Maternity Physio and Pelvic Health

Perineal Massage- do I really want to go there??

The perineum is the section between your vagina and anus. Perineal massage is a way of manually stretching the tissues around the vagina in the last few weeks of pregnancy in preparation for giving birth vaginally. It is usually carried out from week 36 onwards , not recommended if there is a history of premature birth, premature rupture of membranes or a  vaginal infection .

What does research say about perineal massage?

Studies have found some evidence that regular perineal massage towards the end of pregnancy can reduce the risk of tearing in first time Mothers but only by 5% and most of the benefits were noticed in first time mums over the age of 30 years.

Personally I did some perineal massage (once a day for the last 2 weeks of pregnancy) prior to my 3rd vaginal delivery and that was the only labour I didn’t tear or need any stiches whatsoever. There may have been other factors at play including the fact that that area had been stretched to push 2 babies out previously! But I did feel that doing the massage gave me the confidence to know what the vaginal walls and perineum can do and that wow yes, that area really can stretch. Therefore I know that the baby will be able to slide through.

It may help you avoid the fear of tearing, if you worry less then you can relax when the baby is crowning and allow your body to do what it is designed to do.

So if you fancy giving it a go here`s what you do;

  1. Lying on your side with some pillows between your knees is s a good position as the bump won`t get in your way. Reach you hand behind so you can reach the vagina. With a clean hand apply some lubricant (such as sweet almond oil) around the perineum and entrance to the vagina.
  2. Insert 2-3 fingers about 4-5 cm inside the vagina. Gently but firmly pull the vagina back towards your rectum, until you feel a tingling. It shouldn’t hurt or burn. Hold for 1-2 minutes. Keeping the pressure on as you slide the fingers side to side to stretch the vaginal wall laterally for 1-2 minutes and then pull back again towards the rectum. Continue until you fingers feel tired! Remember it shouldn’t feel painful.

Other things you can do to reduce your chances of tearing are:

  • Avoid direct pushing.   “Breath” the baby out and allow the contractions to do their work of helping baby out.
  • Birthing in water can support the perineum, the warmth of the water can also  improve elasticity in the area
  • Keep off your back if possible and remain upright or tipped forward (like hands and knees position). This will help the baby get into the right position to descend and stretch those tissues slowly and naturally
  •  A device invented in Germany called the “Epi-no” (balloon that can be inflated to stretch the perineum) from 37 weeks has been shown to increase the incidence of an intact perineum and reduce the rate of episiotomy. click here for more detail on this study.