Perineal massage
Perineal massage during pregnancy helps prevent tearing during delivery
Perineal massage during
pregnancy involves gentle manual stretching of the tissues that form the birth
canal. The benefits of this ancient practice have been studied by researchers
and there is now strong scientific evidence that when performed regularly
during the last 3-4 weeks of pregnancy, perineal massage increases your chances
of having a vaginal birth without damaging the perineum, reducing the risk of
rupture and episiotomy.
Perineal tears and surgical
incisions (episiotomy) require stitches, which can increase recovery time after
childbirth and often cause scarring, pain, and urinary or fecal incontinence,
which can affect your life long after childbirth. The good news is that by
devoting just 5 minutes a day during the last weeks of pregnancy to massaging
the perineum, trauma to the perineal tissues during childbirth can be
prevented.
The importance of preparing the perineum for delivery
Your perineum includes the
area behind your vagina and vulva and extends to your anus and rectum, and
includes the back of your birth canal. It is the tissues of the perineum that
create a strong pelvic floor, allow you to walk upright, and prevent you from
urinating every time you cough. Needless to say, it's important that these
tissues are intact and strong, but they also need to be flexible enough to
stretch during labor to allow the baby to pass through the birth canal.
Unfortunately, many women's
perineal tissues are not flexible and cannot stretch during childbirth,
resulting in perineal injury or tearing. But, like other types of massage or
stretching, massaging the perineum during the last weeks of pregnancy helps to
relax and stretch the tissues in your perineum. This gentle massage maintains
the elasticity of the perineal tissues and prepares them for natural relaxation
and expansion during childbirth. Perineal massage also allows you to practice
breathing through the burning sensation of stretching the perineum, which many
women say helps them feel more confident and relaxed during labor.
Instructions and tips for perineal massage
As you approach your 34th week
of pregnancy, talk to your midwife or doctor about when you should start your
perineal massage routine. After your doctor has given you the go-ahead, start
massaging your perineum every day for 5 minutes before giving birth. You can
give yourself a perineal massage or ask your partner for a massage. Regular
perineal massage is great for increasing the elasticity of the perineal
muscles, but don't be discouraged if you miss a day or two - just get back to
your routine the next day.
1. Before massaging the
perineum, wash your hands and trim your nails.
2. Find a comfortable position
that allows you to reach your perineum with your arms extended in front of you
or behind you. For example, a) sitting on a bed with bent knees, b) squatting
against a wall for support with or without the help of a stack of books or a
stool, and c) lifting one leg, as in the shower or toilet. Feel free to use
different positions on different days, or even change position during the
massage if you feel uncomfortable or tired.
3. Pour about a teaspoon of the massage gel onto your fingers and apply it to your perineum, making sure your thumbs are also well lubricated. The use of massage gel has two important purposes: it makes the massage more comfortable, and it also helps to moisturize the tissues of the perineum. Avoid using natural oils such as coconut or almond oil, as these products contain oxidizing and inflammatory chemicals and have been linked to increased vaginal infections. Also avoid using water soluble lubricants as most lubricants have a high concentration of salts/ions which can irritate the vaginal tissues. For optimal softening and stretching, be sure to use enough gel to keep your tissues moist throughout the massage - the amount needed and whether to reapply is up to each woman.
4. Perineal massage can be
performed with one or both thumbs, index or middle fingers or two fingers of
each hand. Insert your thumbs or fingers about 2.5 cm into the vagina (to the
first joint or a little further), resting your palms on the inside of the leg.
5. The goal is to stretch and
massage the back of the birth canal to the anus, then from side to side, using
more and more pressure over time. Gently press your thumbs against your anus,
then spread them side to side. Hold this stretched position several times
during the massage and consciously relax the muscles in this area. Continue to
massage down and out to stretch and relax these tissues. The pressure should
not be painful, but it is normal to feel a slight burning or stretching
sensation for the first two weeks. Practicing awareness and breathing when you
feel this pressure will help you feel better when you experience the same
sensations during labor!
6. Continue massage up to 5
minutes. Reapply massage gel as needed.
7. When performing a perineal
massage with a partner, sit facing your partner with your feet on the outside
of your partner's legs. Your partner can use the same techniques as above, but
must use their index fingers instead of their thumbs.
Just 5 minutes of perineal massage a day can benefit you for a lifetime
At first, perineal massage will be unpleasant and even painful. But the more you practice, the easier and more comfortable it will become. Just 5 minutes a day during the last weeks of pregnancy will help relax and stretch the tissues of the perineum to prevent trauma or tearing of the perineum during labor and pain and discomfort in the months and years following your baby's birth.