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Perineal massage

What is perineal massage?

Perineal massage is a method of preparing the outlet of the birth passage, particularly the perineum, for the stretching and pressure sensations during the birth of your baby. It has been used in different countries and cultures throughout much of human history.

The aim is to avoid trauma to that area; either tears or an episiotomy (a cut made in the perineum to enlarge the outlet). A large study 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 (requiring stitches) or episiotomy.

Perineal massage will make you more aware of this area and will assist you to relax and open up for your baby's birth. Women who have consistently performed perineal massage do not report the extremes of stinging and burning that often accompany the birth of their baby's head. Furthermore, perineal massage also decreases the chance of ongoing perineal pain at three months post-delivery.

Recommended practice

It is recommended that antenatal perineal massage be commenced from 35 weeks of pregnancy. The benefit is seen when practised just once or twice a 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 should decrease over time.

What should I do prior to performing perineal massage?

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

Technique

  • Put a water-soluble lubricant, or natural oil like olive 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 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 whilst trying to consciously relax the pelvic floor muscles and allowing the tissues to stretch
  • Relax and repeat once.

If your partner is assisting 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.

Contraindications

Do not perform perineal massage in the following situations:

  • prior to 34 weeks of pregnancy
  • if you are experiencing cervical shortening (sometimes referred as an incompetent cervix)
  • 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 have experience pre-term labour that has now settled
  • if you have had severe blood pressure problems in pregnancy (including pre-eclampsia) or concerns regarding the growth of your baby
  • if you are suffering from vaginal herpes, thrush or any other vaginal infection, as massage could spread the infection and worsen the condition.

Pelvic floor exercises

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. 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 (2012)
  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. Hallam T, The postnatal patient.
  6. Pamaiahgari P. Antenatal perineal massage. The Joanna Briggs Institute (N.D.)
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 12/11/2015.
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