Perineal Massage in Pregnancy
What is perineal massage:
It’s a way of preparing the perineum (space between the vaginal opening and the anus) for the pressure and stretch that occurs during a vaginal birth, as a way of reducing the risk of perineal tearing. It’s a self-massage technique usually performed from 35 weeks onwards, for about 5 minutes, 1-3 times per week.
Why do it? What’s the evidence say?
We have great supportive evidence (from a Cochrane review) that perineal massage from 35 weeks onwards can significantly reduce the risk of tearing or the need for an episiotomy. Because of this research, pregnant women should be encouraged to try perineal massage and given advice on how to do it.
There is also evidence that suggests that performing perineal massage during the active stage of labour can help to significantly reduce the second stage of labour (the pushing phase).
When NOT to do perineal massage?
Before 34 weeks gestation
If you have placenta praevia (low-lying placenta) or any other conditions that have caused bleeding in the second and third trimesters.
Any signs or symptoms or diagnosis of vaginal infection (vaginal herpes, thrush etc)
Any concerns regarding the cervix ie. cervical stitch or shortening.
How to do it?
Set yourself up in a private, comfortable space with a gentle lubricant, a warm compress (like a face washer) and a few pillows. Make sure to wash your hands before you begin. If you like you can use a mirror to help visualise the area.
Place the warm compress on the perineum for 10 minutes, or have a nice warm bath.
Put the natural lubricant on your thumbs and on the perineum.
Place your thumbs inside the vagina (about 3-4cm) and gently press down and back towards the anus until you feel a gentle stretch or tingling sensation. It should not be painful!
Hold this pressure for 45-60 seconds, then start to move your thumbs to the sides of the vagina in a U shape motion for the next 3-4 minutes. Try to maintain that same pressure as you glide from one side to the other.
This is a good opportunity to practice your relaxation techniques or your breathing exercises.
REMEMBER: the point is NOT to cause pain but to feel a stretch sensation. If you have pain, stop. Speak to your Pelvic Health Physio, Midwife or Doctor.
References:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3/epdf/full
Aquino, C.I., Guida, M., Saccone, G., Cruz, Y., Vitagliano,A., Zullo, F., Berghella, V. (2020) Perineal Massage during labor: a systematic review and meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine 33 (6).