Perineal massage is a common topic brought up when preparing for birth to help lower the risk of tearing during birth, also called a laceration.
Sometimes it can be unclear exactly how to do it, and how often it should be done. And, is it even beneficial to preventing tearing, or will it just be another thing to add to your list of things to do?
We will discuss all of that in this blog!
Perineal Massage
Perineal Massage is the stretching of the perineal tissue of the perineum:
- help increase the elasticity of the perineal tissue so that it is able to stretch to accommodate baby.
- creates a conditioned response in your body for when crowing occurs.
- helps you learn to remain relaxed and open in the body, specifically the pelvic floor when baby starts to really stretch the perineum to be born!
What is the perineum?
It is a diamond-shaped group of tissue and muscle that extends from the pubic symphysis to the coccyx. The perineal body contains the perineum, which is the portion of skin between the vulva and anus in those of us with a vagina. In a way, this is what makes up the outlet of the pelvis!
It is recommended to start between 34-35 weeks of pregnancy.
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How often should you do perineal massage?
Research did not specify which was better, just that perineal massage in general was beneficial compared to doing nothing. This recommendation is dependent on who you ask:
- Some recommend perineal massage daily for 10-20mins.
- Others recommend only a few times a week like 3-4 times a week for a similar time length.
- Some even recommend it only once a week.
Benefits of Perineal Massage
What are the benefits reported by doing perineal massage during pregnancy?
- Decreased risk of 3rd and 4th degree perineal lacerations (These are the more severe type of lacerations that lead to the most long term complications and longer recovery times) Read more on types of lacerations here.
- Decreased risk of episiotomy
- Increased chance of intact perineum
- Decreased perineal pain at 3 months postpartum
How to perform?
Seeing a Pelvic Floor Physiotherapist can be beneficial to be shown how to do this in person or virtually! Hayley Kava PT is a great resource that offers virtual services! She also offers a perineal massage FREE guide!
When performing perineal massage, it is not the most comfortable sensation.
A similar sensation I can think of is when you stretch your mouth open with your fingers, and you feel that pulling sensation on your lips. That is what we are doing to the perineum!
Think of the perineum like a clock. The clitoris/urethra being 12 o’clock and the rectum/anus being 6 o’clock.
When doing perineal massage we want to avoid the top of the clock because that can be really uncomfortable and is not shown to be beneficial or needed. Avoiding from like 10 o’clock to 2 o’clock. Focusing on massaging 3-9 o’clock. Some will say avoid 6 o’clock because it can be the most uncomfortable and can stimulate the feeling of having to have a bowel movement.
When doing the massage there are two techniques:
Static stretch: This is where we use 1-2 fingers inserted into the vaginal opening (introitus) 1-2 inches then applying downward pressure. Holding that for a few seconds while focusing on our breath to relax into the sensation. Doing this in different directions from 3-9 o’clock.
Dynamic/Sweeping stretch: This is where you use 1-2 fingers inserted into the introitus but instead of holding the stretch in one spot, you use a sweeping motion to go back and forth from left to right (3 o’clock to 9 o’clock).
When you are 34-36 weeks you do have your belly in the way of being able to easily do perineal massage so you have some options!!
Yourself
You can do the massage yourself but utilizing different positions to be able to reach the perineum easier and more comfortably.
Depending on the position you are in, using different fingers makes it easier, such as a reclined seat, 90/90 position, or even a standing lunge in the shower.
Handheld Tool like the Perimom*
Handheld tools like the Perimom make doing perineal massage by yourself easier and more accessible! It gives you an extension of your hand to be able to get around you belly, and give you more leverage that you may not be able to achieve using just your own hands.
There are many different handheld tools out there but we have recently been try out the Perimom*!
- The handle and design of the tool makes it easier to handle when doing perineal massage. It is larger where you will hold onto it. This can be great especially if you develop carpal tunnel near the end of pregnancy and holding smaller things is uncomfortable
- The tip of the tool is smooth around and has different feeling than the rest of the tool to help make the massage/stretching a little more manageable
- There is a channel in the middle of the tool that allows you to pour your lubricant of choice to help keep the mess down when doing your massage! I have not seen this option is other perineal massage tools.
Your Partner
This can become a task for your partner if you find it too uncomfortable to do yourself. If your partner is willing then this may be a better option for you!
Some tips:
- COMMUNICATION!!! This is key when doing it because you want them to be applying the right pressure, not too much or too little
- They will likely be using their pointer and middle finger for the technique.
- Being in a comfortable position for both of you, either reclined sitting up or using wedges while laying down.
- Don’t let it lead to anything intimate. This is what I have been told by some PTs that it can defeat the purpose of the massage because it gives the brain a different message for perineal massage. So you don’t get that conditioned response for crowning.
Is it effective?
Based on research it can go either way.
Evidence Based Birth (EBB) recently did an entire series on their podcast on protecting the perineum. She looked into all the research on perineal massage during pregnancy and found that the evidence is not strong. There are other more effective ways to decrease the risk of lacerations other than perineal massage during pregnancy. This was release last March, 2022.
Since then, another meta analysis was release in July 2022. This one has more articles but did include the ones that EBB stated were poor in quality or potentially fraudulent. The meta analysis determine that perineal massage IS beneficial for the reasons I listed above. It did not decrease the risk of 1st and 2nd degree lacerations between the two groups, but did decrease the risk of 3rd/4th degree as well as episiotomy usage. It was also found to be MOST effective for first time vaginal birthers.
Using handheld tools has also been shown in research to increase the stretchability of the perineum. So using a handheld tool, like the Perimom*, along with manual work to perform perineal massage can be more beneficial than using your hands alone!
Conclusion
What does all this mean? If this is the first time baby will be born through the vagina AND you are wanting to do something to potentially lower you risk of tearing. Perineal Massage may be a viable, evidence backed option!
If doing perineal massage is NOT comfortable or something you feel comfortable adding into your pregnancy routine. THAT IS OKAY TOO!! There are other ways to reduce your risk of tearing! Read 3 tips here
*Affiliate link where we earn a commission on any sales through the link at no added cost to you*
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