Perineal massage during late pregnancy may encourage elasticity and reduce the risk of tearing during childbirth.

The perineum is the area between the vaginal opening and anus.

Some women choose to use perineal massage as a way of hopefully reducing their risk of perineal trauma during childbirth.

Please note that perineal massage is not recommended before week 34 of pregnancy.

What The Science Says About Perineal Massage

Studies have found evidence that regular perineal massage towards the end of the pregnancy can reduce the risk of tearing in first time mothers.

This research also identified that the benefits of perineal massage were greatest for women aged over 30 who had not previously given birth.

Regular perineal massage during later pregnancy reduced the risk of perineal trauma that required stitches by 5% for first time mothers.

How To Do Perineal Massage

Once you reach week 34, you could include perineal massage as part of your preparations for childbirth. There is no conclusive evidence on how many times a week you should massage your perineum to reduce tearing during birth.

One study found that the women who massaged their perineum most frequently had the best outcomes.

But a conflicting study found that perineal massage 1.5 times per week (on average) provided a statistically significant reduction in the incidence of episiotomy, unlike the women who massaged more frequently.

It is advisable to check with your healthcare provider before starting perineal massage.

What You’ll Need

Very clean hands with freshly trimmed nails (yours or your partner’s)
Some pillows
Some lubrication (see our suggestion below, else try organic extra virgin coconut oil, or a water-based lubricant)
If you’re doing the massage yourself, you will need a mirror so you can see what you’re doing
A gentle touch

BellyBelly recommends perineal massage with award winning Weleda Perineum Massage oil, which contains almond oil and wheat germ oil (which is rich in Vitamin E). It was developed by pharmacists and experienced midwives to help increase the elasticity of and blood flow to the perineum.

Step By Step Guide To Perineal Massage

Step 1: Find a quiet, private place to lie down. Use the pillows to support your back so that you are in a semi-upright position. You may like to turn off the lights, and play some calming music to help you feel relaxed.

Step 2: Apply oil or lubricant to your fingers, thumbs and perineum. The lubrication should prevent discomfort.

Step 3: Next, insert two fingers around 3-4cm deep into your vagina. Gently, but firmly, apply pressure towards your anus. At the same time, gently pull your two fingers apart so that your perineum is being stretched both downwards and outwards. Keep applying pressure until you feel a slight tingling sensation, this is your perineum being gently stretched. This should not hurt, and you should not notice any burning.

Step 4: Imagine that your vaginal opening is a clock face. Next, pull your two fingers down to 6, then stretch them outwards and upwards towards 3, applying pressure. Repeat this 20 or 30 times, then move to the other side and repeat the same motion 20 or 30 times from 6 to 9.

Step 5: Stretch the perineum externally. Place two or three fingers from each hand in the centre of your perineum, and stretch the skin outwards towards your thighs.

Step 6: Next, place your fingers in a V in the middle of your perineum and pull upwards towards your vaginal opening.

Step 7: Finally, place your thumbs in the middle of your perineum, and push them apart in opposite directions.

Should I Use A Pelvic Preparation Device?

You may have seen products on the market to help prepare a woman’s perineum for birth. They are devices that are claimed to help stretch a woman’s perineum, in order to make birth easier. Midwife Rachel Reed from Midwife Thinking says:

“There is a rather scary device called an Epi-No designed to use during pregnancy to stretch the perineum. The limited research regarding the effectiveness and safety of this device is inconclusive (Kovacs, Heath & Campbell 2004; Shek et al. 2011). Personally I worry about potential long term effects of repeatedly stretching the perineum to the size of a babies head. Although a woman may give birth a number of times during her life, she will usually have more than a day between each baby’s head stretching her vagina. It is also a reflection of our technocratic culture that a ‘device’ is considered to be necessary in order to prepare for childbirth.”

Important Note

It’s important to make sure you avoid focusing on any fears of tearing. By worrying that you’re going to tear, you’ll likely end up tense and stressed, which can hinder the labour process and your experience of it. Your body is designed to birth – always remember that. Even if your ‘thinking’ brain says it doesn’t know how to do it, another part of your brain, the ancient brain stem, does. Your body effortlessly breathes, blinks, digests food, just as your perineum will stretch in order to give birth. You don’t need any fancy devices to make your body work better – after all, mother nature has worked beautifully all this time! You conceived, you can give birth too.

What does hinder your ability to birth well is the amount of interventions you have, so keep all unnecessary interventions to an absolute minimum. For example, if you choose to have an epidural (which is more likely if you have an induction of labour), you’ll have to remain in bed for your labour, losing your mobility. You’re also more likely to need forceps or vacuum, especially if you’re a first time mother.

The epidural will numb the pain, but unless the epidural has worn off, you wont be able to feel yourself push either, so it can be hard to know what you’re doing and whats working. Forceps or vacuum require an episiotomy, or a cut in your perineum. Inductions of labour (with medication) lead to an increased use of pain relief, especially epidurals. So make sure you’re well informed about induction of labour.

Things you can do to help reduce the chances of tearing include:

Keeping off your back during labour and birth (choose upright positions during labour, birth while on hands and knees)
Avoid directed pushing (work with your body, with the contractions)
Birthing in water (supports the perineum)
Have someone apply a warm compress during birth (if not in water)
Refuse an unnecessary induction
Learn natural pain relief methods to avoid reliance on interventions
Having an active labour (helps your baby to get into a great position for birth).

If you’ve not had independent birth education classes (i.e. non-hospital based), BellyBelly highly recommends them.