Perineal massage
Although they're no longer done as a matter of routine, even the thought of an episiotomy can bring tears to your eyes so it's hardly surprising that most women are keen to avoid tears, cuts and stitches during birth.
Regardless of whether this is your first baby, or you've had perineal trauma in previous deliveries and want to avoid it this time round, performing perineal massage during the last few weeks of your pregnancy could be just the solution.
- What is perineal massage?
- What are the benefits?
- Who should do it?
- When should it not be used?
- Are there any dangers?
- How is it done?
- What babyworlders are saying
Preparation for delivery begins during pregnancy with the hormones Progesterone and Relaxin softening muscles and ligaments to encourage stretching, and this includes the perineal area. Perineal massage is a technique which, by encouraging blood flow to the area, increases the elasticity of the perineum for birth.
The perineum is the area of skin between your vagina and rectum which can be cut (episiotomy) or can tear during delivery. In 2006 the Cochrane Database reviewed studies on perineal massage that included 2,434 women.
As well as finding that perineal massage reduced the need for stitches, it also found that fewer women needed and episiotomy, and there was a big reduction in the number of women reporting pain 3 months after the birth.
Perineal massage has many benefits which all help to reduce trauma during birth.
- It stimulates the blood supply to the perineum and helps speed the healing process after the birth
- It helps prepare you for the feeling of pressure and stretching that comes as your baby's head is born
- It helps to familiarise you with some of the sensations such as tingling or burning so you are less likely to tense up
- It can help you to relax when you have a vaginal examination
Midwife Tania Pearce to provide expectant parents with a more personal approach to antenatal and post natal education, including the benefits of perineal massage. She says, "From my experiences as a midwife I have noticed that women who have done perineal massage are more likely to have perineums that stretch well around the baby's head.
"These women also have more control over the expulsion of the baby's head, and allow it to be born slowly. "Because they are use to the sensations they are experiencing they are not frightened of them and don't rush the birth.
The Cochrane Review recommends that all women should be advised about the benefits of perineal massage so that they can make their own informed choice about whether to do it or not. Tania agrees that the techniques should be routinely explained during the antenatal period.
"A relatively easy and effective procedure can have both short term as well as long term benefits," she explains.
"During the birth, women are not frightened of the crowning head sensation, post birth they are less likely to tear and long term they are less likely to experience pain, thus having a positive impact on a woman's birth experience as well as subsequent births."
Perineal massage should be avoided if you are suffering from active herpes lesions, thrush or any other vaginal infection as massage could spread the infection and worsen the condition.
Perineal massage is very safe for both you and you baby, although Tania does stress the need to perform it properly.
She says, "It's important that the massage is done correctly by avoiding the urinary opening so as to prevent urinary infections."
You should start perineal massage about 4 to 6 weeks before your due date, and while there are different ways to perform it, they generally all follow the same techniques. Tania shares the massage that she teaches at her antenatal classes:
- Wash your hands.
- Find a private, comfortable place and sit or lean back in a comfortable position. Some women lie on their side and bring their hand round the back. Use cushions to support your legs.
- Use an unscented vegetable oil, such as sunflower oil or olive oil on your thumbs and around the perineum.
- Place one or two thumbs (or fingers if you can't reach) about 1 inch (2-3cms) inside your vagina. Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation.
- Hold the pressure steady at that point with your thumbs for about 2 minutes until the area becomes a little numb and you don't feel the tingling as much.
- Keep pressing with your thumbs. Slowly and gently massage back and forth over the lower half of your vagina. Do this for 3-4 minutes. Remember to avoid the urinary opening. You can start with very gentle massage, increasing the pressure as sensitivity is reduced.
- As you massage, pull gently outwards (forwards) on the lower part of the
vagina with your thumb(s) hooked inside. This helps stretch the skin as the
baby's head will stretch it during birth.
You can also ask your partner to perform the massage, especially as you near your due date and become less mobile. If the thought of vegetable oil doesn't appeal, you can also use Vitamin E oil, coconut oil or any of the specially prepared perineal massage oils that are now available.
Nina has been advised by her midwife to start perineal massage at 36 weeks. She says, "I first read about it in a book and thought it would be a good idea as I had stitches with my first."
Chelle did perineal massage during her first pregnancy and didn't tear. She says, "I am so pleased that this is being discussed! It's usually such a taboo subject!"
Mrs Woodman is pregnant with her third child and even though her previous two births resulted in no tears or episiotomies, she is still keen to try perineal massage this time round. "I suffered a small graze each time (with my two other children), and I am still scared of tearing this time so I'm going to start doing this. I'm looking forward to giving birth now just to see how well perineal massage works!"
However, perineal massage isn't for everyone. 'E' explains why she didn't do it more than two times with her first pregnancy. "I only managed one or two massage sessions - I found I lacked the discipline it would take to commit to a regular schedule of it. Personally I found performing it on myself rather uncomfortable in that it is not easy to reach down while heavily pregnant. I tried to get my husband to do it for me but then time arrangement was difficult, there was always something more pressing that needed doing or more pleasurable to do."
by Clodagh Foelster
About midwife Tania Pearce Tania first trained as a nanny moving into midwifery in 1999. Since then she has worked as a hospital and community midwife helping mums to give birth at home and in hospital. In 2002 she developed her own antenatal classes and breastfeeding workshops which she runs alongside her full time role as an NHS midwife. Tania has a website called bump2bubba.co.uk
Where to next?
- Concerned about having an episiotomy? Our midwife tells you all you need to know.
- Worried about having a Caesarean? Chat to others in our Caesarean section forum
- Find out more about your health and well-being during pregnancy
- Get the low-down on Caesarean births and what to expect
- Visit our main Labour and birth section
- Talk to other pregnant women on our Labour and birth discussion forum
