Evidence for Perineal Massage
In 1999, a groundbreaking study showed that first time mothers who did prenatal perineal massage had an increased likelihood of an intact perineum (no tears.) There was no difference with mothers who had already given birth.
While evidence supports the use of perineal massage as a way to reduce tearing and as an alternative method to performing an episiotomy, exactly how to do it is often confusing.
Here are great step-by-step instructions found in the book, Pregnancy, Childbirth and the Newborn, by Simkin, Whalley and Kepplar. (See the resource list on pregnancy books for more recommended reading.)
Perineal massage should be started at 34 weeks of pregnancy or 6 weeks before your due date.
How to do Perineal Massage
Perineal massage can be done by you or your sexual partner. The first few times, take a mirror and look at your perineum so you know what you are doing. Be sure your fingernails are short. If you or your partner has rough skin, it might be more comfortable to wear disposable rubber gloves. Wash your hands before beginning.
STARTING POSITION:
Make yourself comfortable, in a semi-sitting position, squatting against a wall, sitting on the toilet, or standing with one foot up on the edge of the tub or a chair. Some women may find it comfortable to do perineal massage in the shower.
MASSAGE:
1. Lubricate your fingers well with oil or water-soluble jelly. Some people recommend wheat germ oil, available at health food stores, because of its high vitamin E content, but other vegetable oils, such as olive oil or water-based lubricants such as K-Y jelly can also be used. Do not use mineral oil or petroleum jelly. Wash your hands before dipping into the lubricant again.
2. Rub enough oil or jelly into the perineum to allow your fingers to move smoothly over the tissue and lower vaginal wall.
3. If you are doing the massage yourself, it is probably easiest to use your thumb. Your partner can use his index fingers. Put the fingers or thumb well inside the vagina (up to the second knuckle); move them upward along the sides of the vagina in a rhythmic U or sling-type movement. This movement will stretch the vaginal tissue (mucosa), the muscles surrounding the vagina, and the skin of the perineum. You can also massage by rubbing the skin of the perineum between the thumb and forefinger (thumb on the inside, finger on the outside or vice versa). In the beginning, you will feel tight, but with time and practice, the tissue will relax and stretch.
4. Concentrate on relaxing your muscles as you apply pressure. As you become comfortable massaging, increase the pressure just enough to make the perineum begin to sting from the stretching. (This same stinging sensation occurs as the baby’s head is being born at the end of the pushing stage.)
5. It is recommended to do this massage for 5-10 minutes daily from the 34th or 35th week of pregnancy until labor. Check with your caregiver if you have questions.
Perineal massage is only one way to help stretch the perineum. See the articles on avoiding episiotomies and writing a birth plan for more information.
Did you use perineal massage in your pregnancy? Did it help during birth? Let us know.
Brenda Lane - Brenda Lane is a published author, Lamaze certified childbirth educator, DONA certified birth doula and approved birth doula trainer.
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