Perineal massage during pregnancy helps to gradually soften and stretch the vagina and the perineum in preparation for birth. This leaflet explains why this could be helpful and gives instructions on how to perform this exercise.
You can talk to your community midwife about perineal massage for more information.
What is the perineum?
The perineum is the area of skin and muscle between your vagina and anus. The perineum naturally stretches during the birth to allow your baby’s head and body to be born. This natural stretching sometimes results in perineal tears. At times, when the baby needs to be born quickly or the mother needs assistance, a small cut called an episiotomy is made in this area.
How often do perineal tears occur?
It is estimated that 85% of all women who give birth vaginally will tear. About two thirds of these women will need stitches.
What can I do to avoid perineal tears?
Several studies have shown that perineal massage from 35 weeks of pregnancy reduces the likelihood of the need for episiotomy and the incidence of perineal tears that require stitches. Perineal massage has also been shown to reduce perineal pain in the months post birth for women who have had more than one vaginal birth.
What are the benefits of perineal massage?
The evidence suggests that women having their first baby, women 30 years and older and women who have had episiotomies before, can particularly benefit from perineal massage. Perineal massage can also be beneficial to women who are planning a first vaginal birth after caesarean (VBAC).
Reasons why you should consider perineal massage:
- It helps to gradually soften and stretch the perineum ready for birth and reducing the risk of a perineal tear that requires stitches.
- It helps you know your body and prepares you for the feeling of pressure and stretching that you feel as your baby’s head is being born. This will help you relax and take active part in the birth of your child.
- It can promote closeness between you and your partner.
Who does the massage?
You or your partner can do the massage. It is entirely up to you.
When should I start and how often should I massage?
It is recommended that you start massaging any time from 35 weeks of pregnancy and massage at least three to four times a week for at least five minutes each time. However, even undertaking perineal massage for as little as once or twice a week from 35 weeks may be of benefit.
How do I do it?
The first few times, take a mirror and look and your perineum.
Wash your hands before beginning, make sure your bladder is empty, and position yourself comfortably. You can do the massage in several positions; semi-sitting, squatting against a wall, or standing with one foot raised and resting on the bath, toilet or a chair.
It is probably more comfortable to do the massage after a bath, as the warmth of the water can help soften the surrounding tissues.
- Lubricate your fingers well. It is advisable to use unscented organic based oil like olive, sweet almond or sunflower oil. If you are sensitive to any of these, you can use a water soluble jelly such as KY gel. You need enough to allow your fingers to move smoothly over the perineum and lower vaginal wall. You can also use your body’s natural vaginal lubricant. Do not use baby oil, mineral oil, or petroleum jelly.
- If you are doing the massage yourself, it is probably easiest to use your thumbs. Otherwise your partner can use both index fingers.
- Place the fingers or thumbs about 2 inches (5cm) into the vagina (up to the second knuckle)
- Using your two thumbs press downwards in the direction of your anus so that you feel a stretch of the muscles surrounding the vagina and the vaginal tissues. Once you have this downward pressure, use your thumbs to sweep from side to side in a rhythmic U shape movement.
- Concentrate on relaxing your muscles. This is a good time to practice slow, deep breathing techniques.
- You can also massage the skin of the perineum between the thumbs and forefinger
3. As you or your partner perform the massage, apply steady pressure downwards towards the back passage, until you feel a tingling sensation. This will help you become familiar with the sensation that you will experience when the widest part of your baby’s head begins to stretch you.
4. Use more oil if required to reduce friction.
5. In the beginning your perineum may feel tight, but with time and practice the tissues will relax and stretch.
6. This massage should not be painful. Should you find it so, stop and start again.
Partners
If your partner is performing the perineal massage, follow the same basic instructions as above. However, your partner should use their index fingers to do the massage (instead of thumbs). The same side-to-side, U-shaped downward pressure method should be used. Good communication is important - be sure to tell your partner if you have too much pain or burning!
What if I cannot do it?
Women have different experiences before becoming pregnant. If you feel distressed or frightened and would like to discuss it further, please contact your midwife.
Are there any risks of perineal massage?
There are no known risks of perineal massage. However, do not perform perineal massage if you think your waters might have broken or if you are suffering from vaginal infections such as thrush or herpes. Please contact your midwife in these circumstances.
For further information, please contact:
Your community midwife/team (refer to your antenatal notes)
Useful references
Beckmann MM, Stock OM (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews, Issue 4. Available from: Cochrane Library Antenatal perineal massage for reducing perineal trauma (opens in a new tab)
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