How To Do Perineal Massage And What Are The Benefits

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Approximately 85% of women who choose vaginal birth experience perineal damage. The condition occurs due to a tear during childbirth (1). However, a prenatal perineal massage may help you avoid perineal tears and the accompanied pain and trauma after delivery.

Various studies demonstrate the benefits of perineal massage for labor in preventing a tear in the perineum. Read this post to know what perineal massage is, the techniques to use, its benefits, and how it works.

What Is The Perineum?

The delicate area between the anus and the vagina is called the perineum. It is prone to tears during a vaginal delivery, as the baby applies pressure while moving through the birthing canal. The tears, if tiny, will heal soon but deep lacerations that need stitches will take time to heal, especially in the case of first-time moms.

Quick fact
The tissues of the perineum create a strong pelvic floor which is essential for walking straight and preventing urinary incontinence during activities such as coughing (10).

What Is Perineal Massage?

During the delivery, the perineum tissues need to relax and open up to facilitate a smooth descent of the baby. A massage stretches the muscles to improve the flexibility of the perineum during childbirth, thus minimizing the chances of a tear.

What Are The Benefits of A Prenatal Perineal Massage?

Image: Shutterstock

Perineal massage aims to prevent any trauma to the perineum during a normal delivery. Here are a few advantages of getting a perineal massage before delivery (2):

It increases the flexibility of the perineum and makes childbirth less painful. The flexibility of the perineal tissues prevents the trauma of the muscles.

  • It increases the suppleness of the perineum, which further aids in the easy recovery of any perineal tears during delivery.
  • A massage in this area increases blood circulation in the region.
  • It helps you focus better to open up the perineum during delivery.
  • Reduces the need for an episiotomy.
  • Reduces post-delivery perineum pain.
  • Helps soften the rigid perineum or previous scar tissues.

A study by the University of California, Los Angeles (UCLA) Center for East-West Medicine asserts that a perineum massage puts pressure on the points that can help ease constipation, thereby relieving hemorrhoids during pregnancy (3).

Try the perineal massage after talking to your doctor, and only if you are comfortable with it. Keep reading to know when and how you can try this massage.

Point to consider
Delivering with an intact perineum may help decrease the risk of blood loss, infection, and pain in the perineum (11).

When To Start Perineal Massage And How Often To Do It?

The ideal time to begin antenatal perineal massage is the 34th week of pregnancy (2). Based on your comfort levels and preferences, either you or your partner can perform the massage,

How To Get Started?

Image: Shutterstock

You may follow these steps before the antenatal perineal massage (4), (2).

  • Empty the bladder
  • Trim the nails and clean the hands properly

Take warm baths or use warm compresses on the perineum for ten minutes before the massage.

Quick fact
Experts recommend that women perform perineal massage daily or at least on alternate days for maximum efficacy (12).

How To Do Perineal Massage?

First, position yourself comfortably.

Some comfortable positions to try

  • Sit comfortably on a bed or sofa, with the knees bent out. Use pillows to support your back.

Image: Shutterstock

  • Rest your back in a bathtub and keep one leg up on the side of the tub. Alternate with the other leg when required.
  • Stand with one leg up on the stool. Alternate with the other leg.
  • Sit on a toilet with legs wide open.

Technique

  • Sit in a place where you will be comfortable and feel secure and uninterrupted.
  • Use a mirror to familiarize yourself with the vaginal opening.
  • Insert both your thumbs, around 2in (5cm) into the vaginal opening. Place them on the back of your vaginal wall, with your forefingers resting on the buttocks.
  • Using your thumbs and forefingers, gently press down towards the rectum and massage for about five minutes in an ‘upward and outward’ motion to make a ‘U’ stretching pattern. As you massage the area inside the vagina, you will feel a stretching/ tingling sensation of the outer skin.
  • This ‘stretching’ feeling is similar to the feeling that you experience when the perineum opens up during delivery. Hold the stretch for 30-60 seconds and then release (5). If your partner is helping you, then he must use his first and second fingers to start the massage.
  • Try to relax the perineum during the massage.
  • As you massage it, the perineum becomes elastic. Then, slowly increase the pressure towards the rectum. This will help you cope and relax with the pressure you will experience during labor when the head of the baby is about to come out.
  • Massage as recommended for better results.

A tool named Epi-No was developed to protect the perineum from any trauma during childbirth. However, a systematic review of this device, in nulliparous women, claims no significant reduction in perineum tears or episiotomy rates (6).

What Are The Contraindications To Perineal Massage?

Perineal massage is not recommended (4):

  • If the gestation age is less than 34 weeks.
  • If you have a case of an incompetent cervix.
  • In the case of placenta previa or if there is vaginal bleeding due to any other conditions during the second half of pregnancy.
  • In the case of thrush, vaginal herpes, or any other vaginal infections that may spread and worsen due to the massage.

If you feel pain at any point of massage, then stop doing it and continue it after some time. If pain persists, then inform your doctor.

In addition to the massage, you can also try other techniques to minimize the risk of a perineum tear during labor.

Tips To Reduce Perineal Tearing

The following tips help reduce the chances of perineal tear:

  • Be in an upright position during labor.

Image: iStock

  • When you are in labor, start pushing as soon as you feel the contractions.
  • Water birthing reduces the incidence of perineal tears (7).
  • In the case of normal delivery at a hospital, apply warm compresses on the perineum.
  • Do not oblige to labor induction if there is no medical emergency.
  • Go for natural pain relief methods to avoid medical interventions.

Frequently Asked Questions

1. How does a perineal massage feel?

You may feel a stretch and pressure around the perineum for a few weeks when you start having a perineal massage. This feeling will eventually go away (8).

2. Does perineal massage work?

A study on 99 participants revealed that perineal massage significantly reduced the duration of second-stage labor and the need for episiotomies. Therefore, it is believed to reduce perineal damage during childbirth (9).

3. Can I bleed after a perineal massage?

aNo, if you bleed after a perineal massage, you may have ruptured some membranes or have an infection such as vaginal herpes or thrush. In such cases, you should stop massaging and see a doctor (8).

Practicing perineal massage from the 34th week of pregnancy will help you improve your perineum flexibility, allowing you to have a smoother, less painful vaginal birth with no perineal trauma or tear. Prior to the massage, trim your nails and empty your bladder. Also, you can take a warm bath or use warm compresses on the perineum for at least 10 minutes. Then get on to a comfortable posture and follow the right procedures.

Infographic: Other Ways To Prevent A Perineal Tear During Childbirth

Perineal tear and the need for episiotomy can be prevented by stretching the muscles during delivery. You may follow these measures as per the midwife’s or the doctor’s instructions depending on the fetal wellbeing and other factors. Go through the infographic to determine how to prevent perineal tears and avoid an episiotomy during labor.

ways to prevent a perineal tear during childbirth [infographic]
Illustration: MomJunction Design Team

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Chris Kettle Susan Tohill; (2008); Perineal care.
    https://pubmed.ncbi.nlm.nih.gov/19445799/
  2. Antenatal perineal massage.
    https://www.ouh.nhs.uk/patient-guide/leaflets/files/69432Pmassage.pdf
  3. Perineal Massage Can Help You Poop.
    https://www.proctologyinstitute.com/2017/05/19/perineal-massage-can-help-you-poop/
  4. Perineal massage.
    http://brochures.mater.org.au/brochures/mater-mothers-hospital/perineal-massage
  5. Perineal massage in pregnancy.
    https://www.nct.org.uk/pregnancy/worries-and-discomforts/common-discomforts/perineal-massage-pregnancy
  6. Luiz Gustavo Oliveira Brito et al.; (2015); Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review.
    https://pubmed.ncbi.nlm.nih.gov/25851585/
  7. WATER BIRTHS – DOES IT REDUCE PERINEAL TEARS AND PROTECT THE PELVIC FLOOR?.
    https://www.ics.org/Abstracts/Publish/47/000693.pdf
  8. How To Do A Perineal Massage (With and Without A Partner).
    https://www.thebirthcollective.org/how-to-do-a-perineal-massage-with-and-without-a-partner/
  9. Farideh Akhlaghi et al.; (2019); Effect of Perineal Massage on the Rate of Episiotomy.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072029/
  10. Perineal Massage During Pregnancy.
    https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/perineal-massage-pregnancy/
  11. Prenatal Perineal Massage.
    https://www.sahealth.sa.gov.au/wps/wcm/connect/708bce01-a52d-4142-87e1-79c3ca4d51b7/Prenatal+perineal+massage+consumer+health+information+-+Physiotherapy+FMC.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-708bce01-a52d-4142-87e1-79c3ca4d51b7-o9tziG1

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