Perineal Massage

Your perineum is the area of tissue between the vagina and your anus (back passage). It connects with your pelvic floor muscles and helps to support your pelvic organs.

What is perineal massage?

Perineal massage involves gently massaging the perineum. With time and practice the tissues will become more elastic. This will help with the pressure felt during birth when your baby’s head delivers. Perineal massage should be comfortable to you, but you need to feel the tissues being stretched and massaged for it to be useful.

Benefits of perineal massage

Research shows that perineal massage can be of benefit in reducing perineal tears that need stitching at the time of the birth of your baby (Cochrane, 2014).

Research suggests that perineal massage can help all women but especially those over 30 years of age and those in their 1st pregnancy.

Perineal massage alone may not prepare and protect the perineum, but combined with a better education of labour, birth and attending birth workshops or parent craft, it may help you to be mentally prepared. The feeling during perineal massage is similar to what you will feel when your baby’s head is crowning.

Alternative positions in labour and during your birth such as sitting forwards, squatting, use of birthing balls, kneeling, hands/knee position, sitting back to front on a chair, (which is known as optimal positioning for labour), could lead to a reduced chance of perineal trauma. Pelvic floor exercises / Kegel exercises could also be of benefit to you alongside perineal massage.

Ask your Midwife for advice on pelvic floor exercises and alternate birthing positions.

When can I start perineal massage and how often will I need to do it for it to benefit me?

It is suggested that you can start perineal massage from 34 weeks pregnant up until delivery. You can perform perineal massage as often as you wish, but most women will benefit from daily or at least alternate day massage.

Do not do perineal massage if you have genital herpes, genital warts, candida (thrush) or any other genital infections.

Preparation for perineal massage

• Find a comfortable place to do the exercises yourself or where you and your partner won’t be disturbed.
• A good time to do perineal massage is after a bath when the blood vessels in the perineum are dilated and hence softer and more comfortable to touch. You should be more relaxed after a soak in bath.
• Use unscented oils e.g. Olive oil, sweet almond oil or other organic, vegetable based oils, or KY jelly which is water based. Do not use synthetic oils such as baby oil or petroleum jelly (Vaseline).
• If you are doing the massage alone, you may need a mirror to see where you are putting your fingers.
• Educate your partner as to what is expected from them. If your partner is doing the massage they can use either thumbs or fingers but need to be sensitive to your body and only put on the amount of pressure that you can tolerate.
• Trim your finger nails to prevent scratching your perineal and vaginal tissues.
• Wash your hands.
• Sit propped up with pillows as support, on for example the sofa or the bed or laid in the bath with one leg up on the side of the bath.

How to perform perineal massage

You can perform perineal massage either by yourself or with your partner’s help. You should feel some stretching and burning sensations but this should not be painful or too uncomfortable. Try to relax your perineum as much as you can during the massage.

• Lubricate thumbs and place 2-3cm inside the vagina. If doing this alone you may only be to use 1 thumb or finger at a time on each side and then change over.
• Press the thumbs downward towards the rectum and pull out to the sides of the vaginal walls and hold for 1-2 minutes or for as long as you can tolerate. Do this for about 5 – 15 minutes. Gently massage by moving the thumbs and forefingers together in an upwards and outwards movement in a rhythmic “U” or sling type movement.
• Pull the thumbs outwards as though imagining how it would feel when the baby’s head is being born.

If your partner is reluctant to help you do perineal massage you can do it yourself. Insert your finger or thumb into your vagina at the 6 o’clock position and press downwards and move it through to the 3 o’clock then the 9 o’clock position in a sling like movement.

Important points to remember when performing perineal massage

• If there is previous scar tissue then concentrate on this area more to give more stretch to the area.
• Avoid the urethral opening as this may lead to urinary tract infection or soft tissue damage.
• Being too vigorous could lead to swelling or bruising.
• Stop if there is any pain.