Planning for the arrival of a newborn is a huge task, encompassing everything from child-proofing the house and setting up the nursery to creating a birth plan.
In the last month or two before your due date, perineal massage is a key addition to your antenatal regimen which helps your body get ready for the experience of childbirth.
This straightforward practice can make a huge difference to your recovery, leading to increased blood flow and perineal elasticity, reduced risk of vaginal tearing, less discomfort during birth, and less postpartum pain.
If you're not quite sure where to get started with perineal massage, we've got you covered. This article will explore its benefits and how to incorporate it into your routine.
What's the perineum?
The perineum is the area of skin between the anus and the vulva.
While it might not be the most well-known part of the body, it becomes very important during labour and childbirth as the vagina stretches to accommodate the baby's head and body.
On the inside of your body, the perineum is actually the lower part of the pelvic cavity and the connection point for the pelvic floor muscles.
Because of its proximity to the vagina, perineal tears can occur naturally during a vaginal delivery.
Tears can range from less severe, involving only the vagina, to most severe, involving the vagina, the perineum and the rectum.
Around 26% of births result in a tear that may require stitching [1]. Thankfully, the perineum has a remarkable healing capacity and with proper medical care and rest it is possible to make a full recovery.
A surgical cut to the perineum called an episiotomy is performed on around 20% of people giving birth in Australia.
Often used as a preventative measure, episiotomies can be medically necessary if the health of the mother or baby is at risk.
However, recent evidence has shown that an episiotomy is frequently more painful and requires more healing time than a natural tear [2]. While episiotomies were common in the 20th century, they are now only recommended in certain situations.
What are the benefits of perineal massage?
The perineal massage was first studied in the 1980s.
It has been shown to increase blood flow to the area, preparing the skin and tissue for the later stages of childbirth and decreasing the need for an episiotomy.
According to a recent meta-analysis, antenatal perineal massage is associated with reducing perineal trauma and postpartum complications [4].
Perineal massage was also linked to better wound healing and less pain, as well as a shorter duration of the second stage of labour (when the baby is moving out of the uterus and into the vagina).
What is perineal massage?
Perineal massage during pregnancy is a technique used to knead and stretch the soft tissues of the perineal area, with the goal of preparing the skin for childbirth and preventing injury.
It involves inserting the thumbs or fingers into the vagina and moving them in a firm downwards and side-to-side motion, repeating the movement for 5-10 minutes.
It is recommended to start perineal massage from around 35 weeks and perform it no more than 3 times a fortnight [3].
How to massage the perineum
While it may feel strange at first, perineal massage is relatively easy to do.
Before getting started, it can help to have a bath or shower and put on some music or your favourite TV series. Breathing out slowly can also help relax the muscles around the vulva, but you may have to experiment to find what works for you.
Make sure to empty your bladder and wash your hands before you begin.
Some people find standing with one foot propped up on a chair or the bath more comfortable, while others sit on the edge of the bed or lie on their side.
A natural oil or a water-based lubricant can help loosen the muscles around the vaginal opening and the perineal area [3], as can a warm compress or practising perineal massage in the bath.
To begin, insert one or two fingers or your thumbs about 3-4 centimetres inside your vagina and press your fingers down towards your anus and outwards towards the sides.
Hold this stretch for up to a minute, then start to move your fingers in a U-shape while maintaining the downward and outward pressure. Continue the massage for 5-10 minutes [5].
Can your partner help you with the massage?
Some people perform perineal massage themselves, while others enlist the help of a partner — it completely depends on what is more comfortable for you.
A partner can help out if you're struggling to reach your vaginal opening (especially in the later stages of pregnancy) or simply be there to provide emotional support and encouragement.
Like labour and birthing classes, perineal massage can be an opportunity for partners to learn about the experience of pregnancy and build an emotional connection with the pregnant person and the baby.
Of course, it’s essential for anyone engaging in perineal massage to have clean hands and trimmed nails and to communicate openly throughout the process.
When is it safe to start massaging the perineum?
After 35 weeks, perineal massage is safe for most pregnant people.
However, if you have herpes, thrush or any other genital issue, it's best to avoid any contact with the vaginal area until it is resolved as massage can spread vaginal infection.
Perineal massage is also not recommended for those with low-lying placenta or severe blood pressure problems during pregnancy. If you have any questions or concerns, make sure to discuss them with your doctor before beginning the practice.
What else can you do to prevent perineal trauma?
Along with antenatal perineal massage, the use of a warm pack in the lead-up to the birth has been shown to reduce the most severe perineal tearing and to help with pain levels [1].
This simple treatment consists of a warm soaked sterile pad placed on the perineum and has been popular with midwives for decades.
The exact science behind it isn't clear, but some think that the heat helps relax the perineum and distract from the pain. Heat packs aren't usually used if the person in labour has an epidural in place.
Regular pelvic floor exercises are also recommended to maintain strength, whether you're pregnant or not [6].
These exercises can assist with muscle control during labour and delivery, as well as maintaining control over bladder and bowel functions and minimising back pain. Practising both long holds and quick squeezes will help set you up for a successful birth and recovery.
According to a 2016 review, the position of the mother during childbirth also has an impact on the incidence of perineal tears.
Kneeling and all-fours were the most protective positions for the perineum, while sitting, squatting and using a birth stool resulted in a higher rate of perineal trauma [7]. Additionally, a water birth was found to cause an increase in perineal tears when compared to a normal hospital birth.
Tips for perineal healing after birth
Postpartum recovery will be different for everyone, but it is essential to take care of your physical and mental health as a new mum.
Along with plenty of downtime, there are a couple of ways to ease discomfort and promote healing.
Sitz baths (sitting in warm water) and pouring water over the perineum can provide some relief, as well as restarting pelvic floor exercises as soon as you can to facilitate blood flow to the area [8].
Kin’s Postpartum Recovery Bundle is made up of a 6-step care pack designed to help you heal and recover.
The Peri Bottle is used to gently rinse your perineum, while the Mesh Panties are soft and supportive. They can be used with the Postpartum Padsicles (to cool and absorb) and the Healing Foam to fight bacteria and relieve irritation.
Finally, the Nourishing Cream is designed to reduce the appearance of stretch marks and the Postnatal Vitamin supports your nutrition during breastfeeding and healing.
If you have stitches from a perineal tear, they will usually dissolve after a couple of weeks and the soreness should be gone after around a month. Consult your doctor immediately if you suspect you have a vaginal infection. Otherwise, rest as much as possible and enjoy getting to know your new baby.
Image credit: Getty Images
.svg)