Perineal massage is a practice recommended for women in the final weeks of pregnancy, typically from the third trimester onward. This massage helps improve the flexibility of the perineal tissues and can reduce the risk of tears or the need for an episiotomy during childbirth. In this article, we’ll explore the benefits of perineal massage and how to perform it correctly.
What is the perineum and what happens to it during labour?
The perineum is the area between the vaginal opening and the anus. It forms part of the pelvic floor and is made up of skin, muscle, and connective tissue. During childbirth, this area stretches significantly to allow the baby to pass through the birth canal.
As labour progresses and the cervix reaches full dilation, you may begin to feel pressure in the rectal area. This can often feel like the need to have a bowel movement, but it is actually the baby's head descending through the pelvis. As the baby moves through the narrowest part of the pelvis, the pressure intensifies.
Most of the baby’s descent and cervical dilation is not visible externally. Only at full dilation, and once the baby’s head has moved down, may the head become visible through the vaginal opening. This stage is known as “crowning”, when the vaginal opening stretches around the baby’s head, also expanding the perineum. The tissues stretch gradually, and during this time, you may feel a burning sensation. The body naturally produces lubrication to support this process and soften the tissues.
In some cases, where the tissues are not sufficiently flexible, the baby’s head is large, or other factors are involved, a midwife may perform an episiotomy – a small surgical cut to prevent more severe tearing.
Perineal massage is one way to help prepare the tissues in advance, reduce the likelihood of tearing, and potentially avoid the need for an episiotomy.
How can perineal massage help?
Perineal massage helps increase tissue elasticity and prepares the perineum for the stretching required during childbirth. It is recommended to start from around week 35 of pregnancy. This can be done either as self-massage or with the support of a partner.
How to perform perineal massage
Begin daily massage around week 36, for 5 to 10 minutes each day using a suitable oil.
Before starting, it’s important to relax the pelvic floor muscles. Naturally, inserting a finger into the vagina can trigger a tightening reflex, so breathing calmly and progressing slowly can help ease discomfort.
The massage involves a gentle side-to-side motion combined with a light stretching downwards towards the anus.
It’s normal for some women to experience discomfort or emotional sensitivity during the massage. Our bodies – particularly the pelvic and vaginal areas – can store physical memories, and massage may bring up unexpected sensations or emotions. Approach the practice with patience and awareness, allowing space for your personal experience.
Recommended oil for perineal massage
We recommend using a dedicated perineal massage oil. One gentle and effective option contains grape seed oil, calendula, evening primrose oil, lavender essential oil, and plant-derived squalane. It’s also formulated without wheat germ oil or almond oil, making it suitable for sensitive skin.
What if I choose not to do perineal massage?
Although perineal massage offers benefits, it is not essential.
If you find it uncomfortable, painful, or emotionally distressing, there’s no cause for concern. Many women give birth without performing perineal massage and do not experience tearing, while others may still require stitches despite regular massage. The outcome depends on many factors, including birth position, your natural tissue elasticity, and your individual anatomy.
During labour, midwives often use oil to massage the perineum while the mother is pushing, which can help soften and stretch the area. Warm compresses may also be applied to promote relaxation and comfort in the muscles.
Before applying any compress, be sure to test the water temperature on another part of the body to avoid burns. Many women find the warmth soothing and that it helps prevent involuntary tightening of the pelvic floor as the baby is born.
Sources
- Royal College of Obstetricians and Gynaecologists (RCOG): The RCOG recommends that from 35 weeks of pregnancy onwards, women or their partners can perform daily perineal massage to reduce the risk of tearing during childbirth. This practice is particularly beneficial for first-time mothers.
- National Childbirth Trust (NCT): The NCT provides a step-by-step guide on how to perform perineal massage, emphasizing its benefits in preparing the perineum for childbirth. (NCT (National Childbirth Trust))
- Cambridge University Hospitals NHS Foundation Trust: This NHS Trust explains that perineal massage during pregnancy helps to gradually soften and stretch the vagina and the perineum in preparation for birth, reducing the risk of perineal tears that require stitches. (Cambridge University Hospitals)
- Leeds Teaching Hospitals NHS Trust: They suggest starting perineal massage any time after 34 weeks of pregnancy, recommending massage 3-4 times a week for 5-10 minutes each time. (flipbooks.leedsth.nhs.uk)
- Oxford University Hospitals NHS Foundation Trust: Their leaflet outlines the advantages of perineal massage, including improved blood flow to the perineum and increased ability to stretch during childbirth, potentially reducing the need for an episiotomy. (ouh.nhs.uk)
- Maidstone and Tunbridge Wells NHS Trust: They recommend starting perineal massage from 34 weeks of pregnancy, noting that it can help familiarize women with the feeling of pressure and stretching during childbirth, aiding relaxation and confidence during delivery. (Maidstone and Tunbridge Wells NHS Trust)
- Milton Keynes University Hospital NHS Foundation Trust: Their patient information leaflet states that perineal massage can reduce the risk of perineal trauma requiring suturing and the need for an episiotomy. (Milton Keynes University Hospital)
- Imperial College Healthcare NHS Trust: They advise that perineal massage is most effective when started from around 35 weeks of pregnancy and performed regularly. (imperial.nhs.uk)
- East Lancashire Hospitals NHS Trust: Their guide suggests performing perineal massage from 34 weeks of pregnancy, three times a week for approximately 5 minutes each time, to help the perineum stretch more easily during childbirth. (elht.nhs.uk)
- Cochrane Systematic Review: A Cochrane review found that antenatal perineal massage reduces the risk of perineal trauma requiring suturing and the need for an episiotomy. (rcog.org.uk)
These references provide evidence-based support for the benefits of perineal massage during pregnancy. Incorporating them into your article will enhance its credibility and provide readers with authoritative sources for further information.