Perineal massage is associated with a lower risk of severe perineal trauma and postpartum complications. Most vaginal births are associated with trauma to the perineum. It can lead to significant issues such as pain, scar tissue or incontinence.
What is the perineum?
The perineum is the area of skin and muscle between the vagina and anus.
What can happen to the perineum?
The pressure of giving birth on your perineum means it may tear or need an episiotomy (surgical cut) when your baby is born.
Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy. An episiotomy is a non-routine surgical cut to the vaginal opening, which is intended to prevent more serious tears. Up to one in 10 women experience pain for up to 18 months after a serious perineal tear or episiotomy.
Benefits of perineal massage
Perineal massage helps to:
- lower the chance for episiotomies
- lower the chance of perineal tears, particularly the risk of third- and fourth-degree perineal tears
- heal wounds if they occurred
- reduce perineal pain
- reduce the second stage of labour
How to do perineal massage?
Perineal massage is performed daily for 5-10 minutes from 34 weeks gestation.
Warm bath or compress
Sit in a warm bath or use a warm compress to the perineal area before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
Short nails
The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
Comfortable position
You need to be relaxed during the massage, so it’s important you find a comfortable position. Some women prefer to do it in bed. Prop yourself up with pillows to support your back and bend your knees. Another good position is standing with your foot propped up on a stool or a toilet seat to make the area more accessible.
Lubricant
Use a lubricant like vitamin E oil, almond oil or olive oil.
Thumbs or fingers
Insert your thumb or index finger into the vagina (about 2 inches deep) and massage the internal and external perineal region for about one minute, imagine a clock face between 3 o’clock , 6 o`clock and 9 o’clock.
Then stretch down at 6 o`clock, hold for about 6 counts. Move onto 3 o’clock and stretch for 6 counts. Move back to 6 o` clock and stretch down for another 6 counts. Repeat this 2-3.
From here, move over to the other side. If you are doing the massage in standing, it is time to switch legs on the stool or the toilet seat. Gently stretch down again at 6 o` clock, hold for about 6 counts. Move onto 9 o’clock and stretch for 6 counts. Move back to 6 o` clock and stretch down for another 6 counts. Repeat this 2-3 times.
Repeat daily or when possible. It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area. You can watch the instructional video here: https://www.instagram.com/p/Caj7tAuAR-O/
Do not do perineal massage if you have:
- genital herpes
- thrush
- bacterial vaginosis
- any vaginal infections
Can`t get to it
If you find it difficult to access the area, you can use:
- pelvic wand like this one https://mnaphysiotherapy.com/product/pelvic-wand-pelvic-muscle-massager/. Watch the video here how to use it correctly: https://www.instagram.com/p/Cf08VhDAsPr/
- dilator https://mnaphysiotherapy.com/product/dilators-set-pink/
- G-spot vibrator
Ask your women`s health physiotherapist if you are not sure how to use the above tools.
Can perineal massage help me avoid a tear or an episiotomy?
It’s possible, although not guaranteed. A number of things can affect whether you tear or have an episiotomy during childbirth.
Is there anything else I can do to prevent a tear or an episiotomy?
- A kneeling, side-lying, or all-fours position may help reduce pressure on the perineum
- Visit a women`s health physiotherapist to ensure your pelvic muscles are supportive during pregnancy, you can release them during labour and they return to being supportive after you give birth
- Join antenatal classes to help you to prepare for labour and the birth of your baby.
To book an appointment click here https://mnaphysiotherapy.com/contact/
References:
https://www.rcog.org.uk/en/patients/tears/reducing-risk/
https://www2.hse.ie/wellbeing/pregnancy-and-birth/labour/preparing/preparing-your-body/