Let’s be honest from the start, if this is your first pregnancy, then the thought of having to do perineal massage might not thrill you. If you tore with your last birth, then the thought of perineal massage certainly isn’t going to thrill you. The reason being – when perineal massage is done properly, it hurts!
So why do we need to do it?
No birthing mother wants to tear their private parts. As you know however tearing can and does, sometimes happen in labour.
Why? What leads to tearing? What makes one more vulnerable to this happening?
Here’s what we know:
Factors that influence tearing:36
- The strength of your contractions
- The stretch ability or elasticity of your body tissue
- The size of your baby
- Position of your baby’s head
- Your position during delivery
- The speed of your delivery
- The skill of your attendant
- Scarring from previous deliveries
Literature also indicates that there is benefit to consistently massaging your perineum during late pregnancy as this increases the elasticity of these tissues.35 With greater elasticity we decrease our chances of tearing. That’s always a good thing.
Some women approach perineal massage half-heartedly, presuming that all will be fine. Sadly, many women are then unprepared for the likely scenario of an episiotomy during labour, because their pelvic floor and perineum will not relax and accommodate for their baby. After hearing countless birthing stories, most women after birth wish that they had taken more time to prepare their bodies for labour.
Perineal stretching is also vitally important if a birthing mother has scar tissue from a previous birth. Scar tissue loses elasticity and generally remains restrictive in nature.
HOW DO I MASSAGE MY PERINEUM?
Your mission, should you choose to accept it (YOU CAN DO IT!), is to stretch and massage the tissues around your vagina and perineum.
To begin, wash your hands well, then lean back into a relaxed position. Remember, if this stretching doesn’t feel uncomfortable and hurt a little, then you are not stretching firmly enough. So be brave, take a deep breath and relax into preparing your body for a gentle and safe birth.
You don’t have to do perineal massage on your own; I would certainly recommend that you try it after making love. True, this does sound a bit messy, but it’s better that you and your partner get used to being messy. Birthing is messy. Birthing is real. Having your partner stretch your perineum as a pre-labour activity is very real.
- Place two fingers inside your vagina and pull down and out slightly. Pull down firmly until you feel a good stretch. Then pull down a little bit more.
- Then pull sideways firmly.
- Swap hands and stretch the other side.
- Repeat these three directions 10–20 times.37
- Locate the area of skin at the centre of your perineum, directly between your vagina and anus. Place your index and middle fingers of both hands opposite each other and pull your fingers out towards your thighs, dragging the skin with you. This creates tissue pull through the superficial layers of skin.
- Repeat 10–20 times.
- Then turn your fingers in slightly and drag them up towards your pubic hair. Repeat 10–20 times. Then move back to the centre point of your perineum and place the tips of your thumbs opposite each other. Move one thumb up towards your vagina and the other thumb down towards your anus (this feels as delightful as a ‘Chinese burn’!).
- Repeat 10–20 times.37
See Well Adjusted Babies 2nd Edition for diagrams.
If you and your partner want to take a natural approach to labour, then you will need to become comfortable with looking at and touching your female genitalia. There is little room for modesty when preparing for childbirth. Watching a birth is a gift—a humbling miracle—but let’s not kid ourselves, it is certainly not glamorous.
If your partner refuses to participate or resists helping you with the massage, then this is a very clear indication that together you need to clarify your birthing preferences and objectives.
As a couple or individually you can use KY jelly, vitamin E oil or jojoba oil for massage. When you are performing this stretching, it is important to focus on opening up your body. Try to relax, and have confidence in your body’s ability to stretch and give birth to your baby.
When do we start? Begin perineal massage any time from 30 weeks.
How often? If perineal massage is performed correctly (it will hurt); twice a week.
For how long? Perineal massage should take 15–30 minutes.
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Yours in Health,
Dr Jennifer Barham-Floreani
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36) i. Eason E et al. Preventing Perineal Trauma during Childbirth: A Systematic Review. Am J Obstet Gyn. 2000;95(3):464-471.
ii. A Guide to Healthy Pregnancy & Childbirth. Auckland: Auckland Homebirth Association; 1993.
37) A Guide to Healthy Pregnancy & Childbirth. Auckland: Auckland Homebirth Association; 1993.