All You Need To Know About Perineal Massage

Why and how to do perineal massage

Perineal massage is a technique which helps increase the elasticity of the perineum for birth, supporting the body with its natural processes. Read on for some easy to follow instructions on how to do perineal massage and everything else you need to know.

Through massage, a mother can quite literally get in touch with her changing shape and understand her body’s capabilities, so the prospect of labour becomes a little less daunting. During pregnancy the hormones progesterone and relaxing are released by your body, naturally softening and relaxing connective tissues such as ligaments to encourage stretching, including in the pelvic area. Perineal massage is a technique which helps increase the elasticity of the perineum for birth, supporting the body with its natural processes.

What and where is the perineum?

The perineum is the small area of firm skin and muscular tissue between the vagina and the anus. The perineum plays a significant role in women’s health. This muscular tissue connects with pelvic floor muscles, offering support to the pelvic organs. It works extra hard in pregnancy due to the extra weight it bears. Tearing of the perineum during childbirth can weaken this support, making later pelvic floor problems or prolapse of the uterus more likely.

What is perineal massage?

Perineal massage is a technique which, by encouraging blood flow to the area, increases the elasticity of the perineum for birth. Some women prefer to massage their perineum themselves but others find it useful to ask their partner to help. Massage helps increase the perineum’s capacity to stretch more easily and less painfully during birth.

Why should I massage my perineum? This area is naturally stretchy – otherwise, we wouldn’t be able to birth our babies – but it can also tear during childbirth, especially if the birth is quick. Massaging the perineum helps relax the cellular matrix and keep the connective tissues supple and elastic - our best defence against tearing. Massage also increases the perineum’s capacity to stretch more easily and less painfully during birth. Regular perineal massage has been shown to improve the skin’s elasticity and reduce perineal trauma. Studies (see footnote) examining the effects of perineal massage during pregnancy confirm that “timely and regular perineal massages reduce the likelihood of perineal tearing or cutting during childbirth”. Many women also report that the area gets back to normal more quickly afterwards, too.

What are the benefits of perineal massage? While your midwife may massage the perineum during labour, doing perineal massage yourself during the last few weeks of your pregnancy has a number of potential benefits:

Easing pain during birth crowning

For many women planning a natural birth, the thing they are most afraid of is the discomfort associated with crowning, which is when your baby's head starts to emerge bit by bit during each contraction, sometimes giving a stinging sensation. Gently stretching the perineum during the last few weeks of pregnancy will encourage the perineum to stretch more easily when the baby is crowning.

Avoid focusing on fear during birth

If you worry that you’re going to tear, you could end up tense and stressed, which can hinder the labour process and your experience of it. Perineal massage can help prepare you for the familiar feeling of pressure or tingling as your perineum relaxes and stretches. If you have a better understanding of your body’s capabilities, it will give you the confidence to keep calm and relaxed during labour.

Avoiding tearing

Up to 85% of women suffer some amount of perineal trauma during childbirth (Albers et al. 2005). Regular perineal massage has been shown to improve the skin’s elasticity and reduce perineal trauma. Studies examining the effects of perineal massage during pregnancy confirm that “timely and regular perineal massages reduce the likelihood of perineal tearing or cutting during childbirth”. Many women also report that the area gets back to normal more quickly afterwards, too.

Reducing the likelihood of an episiotomy

A Cochrane review (Beckman and Garrett, 2006) comparing perineal massage during pregnancy with usual care found an association with an overall reduction in the incidence of perineal trauma, and women that practised perineal massage during pregnancy were less likely to have an episiotomy.

Reducing pain 3 months after birth

As well as finding that perineal massage reduced the need for stitches, the Cochrane review also found that there was a reduction in the number of women reporting pain 3 months after the birth.

When should I start doing perineal massage, and how often? You can apply perineum oil and gently massage your perineum at any time during your pregnancy to familiarise yourself with this part of your body, but it’s best to start active perineal massage (following the exercises below) from around 34 weeks of pregnancy. If you haven’t started yet and are nearer your due date, don’t worry, you can start now. Try to start with a few minutes at a time, then build up to doing it for ten minutes, three to four times a week. Perineal massage can also help tone the muscles after birth. Start gentle massage as soon as you feel comfortable, once any stitches or tears have healed.

What do I need to get started? A good time is after a relaxing bath or warm shower because blood vessels in the area are dilated and this makes the perineum softer and more comfortable to touch. It’s a good idea to empty your bowel and bladder before starting and wash your hands. Find a quiet, relaxing place and sit or lean back in a comfortable position. Some women lie on their side. Use cushions to support your legs.

Which oil is best to use for perineal massage? Nourishing plant oils would be the no.1 choice, free from potentially irritating artificial additives. The Weleda Perineum Massage Oil is specially developed for perineal massage. It is free from mineral oils or petrochemical derivatives and contains no synthetic ingredients or artificial additives of any kind. This top quality oil has been dermatologically-tested for skin tolerance for this sensitive area and contains 100% natural ingredients and pure plant oils carefully selected for suitability for the perineum. The oil is NATRUE-certified genuinely natural. Nourishing Sweet Almond oil is prized for its mildness, and makes the skin supple and flexible. This fine oil is renowned for being well tolerated by all skin types, and Weleda source theirs from organic orchards that stretch over 100,000 acres of the Valencian countryside in Spain. Almond is combined with precious Wheat Germ Oil, which again has a softening effect on the skin, and is rich in Vitamin E and unsaturated fatty acids to increase skin elasticity. The finishing touch is a mix of carefully selected essential oils suitable for the final few weeks of pregnancy. Clary Sage (Caliva Sclarea) adds a gentle aroma and contains the natural component Sclareol which relaxes the tissues of the perineum. Together with the marzipan-mellowness of the almond oil, the delicate fragrance remains subtle and is ideal for pregnancy when our sense of smell is often heightened and we tend to steer away from overpowering or synthetic fragrances. Developed with doctors and midwives, this relaxing oil is a great way for mums to nurture themselves, and prepare for birth.

How to do perineal massage Having washed your hands, find a comfortable, relaxing space. You can do the massage yourself or it can be a way of involving your partner in your pregnancy. Begin by placing both hands on your perineum and just relax about touching this part of your body. We can hold a lot of tension around the perineum, and releasing any tension here is good preparation for birth. Pour a little oil into one hand and rub your hands together to warm them. Then gently smooth a little oil over the whole of your perineum. Stroke in whatever way feels comfortable for you. Get to know the different areas of skin - some soft and delicate, and some firm and more muscular which will stretch out in labour. Massage this a little more firmly. You could apply a little pressure here as you breathe out. Try doing your pelvic floor exercises. As you breathe out draw up your pelvic floor and as you breathe in, relax. Make sure that your buttocks are not tightening. Make the exercises harder by tightening the muscles gradually on your out-breath, imagining that you are going up floors in a lift. Go down the floors with the in-breath. Don’t clench your jaw: relaxing your jaw in labour can help relax your perineum. You can also do some gentle pulsing, tightening and releasing, as you breathe out. If you feel comfortable, you can try doing these exercises with a finger or thumb inside your vagina. In the last few weeks of pregnancy you can try stretching out the perineum to prepare for birth. To do this, place your finger or thumb inside your vagina up to the second knuckle, and gently massage in a rhythmic U shaped movement the lower part of the vaginal opening nearest to the anus (if you imagine a clock face, it’s the section from 3 o’clock to 9 o’clock). This will gently stretch the vaginal tissues and muscles. As you feel comfortable you can try increasing the pressure and adding in a stretch back towards the anus. This may sting slightly; this stinging sensation occurs when the baby’s head is born.

Perineal massage - step by step

1. Apply the oil with the fingertips circling the external labia and over the area between vulva and anus. Insert the tip of the thumb into the vulva and massage the internal and external perineal region for about one minute, imagine a clock face between 3 o’clock and 9 o’clock.

2. Start with circling motions, then use more pressure, for one to two minutes in rocking motions. Then use a little pressure to stretch the perineum in rocking motions from the inside out

3. While breathing out, stretch the tissues radially towards the anus.

4. Then arch the thumb across the perineum from below and down. Repeat the stretching across an imaginary clock face between 3 o’clock and 9 o’clock. You should feel pulling and a resistance to the stretching which should not, however, be painful

How to do perineal massage for a partner Perineal massage can also be given by a partner, especially as you near your due date and may become less agile. They can follow all of the instructions above, but use their index finger rather than their thumb.

When should you NOT do perineal massage? Don’t try perineal massage if you think you may have a vaginal infection and avoid it if your waters may have broken. Gentle perineal massage (without the stretching) can also help tone the muscles postnatally. If you have any stitches or tears following the birth, wait until they have healed before beginning the massage. The most important thing is to listen to your body to decide what feels right. Every pregnancy and every mother and baby are different. If anything feels uncomfortable then don’t continue, and seek further advice from your midwife or a qualified therapist.

Pregnancy Moon Box are including a free Waleda Perineal Massage Oil for a limited time only. This information and image was provided by Waleda UK.

https://www.weleda.co.uk/shop/pregnancy/