What is Perineal Massage? Advice from local RPT

Your entire pregnancy leads up to the big event of birth. You have probably found yourself in many conversations of people trying to prepare you for various aspects of birth or frankly give you their opinion. Often this is people’s opinion on pain management during birth and their birth stories. However, rarely will anyone mention or discuss perineal massage.  No this is not the same as a prenatal massage! This is massaging and preparing the perineum for birth.  Read on to learn all about perineal massage and why you should spend some time in your pregnancy preparing your perineum.

What is the perineum?

The perineum is the soft skin that is found in between the vagina and the anus. This area is prone to tearing during vaginal childbirth mainly due where it’s located and the pressure that it endures while pushing. Tearing is the natural occurrence of this area (which tends to happen more in first-time vaginal births), where an episiotomy is when this area is cut by a medical professional.

What is perineal massage?

Perineal massage is a way to prepare the perineum for birth by stretching and increasing the flexibility of this area. This technique is used in most cultures and has been around for much of human history.

Benefits of perineal massage

Research shows that perineal massage lowers the risk of major tearing or the need for an episiotomy in first time vaginal births.  Other benefits of perineal massage include:

  • Decreased pain during crowning. The ‘ring of fire’ is the sensation that is experienced as your baby’s head is crowning. Regular stretching of the perineum allows the area to stretch more easily which has been reported to ease the burning and stinging that happens during this phase of birth.

  • Increased awareness of this area which has been shown to assist in the ability to open and relax for your baby’s birth.

  • Less postpartum pain and dysfunction. As perineal massage decreases your risk of an episiotomy or severe tearing this results in less chance of ongoing perineal pain and dysfunction following delivery.

How to perform perineal massage

To prepare for perineal massage empty your bladder, wash your hands and find a comfortable position  (such as lying in bed, standing with a foot on a stool/toilet or in the shower). You can utilize a mirror to become familiar with your vaginal opening and the perineum.

How to perform the massage:

  1. Apply a water-soluble lubricant or natural oil like coconut oil on your thumbs and perineum.

  2. Place one or two thumbs into your vagina up to the thumb knuckle. Apply a firm but gentle pressure straight down on the perineum. Hold this for a minute or two while the perineum stretches. You may experience a sensation of burning or stretching. If you are feeling pain lessen your pressure or stop the massage.

  3. Gently press downward toward the rectum and to the sides of the vagina at the same time to stretch the opening, until a very slight burning, stinging, or tingling sensation is felt.

  4. Once you have stretched once, stop, and move your thumb up along the sides of the vagina stretching it from side to side.

  5. If you can use two thumbs, separate your thumbs in opposite directions to apply a stretch.

  6. The massage can be done in one direction at a time (i.e. from side to side, or the thumbs can be swept in opposite directions). Try different ways until you find which is more comfortable for you.

  7. Focus on relaxed breathing while trying to consciously relax the pelvic floor muscles and allowing the tissues to stretch.

Your partner can assist you by performing the massage for you. If this is the case, it is important to communicate and tell your partner how much pressure to apply without causing pain. Instead of using your thumb as described above, your partner can use their index fingers up to the first knuckle.

When to perform perineal massage

It is recommended to start perineal massage around 34 weeks of your pregnancy. It is not as clear how often you should do perineal massage as the evidence is not concrete. However, the consensus seems to be at least once a week and anything more is a bonus! On average, it is suggested you spend 3 to 5 minutes performing the massage.

When you should not perform perineal massage

Do not perform perineal massage in the following situations:

  • Prior to 34 weeks of pregnancy

  • If you have any complications in your pregnancy including placenta praevia (a low-lying placenta) or any other condition where you are experiencing bleeding at this point in pregnancy.

  • If you are experiencing any vaginal infection or STD, as perineal massage may spread the infection and worsen the condition.

Perineal massage is time well spent. Just five minutes a day can help prevent major tearing and episiotomies and in turn prevent long term complications.  Pelvic floor physiotherapists are trained to help women correctly perform perineal massage. If you need more help with perineal massage or have concerns regarding your perineum or pelvic floor please speak to a physiotherapist who specializes in the pelvic floor. As always, check with your obstetrician if you have any questions or concerns.

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