Perineal Massage – June 2023
Our Specialist Pelvic Health Midwife Amanda Argyle is passionate about all things to do with our pelvic health and in particular perineal massage. Please read Amanda’s top tips for protecting your perineum during birth.
Perineal massage
The perineum is the area of skin and muscle between your vaginal opening and your anus, it attaches to the muscles of your pelvic floor.
During the second stage of labour, as your baby moves through the birth canal, the pelvic floor muscles open out and the perineum naturally stretches. When your baby’s head descends to the perineum the tissues begin to stretch slowly, fanning out and opening around your baby’s head.
The perineum naturally stretches during the birth to allow your baby’s head and body to be born.
This natural stretching can sometimes result in a tear on the perineum (perineal tear).
Sometimes, if the baby needs to be born quickly or the mother needs assistance, a small cut called an episiotomy is made on the perineum by a doctor or midwife.
It is estimated 85% of all women who deliver their baby vaginally will sustain a perineal tear.
Around two thirds of these women will require stitches.
What can you do to avoid perineal tears?
Massaging the perineum during pregnancy can help to increase the stretchiness of the area and boosts its blood supply.
Women’s experience of birthing suggests that regular massaging of the perineum can reduce tearing and the need for an episiotomy and research supports this.
Research has shown that perineal massage can be beneficial, in particular, for women giving birth for the first time and for those over the age of 32 years.
The thought may feel quite scary but massaging your perineum is perfectly natural and may prove beneficial for your birth.
Perineal massage may help you in labour and cannot harm either you or your baby. However, perineal massage should be avoided if you have active herpes lesions, thrush or any other vaginal infection as massage may worsen and spread the condition.
During pregnancy, your body produces the hormones progesterone and relaxin which soften muscles and ligaments and encourages them to be supple and stretchy.
These hormone levels rise during the last 6-8 weeks of pregnancy to prepare for birth, so we advise to begin perineal massage at this time; from 32-34 weeks onwards.
Aim to massage the area every day for approximately 5 minutes using unscented lubricant oils such as vitamin E oil, almond oil or olive oil. Unscented personal lubricant would be fine such as KY jelly.
You can do the massage yourself or you can involve your partner.
Find somewhere you can relax, uninterrupted and in privacy with your legs open wide and your knees bent.
Technique
- Find a comfortable position such as squatting with your back against a wall or sitting on a towel on the floor or bed, propped up on pillows.
You could also try reclining in the bath with one leg up on the side at a time, standing in a warm shower with one leg up on a stool at a time, or sitting on the toilet.
It may be useful, initially, to have a mirror in front of you so that you can familiarise yourself with the perineal area.
- Have the oil or jelly to hand.
- Begin by lightly massaging the outside of the perineum and inside the vaginal opening using both hands.
- When your fingers are moving easily, then put either fingers or thumbs into the vagina about an inch or so inside. You are trying to stretch the outer walls of the vagina by pressing out towards the sides.
- Continue with the stretching until you feel a tingling or slight burning sensation. Maintain the pressure and then, making a U shaped motion, massage down the vaginal wall, across the perineum and up the other side. If you massage like this for at least 5 minutes a day, then you should become aware that the elasticity of your perineum has increased.
- Whilst you have your fingers or thumbs inside the vagina you can do a pelvic floor exercise so that you can feel where this muscle is and how strong it is. You will notice that your perineum feels uncomfortable when this muscle is tense and so you should practice relaxing the muscle during the massage.
- If you have any previous scar tissue, you can focus the massage on the scar tissue, this can help to soften to tissue and to help it to stretch.
- Repeat daily or whenever possible.
It can be difficult to massage your perineum by yourself in the later stages of pregnancy, so you might want to start off doing the perineal massage yourself, then as you get nearer to the due date if you feel comfortable doing so, you could ask your partner to do it.
Perineal massage shouldn’t be painful although there might be some discomfort to begin with. If you’re concerned about any pain, or you need further information or support with perineal massage, please talk to your midwife or GP.
Resources
National Childbirth Trust (2021) How to do perineal massage: a step-by-step guide. https://www.nct.org.uk/pregnancy/worries-and-discomforts/common-discomforts/how-do-perineal-massage-step-step-guide [Accessed 26th May 2023].
NHS (2020) Episiotomy and perineal tears. Available from: https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/ [Accessed 26th May 2023].
Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3… [Accessed 26th May 2023].
Schreiner, L., Crivelatti, I., de Oliveira, J.M., Nygaard, C.C. and dos Santos, T.G. (2018), Systematic review of pelvic floor interventions during pregnancy. Int J Gynecol Obstet, 143: 10-18. https://doi.org/10.1002/ijgo.12513
Worcestershire Acute Hospitals NHS Trust, Patient information, Perineal Massage. Policy WAHT-PI-0133 (No date) [Accessed 26th May 2023].
Author: Amanda Argyle, Specialist Pelvic Health Midwife, 14th June 2023
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