Perineal massage is a hot topic that is worth investigating.
The fear that surrounds the question “How will I push my baby out ??!! (while all the while thinking “without doing myself an injury”!! and “will my lady garden ever be the same as it once was” ??!!!) has been asked by birthing women over centuries and is one of the greatest fears that women have about giving birth.
The truth is our bodies are amazing creations, designed and equipped to function beautifully during birth. Part of the magic is the elasticity of the perineum and how this has the capability of stretching naturally to accommodate babies birth.
So! What is the perineum and where do I find it??
The perineum is the soft, naturally elastic skin found between the yoni (vagina) and anus. Because of its softness the skin is susceptible to tearing when under pressure from pushing.
Sometimes birth moves quickly not allowing the perineum enough time to stretch, or, for some reason your baby may need assistance in being born. At these times the perineum can tear or perhaps an episiotomy is required.
Warning! Details about tearing and episiotomy are following.. feel free to jump over the next 2 paragraphs if you don’t want to experience a mental ouchy in your girlie bits!!
Tearing is relatively common especially during a Mama’s first vaginal birth. Tears come in varying degrees from something relatively minor that involves the skin layer only and are known as a graze or 1st degree tear. This tear heals quickly and spontaneously without surgical assistance. A tear that is more traumatic is referred to as a 2nd degree tear and this involves both the skin and muscle layers. These tears require suturing and can take 2 weeks to 2 months to heal. There are also 3rd and 4th degree tears that involve more muscle involvement, can be painful and can take some time to repair.
An episiotomy is a surgical cut of the perineum between the yoni and anus involving both skin and muscle layers and this requires suturing. Episiotomies were once performed routinely but are now less common. They can still be suggested at time of birth as a means of preventing a tear.
So, now that we’ve got the potentially scary facts out of the way, let’s talk about how perineal massage works to minimise the risk of tearing or having an episiotomy..
Perineal massage is an amazing process that combines the use of warmth, moisturising and massage to encourage greater elasticity of your perineum. It is performed with the intent of increasing perineal stretch, elasticity and flexibility which helps to minimise tearing at time of birth. It also enables the Mama to become familiar with the sensations of stretch and pressure in this area making this a less confronting and easily recognised sensation when this is felt during birth.
The increased elasticity is also thought to assist a quicker birth of baby’s head and, in addition, it is also believed to help with the often felt ‘burning’ sensation felt in the perineum as baby’s head crowns.
The process is a simple one that I encourage all my Doula clients to commit to no earlier than around 34-35 weeks gestation. The reason being that it is also at this time that the wonderful hormone Relaxin is released from the placenta and begins its job of relaxing the uterine ligaments, birth canal and arteries. The perineum is not going to want to relax until Relaxin is released.
Mama can perform this massage on her own or she may choose to have her partner assist. It’s important to note that this massage is recognised as a ‘preparation workout’ for the perineum, and not sexy time!
It’s also important that Mama can feel relaxed and trusting in her partner as feeling tense does not allow for the perineum to relax.
What you will need:
- Choose a time where you and your partner can both commit to 10 mins of perineal massage.
- Create a quiet and comfortable place to lie, well supported with pillows so that Mama is in a reclined seated position.
- Warm lubricating oil, such as olive, wheatgerm or jojoba is good, to assist relaxation and comfort.
- If Mama is performing the massage herself then she will need a mirror.
- Very important to make sure that hands are clean and nails are trimmed and clean.
- Create a relaxed environment with soft lighting and relaxing music.
- Mama firstly relaxes her mind and body by warming her perineum with a warm compress, warm pack or bath for 10 mins prior to massage.
- Either Mama or her partner then lubricates hands, fingers, thumbs and perineum with the warmed oil.
- If Mama is performing her massage she will use both of her thumbs.
A tip here for the Mama performing her own massage. If you find it difficult to reach your perineum try standing & placing one foot on a chair to allow easier access to your perineum.
If Mama’s partner is performing her massage then they will insert 2 fingers, from both hands, 2-3 cms into the yoni.
Apply gentle, firm pressure in a downwards direction towards the anus. Breathe and hold this stretch for a couple of minutes as the perineum stretches. It’s normal to feel a small amount of tingling and stretching but not pain. If you do feel pain, or a burning sensation, try less pressure.
- Next, apply gentle pressure outwards by pulling your fingers apart. This is now gently stretching the perineum outwards and downwards. Breathe and hold this stretch for a couple of minutes.
- Next, while imagining your yoni as a circle, apply gentle pressure as you slide your fingers down to the base of the circle then slide and stretch your fingers outwards and upwards to the top of the circle. Repeat for 3-5 minutes (approximately 20-30 times) or as comfort allows.
- Next, to gently stretch the perineum externally, place 2-3 fingers from each hand in the centre of your perineum and stretch the skin in an outwards direction towards your inner thighs. Hold, breathe and repeat as comfort allows.
The great results from perineal massage are not just anecdotal although positive results and responses from first time Mamas are exciting! Perhaps you know a Mama who can give you a positive endorsement of her own experience?
Studies have shown that evidence exists of a reduced risk of tearing in first time mothers. The research also shows that the benefits of perineal massage were seen in Mama’s aged 30, or older, who were having their first birth. Regular perineal massage during the later weeks of pregnancy have been shown to reduce the risks of perineal trauma in first time mothers.
If you have any questions or concerns about this practice please discuss with your care provider before commencing.
For further reading and research please find the following suggested links: