What and where is my perineum?
This is the area between your vagina (the birth canal) and the anus/rectum (where stool exits). This area stretches during labor to allow your baby to exit during childbirth. As the baby’s head is exiting the canal, this area gets stretched. Sometimes tearing can occur, particularly with your first birth. Performing this perineal massage on yourself towards the end of your pregnancy may help prevent this from happening.
What is perineal massage?
This is a method of release that is utilized to help stretch the skin at the vaginal opening, and prepare you for the sensations that may occur as your baby’s head emerges. Some sensations you may have are tingling, burning or stinging.
You may perform it yourself, or you can include your partner. It involves using your fingers, thumbs or both to rub and stretch the perineum. This can assist in increasing the stretchiness and flexibility of the perineum. It may also reduce your risk of having a tear or needing an episiotomy (which is an incision of the perineum made by your midwife or doctor in certain circumstances).
Why should I do perineal massage?
It has been shown that it can help reduce tearing at birth for women having their first baby, make you feel a bit more comfortable and possible quicker recovery following birth, and with those things in mind, being more comfortable/ in less discomfort could mean better bonding with baby and increased ease with caring for them.
When should I start?
It is recommended that perineal massage starts between 34-35 weeks of your pregnancy, and it is done once a day. Initially, you may feel strong sensations of stretching or burning but over time and with more practice, you may notice a change in flexibility and stretchiness of the skin and likely these feelings will decrease. If you have had a previous tear or episiotomy, these sensations may be stronger so make sure to take it slower and have self control of pressure. If you have questions about how to perform or how it feels, reach out to your physical therapist.
How to Get Started
Before beginning you should:
- Empty your bladder
- Wash your hands
- Find a relaxing place to perform (such as your bathroom, bedroom or anywhere else you feel comfortable)
- Sit or lean back- preferably against something sturdy like a wall or headboard. It may help to prop hips/legs up with a pillow.
- To improve relaxation of tissues, it may be beneficial to have a warm bath or warm compress on the perineum for approximately 10 minutes.
- It may also be beneficial to use a mirror for the first few times to assist you in becoming familiar with the area you are massaging.
- You can perform the massage on your own but you also may find it easier for a partner to perform for you.
- It is important to use lubrication; you can use water based lubricant, even olive/wheat germ/ almond/coconut oil or vitamin E cream.
How to perform perineal massage
Put lubricant on your thumbs and possibly index fingers and around the perineum → place your thumbs just inside the vagina, about 3-4 cm (to about the first thumb knuckle and slightly past it) → press downward and to the sides of the vagina wall, stretching the tissue; you can start with light pressure and add pressure/ open wider as you feel comfortable until you feel a tingling/burning sensation. Pause and take a nice deep belly breath- this will increase the stretch of tissue. At first, the pressure may be not heavy but with practice, you will be able to increase it to provide more stretch → Keep a steady pressure and move your thumbs from side to side in a ‘U’ shape. After some time, you may not feel the tingling and the area may be a little numb. Hold this stretch for 30-60 seconds and then release. → You can massage the area with more lubricant and stretch again to tolerant hold then release. Do this daily for 5-10 minutes.
- At first, your perineum will feel tight but as you practice, the tissues will relax and stretch. Focus on relaxed breathing, relaxing your pelvic floor muscles and allowing your tissues to stretch.
- If you partner is helping you do perineal massage, ensure they have clean hands and fingers (either their thumbs or 1-2 index fingers) inside the lower part of the vagina. It is important to stay in communication with your partner about how much pressure to apply without causing too much pressure, discomfort and pain.
When should I not perform perineal massage?
- Before 34 weeks of pregnancy
- If you have a low lying placenta (placenta Praevia)
- If you have gential herpes, thrush or other vaginal infection, which may spread to other areas
- If you or your partner has an open wound or infection on the hands or fingers