Perineal Massage in Pregnancy

Your perineum is the area between your vaginal opening and your rectum (back passage). This area stretches a lot during childbirth, and sometimes it tears.
It is this area that is cut if you require an episiotomy during birth. An episiotomy is a cut to the perineum that is sometimes performed to speed up the birth of your baby or to try to prevent a more severe tear. You may need stitches after your baby is born if you have a tear or have had an episiotomy.
I’m concerned about perineal tears—how often do they occur?
40% to 85% of all women who give birth vaginally will tear. About two thirds of these women will need stitches.
Can my midwife do anything to help me avoid a tear?
There are many ways that your midwife can help to reduce your chances of tearing. For example, your midwife may recommend specific pushing positions and provide gentle pressure on the baby’s head as it comes out.
Warm compresses to your perineum may also help to reduce severe tears.
Can I do anything before the birth to help me avoid a tear?
Reducing tearing has been the subject of many research studies. Several studies have found that perineal massage during the last weeks of pregnancy can reduce tearing during birth. The latest Cochrane systemic review (2013) suggests “antenatal perineal massage reduces the likelihood of perineal trauma in first time mums and perineal pain for second time mums”.
Instructions for perineal massage during
pregnancy
If you wish to use perineal massage, begin 6 weeks before your due date and follow these suggestions:

• Wash your hands well, and keep your fingernails short. Relax in a private place with your knees bent. Some women like to lean on pillows for back support.

• Lubricate your thumbs and the perineal tissues. Use a lubricant such as vitamin E oil or almond oil, or any vegetable oil like olive oil. You may also try a water-soluble jelly, such as K-Y jelly, or your body’s natural vaginal lubricant. Do not use baby oil, mineral oil, or petroleum jelly.
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Place your thumbs about 1 to 1.5 inches inside your vagina (see figure). Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation.
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Hold that position for 1 or 2 minutes.

• With your thumbs, slowly massage the lower half of the vagina using a “U” shaped movement. Concentrate on relaxing your muscles. This is a good time to practice slow, deep breathing techniques.

• Massage your perineal area slowly for 10 minutes each day. After 1 to 2 weeks, you should notice more stretchiness and less burning in your perineum.

What are the advantages of perineal massage?

• It increases the elasticity (stretchiness) of the perineum. It improves the perineum’s blood flow and ability to stretch more easily and less painfully during the birth of your baby.
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Tears in the perineum are less likely and you are less likely to need an episiotomy.
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While you massage, you can practice relaxing the muscles in your perineum. This can help you prepare for the stretching, burning feeling you may have when your baby’s head is born. Relaxing this area during birth can help prevent tearing.

•  Your perineum is less likely to be painful after the birth of your baby.

• It can be particularly helpful if you have previous scar tissue or rigid perineum, which can occur in some horse riders or dancers. All women can benefit from doing perineal massage.
Are there any risks to perineal massage during pregnancy?
Not that we know of. It doesn’t hurt. It is easy to do and most women don’t mind doing it. However, if you have and questions, you can contact your midwife to discuss.

Partners:
If your partner is doing the perineal massage, follow the same basic instructions, above. However, your partner should use his or her index fingers to do the massage (instead of thumbs). The same side-to-side, u-shaped, downward pressure method should be used. Good communication is important – be sure to tell your partner if you have too much pain or burning.
Do not perform perineal massage:
• Prior to 34 weeks of pregnancy
• If you have placenta praevia (a low-lying placenta)
• If you have experienced preterm labour that has now settled
• If you have thrush, vaginal herpes or any other vaginal infection
• If you feel pain at any point, stop and try again another time
• If your waters are released or leaking, contact your midwife for assessment.