What is the Perineum?
The perineum is located between the vagina and the anus. As the base of the pelvic floor, the perineum supports the pelvic floor muscles and contains connective tissues, muscles, membranes, and nerves that help pelvic organs like the bowel and bladder to function correctly.
What is Perineal Massage?
Along with the pelvic floor muscles and vagina, the perineum stretches to its limit during childbirth, particularly during the latter stages of labor when the baby’s head and shoulders exit through the vaginal opening. Perineal massage, which is also known as perineal stretching, is performed to soften and stretch the skin tissue between the vagina and anus before childbirth.
Why is Perineal Massage Beneficial Before Childbirth?
Regularly softening and stretching the perineum with massage in the weeks before childbirth enables the vaginal muscles to more easily loosen and stretch during vaginal birth. As the baby’s head and shoulders pass through the vaginal opening, severe perineal tearing is reduced.
What is Severe Perineal Tearing?
Perineal tears during childbirth are rated into four categories. First and second-degree perineal tears affect only the vagina and heal quickly without stitches. Third and fourth-degree perineal tears, which damage the perineum, anus, and rectal lining are considered severe perineal tearing.
Third and fourth-degree perineal tears during childbirth usually require sutures and can mean a longer recovery. Severe perineal tears can also result in pelvic floor dysfunction, long-term incontinence, pelvic organ prolapse, as well as dyspareunia (pain during sex).
Does Perineal Massage Work?
Multiple studies and the collective experience of many first-time mothers show that massaging the perineum before childbirth works to prevent severe perineal tearing, the need for an episiotomy, and postpartum complications.
Does Massaging the Perineum Prevent Sutures Afterward?
Studies assessing the benefits of perineal massage have shown that it can significantly decrease the likelihood of third and fourth-degree tears which require sutures. However, because each birth, baby, and mother are unique, performing perineal massage before childbirth does not guarantee that you won’t need sutures.
Why is Perineal Massage Recommended Before Childbirth?
Antenatal perineal massage, also known as massaging the perineum before childbirth, is recommended to soften the muscles and skin tissue around the vaginal opening to reduce perineal trauma and avoid postpartum complications.
What is An Episiotomy?
Episiotomies, which involve your OB/GYN or midwife making a small incision in the perineum to enlarge the vaginal opening, were previously carried out to prevent severe perineal tearing. However, new research has shown that an episiotomy contributes to severe perineal tearing instead of preventing it.
Because an episiotomy can prolong the recovery from childbirth and cause postpartum complications like infection, pelvic floor dysfunction, dyspareunia, incontinence, and painful scar tissue, the procedure is currently performed only when the mother or baby is in distress.
Can Perineal Massage Prevent an Episiotomy?
Massaging and stretching the perineum improves the skin and muscle elasticity required for vaginal childbirth. This allows the baby’s head and shoulders to pass more easily through the vaginal opening and significantly reduces the need for an episiotomy.
Can Perineal Massage Prevent Pelvic Organ Prolapse?
The perineum also supports the pelvic floor muscles, which in turn support the pelvic organs and the vagina. Because severe perineal tears result in a lack of support for the pelvic floor muscles, pelvic organ prolapse and pain during sex can become long-term issues if the perineum does not properly heal.
Does Perineal Massage Prevent Incontinence After Childbirth?
While temporary incontinence can be expected after vaginal birth, long-term incontinence can be avoided by practicing regular perineal massage. The perineum is home to several membranes, muscles, nerves, and connective tissues that enable the bladder, bowel, rectum, and vagina to function correctly. If the perineum experiences severe tearing and does not heal completely, long-term urinary and fecal incontinence can ensue.
When Should I Start Perineal Massage?
Female health experts recommend beginning perineal massage on week 35 of pregnancy. It is believed to be particularly helpful for first-time mothers.
How Do I Prepare for a Perineal Massage?
It's helpful to take a warm bath or place a warm compress against the perineum to soften the skin before beginning a perineal massage. Finding a comfortable position is also something you can experiment with before beginning. Most women find it easiest to sit or lie down with pillows supporting the head and shoulders.
How is Perineal Massage Performed?
Perineal massage is performed by lubricating the area with a natural oil or water based personal lubricant and inserting one or both thumbs as far as the first knuckle into the vagina. Gently pressing the thumb(s) toward the rectum will encourage the tissues and muscles to soften and stretch. (For more detailed instructions, click here).
What Oil is Best for Perineal Massage?
A naturally made water-based lubricant is considered one of the best oils to use for perineal massage. Alternatively, plant-based oils like avocado oil, coconut oil, grapeseed oil, olive oil, vitamin E oil, and jojoba oil are all considered safe and effective for perineal massage too.
Which Oils Should I Avoid for Perineal Massage?
Fragranced oils, synthetic oils, petroleum jelly, and any oils with additives or preservatives should be strictly avoided for perineal massage. In addition to disrupting your vaginal pH levels which increases your risk of vaginal infections, synthetic and fragranced oils can also irritate the sensitive skin around your perineum and vagina.
What If I Can’t Reach My Perineum for Massage During Pregnancy?
Due to the growing uterus at week 35, it can be challenging to reach the perineum for massage, however, a Pelvic Massage Wand can make it easier. As well as providing more ease and comfort, Pelvic Massage Wands also offer a deeper and more effective massage for the skin tissues and muscles of the perineum. Alternatively, you can show your partner how to massage your perineum with their thumbs.
Is Perineal Massage Painful?
Perineal massage can cause a stinging sensation when pressure is applied by the thumbs or a Pelvic Massage Wand for stretching. This stinging sensation is similar to the feeling of the skin stretching during vaginal birth and is therefore helpful for first-time mothers to become used to it. However, massaging the perineum should never be painful.
Learning to breathe through this stinging sensation helps expecting mothers to breathe through their contractions and allow the skin to stretch slowly. Pushing hard to relieve this type of discomfort typically results in more severe tearing.
How Often Should I Do Perineal Massage?
OB/GYNs and pelvic health physical therapists recommended performing perineal massage 3-4 times per week.
How Long Should I Massage the Perineum Before Childbirth?
Perineal massage before childbirth should be performed for 5-10 minutes per session at least 3-4 times per week from week 35 of pregnancy.
Is Perineal Massage Safe?
There are no documented risks to performing perineal massage, and it is considered safe for most women after week 34 of pregnancy. However, it’s always best to confirm with your OB/GYN before beginning.
When is Perineal Massage Not Safe?
Your OB/GYN will typically inform you if perineal massage is not safe for you. For example, it should be avoided if you’ve experienced bleeding during the second trimester, have a small cervix, placenta previa, high blood pressure, or a vaginal infection.
Can Perineal Massage Induce Labor?
No. Perineal massage cannot induce labor, trigger contractions, or cause your waters to break.
Is it Safe to Do Perineal Massage During Labor?
Yes. Midwives will sometimes perform perineal massage while the mother is pushing during the second stage of labor to help the perineum stretch gently and slowly.
What Other Exercises Can Help Stretch the Perineum?
As well as perineal massage, regularly performing exercises like child’s pose, deep squats, cat pose, and Kegel exercises while pregnant, can help to prepare the perineum for childbirth.
References
Royal College of Obstetricians & Gynaecologists - Perineal Tears During Childbirth - https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/perineal-tears-during-childbirth/
Pregnancy, Birth & Baby - Anatomy of pregnancy and birth - perineum and pelvic floor - https://www.pregnancybirthbaby.org.au/anatomy-of-pregnancy-and-birth-perineum-pelvic-floor
Cochrane Library - Antentatal perineal massage for reducing perineal trauma - https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3/full