Does Perineal Massage Work?

If you are hoping to have a vaginal delivery then you are probably wondering what you can do to reduce the likelihood of tearing during delivery. The area between the vaginal opening and the rectum, known as the perineum, is the tissue that gets torn (or cut by episiotomy) during your birth. Tearing of the perineum is common if you birth your baby vaginally and up to 50-65% of women will tear. However, sometimes this damage can lead to issues with the pelvic floor such as urinary or fecal incontinence, uterine prolapse, or sexual discomfort.

So, read on to learn if perineal massage is effective at reducing perineal tears during childbirth.

What are the benefits of perineal massage?

1. Prepares the tissues.

   Massage increases the blood flow and may help the tissues and skin of the perineum stretch with more ease and with less pain during childbirth. Perineal massage may also help decrease perineal pain following delivery.

2. Reduces incidence of episiotomy.

   Research indicates that perineal massage decreases the incidence of episiotomy in women who have not had a previous vaginal delivery. 

3. Lowers risk of tearing.

   Around 1 in 15 women who regularly do perineal massage don’t need an episiotomy or otherwise experience a tear requiring stitches.

4. Lowers need for stitches.

   While massage may not prevent tearing, completely it can reduce the severity of tearing and reduce the need for stitches by as much as 10%. 

5. Helps with scar tissue.

   Women who have had a previous injury or episiotomy may find the massage especially useful to soften and stretch scar tissue.

6. Prepares you for birth.

   Perineal massage is uncomfortable. Becoming familiar with the stretching and stinging sensation as you stretch your perineum will prepare you for the sensation of your baby crowning when in labour. By becoming familiar with these sensations during pregnancy, you may find it easier to stay relaxed and focused when birthing your baby.

7. There are no negative side effects.

   While there are no guarantees that perineal massage will ensure an intact perineum during childbirth, there are no negative side effects to performing this massage during pregnancy.

What you’ll need 

1. Very clean hands with freshly trimmed nails

2. Pillows 

3. If you’re doing the massage yourself, you will need a mirror so you can see what you’re doing 

4. A warm compress

5. Lubrication. You can use natural oils, like Weleda perineum Massage oil, or, coconut, almond, or olive. Personal lubricants, like K-Y Jelly, are also a good choice because they’re water soluble. Stay away from using syntheti lubricants, like baby oil, mineral oil, or petroleum jelly

How and when can you do it?

From 34 or 35 of pregnancy, a woman (or her partner) can start massaging the perineum 1–2 times per week, for a maximum of 5 minutes.

How-to perform perineal massage:

• Wash your hands. Begin each and every massage session by washing your hands with a mild soap that won’t irritate the skin around your perineum. 

• Find a comfortable position. You want a space that is both private and comfortable. You may want to perform the massage while lying in your bed or on the couch with your knees bent and your legs open. Use pillows to support under your pelvis or behind your upper body.

• Other options include massage while in the bath, while standing with one leg on a stool in the shower (then switch legs), or while sitting on the toilet. 

• Place a warm compress on the perineum for 10 minutes

• Apply the lubricant to your clean hands. Insert your thumbs approximately 3–4 cm into the vagina and apply gentle pressure downward (toward the anus) and to the side of the vagina until you feel a slight tingling or burning sensation. You may want to use a mirror the first few times you try to make sure you’re getting the right spots.

• Hold for up to two minutes, until the sensation decreases.  Then massage the perineum between thumb and index finger.

• Repeat, applying pressure outwards.

Tips:

Try to relax as much as possible during the massage and continue to breathe throughout. This means relaxing both your body and your mind. You may become more comfortable with the sensations as your tissues stretch over time. 

Tips for your partner:

Your partner may help you if you prefer not to massage yourself or find the position uncomfortable. Instruct your partner to follow the same directions as personal massage, but have them use index fingers instead of thumbs.

Be sure to communicate with your partner if they should apply more or less pressure depending on the sensations of discomfort or burning you’re feeling.

Note:

Try to be relaxed as possible during the massage and continue to breath throughout. Speak with your midwife or doctor if you experience pain beyond the slight discomfort of your tissues stretching. As well, you should speak with your healthcare provider before performing massage if you have vaginal herpes, yeast infection, or any other vaginal infections.

You may even want to ask your healthcare provider about perineal massage during labor itself. In a recent review of studies, researchers discovered that women who received massage during the second stage of labor (during and between pushing) had a lower risk of third and fourth degree tears.

What else can you do to prevent tearing?

Research also shows that regular pelvic floor exercises during pregnancy increases your ability to relax the pelvic floor muscles during delivery. If you have not yet had an assessment of your pelvic floor muscles by a women’s health physiotherapist, book in to have this done.

Staying strong during your pregnancy will also improve your likelihood of an active labour and reduce your likelihood of tearing. Not to mention improving your pelvic floor and core and facilitating an easier postnatal recovery.

Join our Strong Mama Program to be guided through your pregnancy, each step of the way.

Contraindications to perineal massage

Active infection, e.g active herpes.

Performing perineal massage prior to 34 weeks

Cervical shortening

Placenta praevia or any other condition where there is bleeding from the vagina during the second half of pregnancy

Severe blood pressure problems in pregnancy

Precautions

If your waters have broken check with your primary carer prior to continuing perineal massage.

Avoid the urethra to prevent trauma or infection.

So, in summary, perineal massage is definitely worthwhile, although it is not appealing to everyone. We’ve met many women who just are not interested in interacting with their vagina in that way (nor asking their partners to), so don’t feel weird if that is you as well! We just want to share some of what we know to help you make the decisions that are best for YOU.

On that note, please get in touch if you have any questions.

Till next time,

P.S. Have you read our blog on Perineal massage compared with using an EPI-NO? We recommend reading that blog and of-course make sure you have a read of our ‘Tips to Prevent Tearing During Delivery’!