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 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 there is a concern that you might sustain a more serious tear affecting the anus, a small cut called an episiotomy can be made in this area.
How often do perineal tears occur?
It is estimated that tearing occurs in 85% of vaginal births. About two thirds of these tears will need stitches.
What can I do to avoid perineal tears?
Several studies have shown that perineal massage from 34 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 if you have had more than one vaginal birth.
What are the benefits of perineal massage?
The evidence suggests that if you can particularly benefit from perineal massage if:
- you are having your first baby (or you have had a caesarean birth before and are planning a vaginal birth this time)
and/or
- you are 30 years and older
and/or
- you have had episiotomies before.
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 aid relaxation, and can help you feel more in control.
- 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 34 weeks of pregnancy and massage at least three to four times a week for three to five minutes each time. However, undertaking perineal massage for as little as once or twice a week from 34 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 or thumbs well (If you are doing the massage yourself, it is usually easiest to use your thumbs. Otherwise your partner can use both index fingers) 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.
You can top up the oil as needed to avoid any friction.
- Place the fingers or thumbs about 2 inches (5cm) into the vagina (up to the second knuckle)
- Press gently but firmly 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
In the beginning, your perineum may feel tight, but with time and practise the tissues will relax and stretch.
This massage should be firm and can be uncomfortable but not painful. Should you find it so, stop, take a break and try again if you wish to.
You can watch a video on how to perform perineal massage here (opens in a new tab)
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?
Everyone is different and some find perineal massage easier than others for a number of reasons. Please contact your midwife if you would like to discuss any concerns further.
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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