By Jamie Hatcher, CNM ~
Perineal massage is a simple technique that can be done before the birth which may reduce the incidence of perineal trauma or tearing. The technique works by gently stretching the perineal tissues, thus increasing the elasticity of the perineum. Regular practice of perineal massage may also help the woman anticipate and adjust to the sensations associated with crowning and birth.
But does it work?
A review of research studies focused on the outcomes of perineal massage found that there are some benefits! Women who performed perineal massage starting between 34-36 weeks of pregnancy experienced a small reduction in the likelihood of perineal trauma and ongoing perineal pain (1). The most significant benefit noted was a decrease in episiotomy rates among women who did perineal massage. Women who performed perineal massage also reported feeling that the area returned to feeling normal more quickly, and reported less pain 3 months after childbirth. So it looks like perineal massage is a good thing to be doing!
Where things get confusing, however, is when we talk about frequency. According to the research, the women who practiced perineal massage 1-2 times per week experienced the most benefit. Women who practiced perineal massage 3 times per week or more were found to have similar outcomes of perineal trauma as women who did not practice it at all.
So, how often should it be done?
From a research point of view, it means that performing perineal massage 1-2 times per week is the most statistically beneficial. This information was gathered by reviewing all of the studies found on perineal massage and interpreting the overall findings from a statistical standpoint, including assessing the methodology and strength of evidence. In fact, one of the studies included was a large clinical trial that found that the more often women did perineal massage, the more likely they were to avoid tears. We also have to consider the fact that there are limitations in research studies, just as there are many variations in real life. Ultimately, we can say that perineal massage is beneficial but it’s unclear how frequently it should be done for the maximum benefit.
How to get started
You can begin perineal massage around 34-36 weeks of pregnancy. You can either do it on your own or have your partner do it with you. While it may seem awkward to have your partner massage your perineum, it might actually bring you closer together and help them feel more involved in the birth preparation. It’s also a good time for you to practice your labor coping techniques together, with your partner coaching you through the moments of discomfort.
Whether you decide to do it on your own or with your partner, you’ll want to use something for lubrication. Avoid perfumed or synthetic oils; it’s best to choose natural oils such as coconut, sweet almond or a vitamin E oil. You can find specially blended perineal massage oils if that interests you, but these will work just as well.
An ideal time to do the massage is after a shower or bath, as the perineum will be softer and more comfortable to touch. Good positions include in the bath, reclining on your bed or sitting over the toilet. First, make sure you have clean hands. Begin by simply warming some oil between your hands and smoothing it over the whole of your perineum. Take a moment to relax into touching the perineum and focus on releasing any tension you feel there. Become familiar with how the perineum feels, what changes you feel if you tighten or release your pelvic floor or practice kegels. Finally, place either one thumb or both thumbs into the vagina and gently press downward toward the rectum until you feel a slight stinging sensation.
Once you feel this sensation, stop and hold pressure there while you practice breathing and relaxing your muscles. As your perineal tissues adjust to the new sensation and pressure, you can begin to massage along the base of the vagina in a “U” shape, either moving back-and-forth using one thumb or from the center outward using two thumbs. Do this for about 5-10 minutes. Practice this at least 1-2 times per week, or as often as you feel comfortable.
It’s important to note that perineal massage should not be painful. The goal is to use just enough pressure to cause mild discomfort. As your body adjusts to the sensation, you can begin to increase the pressure.
When NOT to do perineal massage:
If you have a vaginal infection, such as yeast, bacterial vaginosis or herpes.
If you are at risk for preterm labor or on pelvic rest. Perineal massage will not induce labor, however it is best to avoid unnecessary stimulation.
See related article “Protecting Your Perineum” by Hayley Oakes LM, CPM as to how to further prevent tearing during childbirth.
Resources & Articles
Video: How to do Perineal Massage – Taught by Two Midwives – https://youtu.be/V1L6HSAEztE