than those who did not. These women were also less likely to report perineal pain 3 months later, whether or not they had an episiotomy.
Obstetrician Dr Yehudi Gordon adds that perineal massage “has long term benefits that may improve urinary incontinence, sex and body image.”
How do you massage your perineum?
In order to effectively massage your perineal tissues you'll need to be ready to get stuck in there, down below.
Many women prefer to do this privately (in front of a mirror), though advanced students of perineal massage may prefer to get their partners to massage the perineum as an opportunity to share intimacy and involve their other half in childbirth preparations.
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Before you get started, make sure you’ve got:
- a warm, comfortable, private environment
- natural massage oil like sweet almond oil, jojoba, coconut butter, wheatgerm or olive oil or a water-based lubricant like KY Jelly. (Don't use any petroleum-based products for perineal massage.)
- a mirror, if you’re doing the massage yourself. Handheld mirrors might be a bit tricky, so you just need access to a bigger, static mirror in your house
- clean fingernails. Whoever’s doing the giving the massage should trim their thumbnails or finger nails and scrub their hands and nails.
Now, for the actual massage itself…
- Sitting with your legs spread comfortably apart, massage a little oil into the outside of the perineum and on your fingers and thumbs
- Insert your thumbs about half a thumb length into your vaginal canal, and apply pressure to the perineum, the area between the vagina and anus. If your partner is doing the massage they should use their index fingers. You should stretch the perineum until you feel a slight stinging sensation. When you feel that sensation hold the stretch for about a minute
- Circle your thumbs to massage the oil into the tissues down to the base of the vagina, gently pulling the tissues forward and back
- Now apply pressure against the sides of the vagina, moving thumbs in a 'u' shape up from the part of the vagina closest to the anus. Again, you should stretch enough to feel a slight stinging sensation, without inflicting pain on yourself
- Gently pull the tissues of the sides of the vagina downwards in imitation of how your baby's head will pull on the tissue during birth. Do this about half-way up the sides of the vagina and don't pull, rub, stretch or put pressure on the urethra at the top.
Remember that the massage should be gentle and not abrasive or vigorous.
Initially, you probably won't be able to stretch the tissues very far before the stinging sensation kicks in, but the point of the massage is that with repetition you'll be able to stretch more and more.
To make sure you do the massage every day, it helps if you build it into your daily routine.
Some women may find that a bath beforehand helps to relax them ready for the massage - others may find the massage itself relaxing, particularly as they become more adept at it.
Does perineal massage hurt?
We're dealing with a sensitive area of the body, so, yes, some women have commented that the first couple of weeks of massage can be uncomfortable, and even produce a painful or burning sensation.
However, most women reported that any pain had decreased, or gone, by the 2nd or 3rd week of massage.
Does perineal massage help your pelvic floor?
You can team perineal massage with your regular Kegel (pelvic floor) exercises to increase tone and control of your pelvic floor muscles.
If you have good control of your pelvic floor muscles, then consciously relax them as you perform the massage.
Why haven’t I been told about perineal massage before?
You’re more likely to hear about perineal massage at NCT or Active Birth classes – as not all midwives actively promote or suggest it.
That said, Gail Johnson, advisor at the Royal College of Midwives, points to evidence that suggests it’s worth a shot – though notes that there’s not a wide range of research available on the subject just yet:
“There is evidence to suggest it can reduce the amount of trauma to the perineum.
“This might be because the skin has been made more pliable, but it may also be because it makes women aware of their bodies, so when they get to pushing they are more body-aware and controlled.”
She adds: “Some women find it beneficial, but I don’t think it’s regularly recommended as a way of preventing tears because the evidence isn’t strong enough yet.
“As research carries on, we might feel more inclined to promote it in the future.”
Will perineal massage definitely stop me tearing or needing an episiotomy?
Firstly, you should know that episiotomies are pretty rare in the UK these days.
“They’re only performed with very good reason,” says Gail. So, the primary aim of a perineal massage would be to reduce tearing.
So far, researchers claim that only 1 in 16 women practicing perineal massage avoids stitches altogether.
But there’s certainly no harm in being more aware of what’s going on down below – because despite all the techniques, you might still tear.
“People shouldn’t be disappointed if it doesn’t work,” says Gail. “Sometimes the baby comes out with its hand up by its head, and you can’t help but tear.”
Tearing can be really uncomfortable, and you may need stitches. It might feel sore, and sting when you go to the loo.
Again, tearing is quite common and, as long as you keep clean and dry, and do pelvic floor exercises, it shouldn’t hamper your recovery.
How else can I try to stop tearing?
“It’s important to ensure you are well nourished and hydrated, as your body will work more effectively,” says Gail.
“And being mobile in labour will increase circulation to the perineum, so it will stretch better.” A slow, controlled delivery is the key to minimising tears: using breathing exercises and performing the ‘braking’ position when the urge to push is strong.
One of the best positions to reduce tearing is lying on your left side with your right leg supported.
“This means the baby doesn’t have to fight against the curve of the birth canal,” explains Gail, “and yet doesn’t come out as quickly as when you give birth on all fours.”
Of course, we know that not every woman will be so lucky to have such control over her labour. Still, good to know, right?
One mum’s experience of perineal massage
MFMer Naomi F tried perineal massage when she was pregnant with her 21-month-old daughter Polly, and she feels it’s worth a try.
“I heard about perineal massage in my NCT class, but what prompted me to do it was a friend who believed it had helped her.
“She knew how much I wanted to prevent tearing, and recommended an oil to use. I started when I was 35 weeks pregnant and tried to do it every day (although probably did it every other day).
“I found it a bit bizarre,” she confesses. “It’s not like you can get someone to show you how, but the more I did it, the more relaxed I felt.
“When I gave birth to Polly, I had a very small tear and didn’t need stitches. It’s not as if she slid out effortlessly though!
“It’s hard to know what would have happened if I hadn’t done the massage, to be honest, but I do think it softened the tissue and made me more aware of the muscles involved in labour. I would recommend it.”
Images: Getty Images