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Perineal massage

Perineal massage is a method of preparing the outlet of the birth passage for the stretching and pressure sensations during the birth of your baby.

How will perineal massage help during birth?

The aim is to avoid perineal tears or an episiotomy, (a cut made in the perineum to enlarge the outlet).  
Research has shown that women experiencing their first vaginal birth, who practice perineal massage from 35 weeks of pregnancy, have a lower risk of serious tearing or episiotomy.

What will perineal massage do?

  • Help you be aware of this area of your body.
  • Assist you to relax and ‘open up’ for your baby’s birth.
  • Help prevent extremes of burning and stinging that often accompany the birth of the baby’s head.
  • Decrease the chance of ongoing perineal pain at three months post-delivery.

When and how often should I do perineal massage?

It is recommended that antenatal perineal massage be commenced from 35 weeks of pregnancy. The benefit is seen when practiced once or twice per week. Performing perineal massage more frequently than this recommendation may decrease the protective effect.1,2

You may experience a strong stretching, or burning sensation when you first start massaging, but this feeling should decrease over time

What should I do before I start perineal massage?

  • Empty your bladder.
  • Wash your hands.
  • Find a relaxing place to perform the massage e.g bathroom, bedroom, or anywhere else you are comfortable. Sit/position yourself comfortably.
  • Use a mirror to become thoroughly familiar with the vaginal opening and the perineum.
  • A warm bath or warm compresses on the perineum for 10 minutes prior to the massage may help with relaxation.

How do I do it?

  • Put a water-soluble lubricant, or natural oil like olive or coconut oil, on your thumbs and the perineum.
  • Place thumbs just inside the vagina to a depth of three to five centimetres. Gently press downward towards the rectum and to the sides of the vagina at the same time to stretch the opening, until a very slight burning, stinging, or tingling sensation is felt.
  • Work the lubricant in slowly and gently, maintaining the pressure and pulling the perineum forward a little as you sweep your thumbs from side to side of the vagina in a ‘U’ shaped motion for approximately two to five minutes.
  • The massage can be done in one direction at a time i.e. from side to side, or the thumbs can be swept in opposite directions.
  • Try different ways until you find which is more comfortable for you.
  • Focus on relaxed breathing while trying to consciously relax the pelvic floor muscles and allowing the tissues to stretch.
  • Relax and repeat once.

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If your partner is helping you or performing the massage for you, they need to use clean hands and one or two index fingers inside the lower part of the vagina. It is important to tell your partner how much pressure to apply without causing pain.

Caution: Avoid pressure at the top of the vaginal opening. Massage gently as forceful massage could cause bruising or swelling. Cease massage with any pain or discomfort.

When you should NOT do it?

You should not perform perineal massage in any of the following situations:

  • prior to 34 weeks of pregnancy.
  • if you have placenta praevia (a low–lying placenta) or any other condition where there is bleeding from the vagina during the second half of pregnancy.
  • if you are suffering from vaginal herpes, thrush or any other vaginal infection, as massage could spread the infection and worsen the condition.

Why are pelvic floor exercises important?

Pelvic floor exercises should be practised daily throughout pregnancy. This practice will help you to be able to consciously relax the muscles of the pelvic floor, which is exactly what you will do to assist in the birth of your baby. Doing pelvic floor exercises in pregnancy has also been shown to reduce the length of labour and risks of severe perineal tearing. Pelvic floor exercises after birth will help you to re-tone your stretched muscles and tissues.

References

  1. Beckmann MM, Stock O. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Systematic Review (2013)
  2. Queensland Maternity and Neonatal Clinical Guideline: Perineal Care, Queensland Government (2018)
  3.  Jones LE, Marsden N. The application of antenatal perineal massage: a review of literature to determine instruction, dosage and technique. Journal Assoc Charter Physiotherapy Women’s Health (2008); 102: 8-11.
  4. Mei-Dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008 Jul; 10(7):499-502.
  5. Perineal massage image: https://www.kingdomofbaby.com/why-a-perineal-massage-is-essential/
  6. Sobhgol S, Smith C, Dahlen H. The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. Int Urogynaecol J (2020); https://doi.org/10.1007/s00192-020-04298-1
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430065
Last modified 17/7/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 30/6/2020
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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