Research has shown that massaging the perineum antenatally from 35 weeks gestation reduces the likelihood of perineal trauma during vaginal births such as tears which require suturing and it can reduce perineal pain post delivery. (Beckmann and Garrett 2006)
The perineum is the area of tissue located between the vagina and anus. It is connected to the muscles of the pelvic floor. The pelvic floor muscles form a hammock to support the pelvic organs. During childbirth, the perineum stretches to enable the delivery of the baby.
According to research by Kettle and Tohill 2008, McCandlish et al 1998 and Sleep et al 1984, approximately 85% of women experience some degree of perineal trauma during childbirth, ranging from first degree tears involving just the perineal skin, second degree tearing which involves both the perineal skin and muscles, third degree tears involving the anal sphincter and finally fourth degree tearing of both the anal sphincter and muscles.
The last two degrees of perineal trauma occur during 0.25%-2.5% of vaginal births (Groutz, Hasson et al 2011) and tend to happen to first time mothers giving birth vaginally, if the baby is delivered facing downwards or is heavier in weight or, if medical interventions such as forceps, ventouse vacuum or episiotomy are used. (Hirayama, Koyanangi et al 2012)
Trauma to the perineum can cause pain and discomfort when having sex (Barrett et al 2000), weakness in the perineum leading to vaginal prolapse and bowel and urinary incontinence. Research by Labrecque et al (2000) suggest that 19% of women develop urinary incontinence following vaginal birth but this figure is probably much higher as many women are too embarrassed to seek help.
What is perineal massage?
It is thought that massaging the perineum during pregnancy can increase muscle and tissue elasticity and make it easier for a woman to avoid tearing during a vaginal delivery.
The benefits of perineal massage
- It increases the elasticity of the perineum by improving the blood flow to the tissues and their capacity to stretch more easily and less painfully during childbirth.
- It can reduce the incidence of perineal tearing and need for an episiotomy. Episiotomy rates have decreased in the UK since the 1990s (Klein 1994, Kettle and Tohill 2008). Recovery from an episiotomy is much longer, more painful and more uncomfortable than from perineal tears which can heal faster. Women who do perineal massage are more likely to refuse an episiotomy unless there is danger to their baby’s life because they want to remain with an intact perineum. They are also more likely to repeat it in any subsequent pregnancies and recommend it to other women.
- It can reduce the incidence of perineal pain post birth.
- It can help if there is existing scar tissue or a rigid perineum, often found in professional dancers or horsewomen.
- Understanding how the perineum works and becoming familiar with how it feels can help a woman to focus on opening up her perineum during labour.
How to do perineal massage
You can start perineal massage any time after 34 weeks of pregnancy. It can be done either by yourself or your partner.
When to do it
An ideal time is during or after having a bath or shower because the warmth from the water increases the dilation of the blood vessels, thus increasing blood flow to the perineum, making it softer and more comfortable to touch. You are also more relaxed.
Use a good unscented organic oil, such as YES organic lubricant which contains nothing but plant extracts which is absorbed into the tissues of the perineum making them supple and more elastic. YES is a great lubricant to use during sexual intercourse when you are pregnant and following the birth as hormonal changes can have an effect upon vaginal secretions. It can help nourish scar tissue and promote the healing process if you have had sutures or perineal tears as well as feeling good.
Get comfortable. Try the following positions:
- Resting back in the bath with one leg propped on the side. Change legs to avoid getting cramps.
- Pile up pillows behind you on the bed/chair/sofa. Bend knees outward as if you were having a vaginal examination and support them with pillows/cushions.
- Sitting on the toilet
- Standing in the shower with one leg supported on a stool. Change legs to avoid cramp.
- Ensure that you feel comfortable and relaxed and will not be disturbed
Place one or both thumbs on and just within the back wall of the vagina. You could use a mirror to ensure that you are correctly positioned. Gently pressing down, move your thumbs in an upwards and outwards sweeping movement, in an upside down “U” or sling shape. Massage for as long as you feel it is comfortable but aim for a minimum of 5-10 minutes daily.
You will find that the more frequently you practice perineal massage, the more elastic your perineum will become and you will be able to increase the depth of pressure on the perineum and increase your ability to release your perineal muscles. This will help you to feel the pressure when in labour and release these muscles to enable the baby’s head to be born.
You may find it easier to massage the perineum using a small vibrator or dildo especially if you find it difficult to reach your perineum over your bump. Use a product made from skin safe silicone. You will be able to use the vibrator after giving birth to help stretch your vagina and scar tissue if sex is painful. A slim vibrator is ideal for this.
Perineal massage should not feel painful. If it does, stop and try at another time. Do not do perineal massage if you have vaginal herpes, thrush or any other vaginal infection.
Be gentle with your body and take time to explore how your perineum feels. It is a great way for couples to connect with each other during pregnancy and can enable your partner to become involved in your care. Always speak to your midwife or a women’s health physiotherapist about perineal massage if you have any concerns about how you should be doing it.