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Perineal massage

What is it?

Perineal massage is a form of massage that is practiced during pregnancy. In the last 4-6 weeks of pregnancy, it is recommended that women start to prepare their perineum for the stretching required during delivery. The perineum is the skin between the vagina and the anus.

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Why practice Perineal Massage?

During labor the baby must the passage through the birth canal, the cervix, the perineum and into the world. The perineum is the skin that surrounds the vaginal opening. In order to make room for the baby's head, this skin dramatically stretches. When the head it too big, or the perineum is too tight, the skin often tears. For many years now, doctors have even practiced episiotomies (making an incision in the perineum) to make room for the baby to pass. Some believe that the episiotomy is better for the skin and for healing than tearing of the skin. Recent research may prove otherwise, but the jury is still out on this.

However, massaging the perineum prior to labor and even during labor can help to soften, stretch and prepare the skin. Midwives report that women who practice Perineal Massage have a reduction in the liklihood of tearing. It is also reported to reduce the stinging and burning sensation reported during delivery. Through practice massage, women become more familiar with the stinging sensation, making it easier to relax the perineum during this final stage of labor. Preparing this tissue with massage is also thought to strengthen the skin, thus, shortening the healing time if the tissue does tear.

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How to practice Perineal Massage

In William and Martha Sears book called The Birth Book, they outline the following technique to practice perineal massage:

Start with clean hands and trimmed finger nails. Scrub your hands and trim your thumb nails. Sit in a comfortable place and spread your legs apart in a semi-sitting birthing position. Use a mirror when you first begin this as it will make it easier to see what you are doing.
Gently rub massage oil, such as pure vegetable oil, or a water-soluble lubricant, such as K-Y Jelly (not a petroleum-based oil) on your fingers and thumbs and around your perineum.
Insert your thumbs as deeply as you can inside your vagina and spread your legs. Press the perineal area down toward the rectum and toward the sides. Gently continue to stretch this opening until you feel a slight burn or tingling.
Do not force or pull the skin intensely beyond this point; simply, hold this stretch until the tingling subsides and gently massage the lower part of the vaginal canal back and forth.
While massaging, hook your thumbs onto the sides of the vaginal canal and gently pull these tissues forward; this mimicks the movement of the skin that will be caused by your baby's head during delivery.
Finally, massage the tissues between the thumb and forefinger back and forth for about a minute.

During the massage you should avoid:

Being too vigorous could cause bruising or swelling in these sensitive tissues.
Avoid putting pressure on the urethra as this could induce irritation or infection.

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Other Information

The Sears book also suggests eventually adding Kegels exercises to your routine to help you feel your pelvic floor muscles.

Many midwives and obstetricians are more skeptical of the value of perineal massage. These people believe that burning and tearing of the perineum can actually be prevented by other practices during labor. These practices include, properly supporting the perineum during crowning, careful timing of the pushes, and slowly easing the baby's head and shoulders out.

Regardless of what your strategy for preparing the vaginal area or perineum for birth, you should make sure to discuss this with your doctor or midwife before labor.

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