Perineal massage is used to prepare the vaginal opening, in particular the perineum, for the stretching and pressure sensations during the birth of your baby. The goal is to reduce the risk of either tears or an episiotomy (a cut made to enlarge the outlet during birthing). Studies have shown reduction in the risk of serious tearing or episiotomy when perineal massage is applied 1-2 times weekly from 35weeks of gestation.
There are 2 aims through the application of perineal massage:
- soften the area mechanically through massage
- familiarise the mother with the sensation of stretch and pressure on the perineum to enable better relaxation and opening of the area into these sensations during birthing and, in particular, crowning
Women that have consistently practice perineal massage do not report the extremes of stinging and burning that often accompany the birth of their baby’s head. Furthermore, perineal massage also decreases the chance of ongoing perineal pain at 3 months post-delivery.
- First vaginal birth (including VBAC)
- Birth after a history of episiotomy or tearing resulting in scar tissue
- Overactive pelvic floor, which can be diagnosed by your women’s health physio or gynaecologist, and is common in conditions such as pelvic girdle pain
- Can be useful in consecutive births
- If you have any concerns, it is best to check with your gynaecologist or women’s health physiotherapist
Start from 34 weeks of pregnancy, 1-2 times weekly (more frequently may decrease the protective effect).
You will likely experience a strong stretching, or burning sensation when you first start massaging, particularly if this is your first vaginal birth. This should decrease over time with practice.
- empty your bladder
- wash your hands and find a place where you can relax to perform the massage (bathroom, bedroom etc). You may find positions such as a semi squat on the wall, one foot on the toilet seat, or sitting in your bed propped up on pillows most comfortable
- if you have a history of pelvic pain, or you find palpation of the perineum particularly sensitive, a warm compress or hot bath for 10 mins prior to the massage can be particularly helpful
- Use a mirror if needed to become thoroughly familiar with the vaginal opening and perineum
Always consult your women’s health physio or gynaecologist if you have any concerns, questions, or queries regarding perineal massage, along with pelvic floor exercises, which should be a part of your antenatal and postnatal plan.
- Use a water-soluble lubricant or natural oil (e.g. olive or coconut oil) on your thumbs and perineum
- Place thumbs just inside the vaginal opening, to a depth of 3-5cms (approximately knuckle to base of thumb).
- Gently press downward towards the rectum and to the sides of the vagina at the same time to stretch the opening, until a slight burning, stinging, or tingling sensation is felt
- Work the lubricant slowly and gentle, maintaining the pressure and pulling the perineum slightly forward as you sweep your thumbs from side to side of the vagina in a “U” shaped motion for approximately 2-5 minutes.
- Focus on relaxed breathing and opening into the stretch while you consciously relax the pelvic floor muscles, allowing the tissues to stretch and open.
If your partner is performing the massage for you they need to use clean hands and one to two index fingers inside the lower part of the vagina. You will need to provide feedback on how much pressure to apply to produce a stretch without causing pain.
AVOID pressure on the vaginal opening. CEASE massage with any pain or discomfort, and consult your gynaecologist or pelvic floor physio if you are unsure at any stage. They can help by providing a demonstration to you, you and your partner, or even apply the massage for you in the weeks leading up to your anticipated delivery if you prefer.
- Prior to 34 weeks of pregnancy
- If you are experiencing cervical shortening (known also as an “incompetent cervix”)
- If you are diagnosed with (or suspicious of) placenta praevia; a low-lying placenta, or any other condition where there is pleading from the vagina during the second half of pregnancy
- If you have experienced any pre-term labour that has now settled
- If you have had severe blood pressure problems in pregnancy (including pre-eclampsia) or concerns regarding the growth of your baby
- If you are suffering from vaginal herpes, thrush, or any other vaginal infection as massage could spread the infection or worsen the condition