Getting ready to welcome your little one into the world? You might already be working on your hospital bag, nursery and labor techniques. Consider adding perineal massage as you prepare your body for delivery! Perineal massage helps soften the tissues that your baby stretches during a vaginal delivery. Perineal massage benefits include less pain, less tearing and helping to prevent unnecessary trauma to your pelvic floor.
Perineal massage involves gentle, manual stretching of the tissues that shape your birth canal. Performed by women for centuries, there is now strong scientific evidence indicating that when done regularly (and properly) in the final few weeks of pregnancy, perineal massage may help increase your chance of a vaginal delivery without damaging your perineum. This results in a decreased chance of tearing and/or an episiotomy (a surgical cut).
Tears and episiotomies require stitching, which can lengthen your recovery time after delivery. They can also cause scarring, pain and urinary (or fecal) incontinence issues which can continue to impact your life in a negative way long after childbirth.
While nothing is guaranteed (as every birth and baby is different!), perineal massage for just 5 minutes a day in the last few weeks of pregnancy an help prevent unnecessary trauma to your perineum during birth! After two natural childbirths, I truly believe that perineal massage made a difference for my births.
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What is the perineum?
So first, let’s make sure you know what part of your body I’m talking about. Your perineum is the area of tissue that stretches between the opening of your vagina and your anus. It’s incredibly important as it attaches to the muscles that make up your pelvic floor, supporting your bladder, bowels and reproductive organs.
A strong pelvic floor helps prevent you from tinkling on yourself every time you cough. It’s super important that after childbirth these tissues remain strong and intact, while being flexible enough to stretch during childbirth to allow your baby to move through the birth canal.
What is a perineal massage?
Perineal massage is a gentle, manual stretching and manipulating of your perineal tissue (AKA pelvic floor) using one or two fingers. The goal of this is to help prepare these tissues to stretch more easily around baby’s head and body, helping to reduce the risk of tearing or scarring during a vaginal delivery.
Unfortunately for many women, their perineal tissues lack enough flexibility and just aren’t able to stretch as easily as needed during delivery, which results in trauma to the perineum, tearing or an episiotomy.
However, studies have shown that perineal massage during the last several weeks of pregnancy can help relax and stretch the tissues of your perineum. This gentle massage done by you or your partner leading up to childbirth helps keeps the perineal tissues flexible and soft, and prepares them to expand naturally during delivery.
I want to be clear that I am not a medical professional, and I am providing this information only for informational purposes. As a mom, and as someone who navigated two natural, vaginal births with no tearing, I believe perineal massage made an impact in my own personal experience.
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Does perineal massage hurt?
A perineal massage should NOT hurt! You should feel a stretching sensation, and maybe a little bit of stinging or burning, but never pain. The pressure you (or your partner) are applying should be gentle and not be enough to cause pain.
If you attempt perineal massage and you feeling pain or anything beyond slight discomfort, be sure to speak with your midwife or doctor.
Does perineal massage really help with labor pain and delivery?
There are many benefits associated with perineal massage! It prepares the tissues of your pelvic floor, increasing blood flow and assisting the skin with stretching more easily during a vaginal childbirth. The easier the stretch, the less pain level for many women.
Keep in mind that for the vast majority of pregnant people, labor is painful. One of the most powerful things you can do to help equip yourself for a successful vaginal childbirth (and learn tools to help with the pain) is to take a childbirth education class.
You can find in-person options in your own area, or you can also seek out information through online courses!
You can look for classes in your area, or there is also an excellent and super informative class online called the Mama Natural Birth Course. It’s 100% online and on-demand, so you can take it at your own pace. You can repeat modules if needed, and if time is an issue, you could do the whole course in a weekend.
This course is seriously amazing and full of SO MUCH information that you are probably already searching for when it comes to having a healthy pregnancy and smooth childbirth.
Not only do they take you through everything you need to know about labor and delivery (including fantastic pain management techniques) this incredible course also has practice videos for you and your partner (which is one of the best ways to practice what you’re reading before it’s go time), childbirth videos (so you can see what your birth might look like), special trainings for VBAC birth, a private Facebook group where you can connect with other moms to be (moderated by a certified doula) AND access to a breastfeeding master class!
Benefits of perineal massage before birth
Perineal massage helps ease pain during crowning
While the pain and sensations associated with childbirth can vary greatly from mother to mother (and even from birth to birth!), the one thing that sems to be consistent for the majority of moms who have a vaginal birth is the “ring of fire.”
When your baby is crowning, your perineum eventually reaches a point of maximum stretching, resulting for many women in a burning sensation. It’s referred to by many childbirth educators as the ring of fire because of this burning sensation as your tissues stretch around your baby’s head.
Perineal massage in the weeks leading up to childbirth allows you to key into the sensation of your pelvic floor stretching prior to birth. This gives you the opportunity to practice relaxing and breathing through the burning sensation of perineal stretching. Many women report that this helps them feel prepared and confident for crowning.
Stretching the perineum helps the baby’s head come out easier and faster
Our bodies are INCREDIBLE. Your vagina is designed to stretch to accommodate your baby during childbirth, and return to pretty close to the same size in a matter of just a few weeks after delivery!
Your perineum, however, is less elastic, and can tear during a vaginal childbirth. This is where the benefits of perineal massage come into play! The gentle stretching that is done with perineal massage is done with that in mind.
Perineal massage prepares the tissues of your pelvic floor, increasing blood flow and assisting the skin with stretching more easily during a vaginal childbirth. The easier the stretch, the easier it may make it for baby’s head to push through while crowning.
Does perineal massage reduce tearing? A perineal massage can help you avoid tearing & possibly an episiotomy
Did you know that your birth team can perform perineal massage during labor, too? Researchers have found in recent studies that “women who received massage during the second stage of labor (during and between pushing) had a lower risk of severe tears.”
During my first birth, my son crowned for nearly 3 hours (and I was in labor for nearly 2 full days). My birth team performed perineal massage using an olive oil mixture during that time and I was shocked that I had barely any damage or trauma after his very long birth.
One of the biggest benefits of perineal massage is reduced risk of tearing or major trauma. Even if perineal massage doesn’t prevent tearing, one study found that it may help to reduce the severity of a tear, helping to also reduce the need for stitches.
Additionally, the less trauma your pelvic floor experiences during birth, the less pain you might feel not only during birth, but during recovery. If you are able to avoid an episiotomy or major stitches, your body will hopefully start to feel better faster.
When should I start a perineal massage in pregnancy?
The general consensus recommendation seems to be starting perineal massage between the 34th week and 36th week of your pregnancy.
As with so many things in pregnancy, recommendations and situations differ from pregnant person to pregnant person. Be sure to talk to your doctor or midwife before starting, and see if they have any specific suggestions or recommendations for your own pregnancy.
How often should you “get” a perineal massage?
Some experts recommend beginning gradually with once or twice per week, while others say you can do up to once a day every day or every other day. Once you have been given the all clear from your health care provider, decide what is best for your own body and situation.
Regular, consistent perineal massage is ideal to promote greater elasticity of the muscles in the perineum. If you miss a day or two, don’t worry! Just start again the next day. The key to perineal massage benefits is consistency. You can perform perineal massage on yourself, or you can have your partner do it.
No matter how often you choose to practice perineal massage, you only need 5 minutes each time to see possible benefits during childbirth.
How to Do a Perineal Massage & Techniques to use During Pregnancy
After you’ve spoken to your doctor or midwife, you can take the following steps starting around 34 weeks of pregnancy to perform a perineal massage on yourself:
- Wash your hands thoroughly and be sure your nails and clean and clipped.
- Sitting in a relaxed position with your head supported, spread your knees apart wide.
- Apply a few drops of olive oil, coconut oil or a lubricant designed specifically for the vagina to your thumb and perineum. Ensure you use enough gel to keep your tissues moist during the massage for the most effective softening and stretching.
- Insert your thumb into your vagina up to about your first knuckle. Remember, you’re massaging your perineum, not your full vaginal wall. Apply a gentle pressure in your vagina, pushing downwards towards your rectum. Maintain this pressure and gently move your thumb from left to right in a U shape. Throughout your massage, hold this stretched position and try to consciously relax your muscles in this area. Keep massaging down and out.
- Continue massaging the perineum for three to five minutes, once or twice a week and up to once a day until delivery.
You should feel a stretch and possibly a bit of stinging or burning, but the pressure should never be painful. If you feel pain, stop and talk to your healthcare provider.
Take your time! Remember, the goal of perineal massage is to stretch and massage the back portion of the birth canal, using more and more pressure over time.
Oils to use for perineal massage
You probably already know that your vagina is made up of a huge amount of microorganisms that are vital for the health of your vagina, your growing baby and your health in general. With that in mind, it’s important that you pick an oil or massage gel for perineal massage that will help keep your lady bits happy and healthy.
You want to choose a massage gel or oil that will help to make the massage more comfortable, while also helping to hydrate the tissues of your perineum. There are a variety of oils that work for perineal massage. Choosing a specific type is up to your own personal preference. Stay away from synthetic oils and lubricants (like baby oil or petroleum jelly).
Here are a few types of oil and gels to try for perineal massage:
You can also choose to use your body’s own natural vaginal lubricant.
How to have your partner do the perineal massage
If you are uncomfortable performing perineal massage on yourself, your partner can also help!
To help make it easier and more comfortable, sit facing your partner, with your legs draped over the outside of theirs. Instruct them to follow the same direction above for a personal massage, but be sure they use their index fingers instead of their thumbs.
Be mindful of your body and the sensations, and be sure to communicate with your partner during the massage. Let them know how much pressure to apply, or if you need them to be more gentle. Focus on the sensations of the burning and stretching as they go, to help you be more tuned into those sensations again during childbirth.
Perineal massage has many benefits and it’s easy to do!
As you prepare for you labor and delivery, adding in regular perineal massage is a great idea. While nothing can guarantee that you won’t experience tearing, perineal trauma or the need to deliver in a different way, perineal massage can help you prepare both physically and mentally for the challenges of labor.
If you try it and decide you don’t like it, it’s ok to skip it! Remember that your vagina and your pelvic floor were designed to stretch to accommodate your baby. Perineal massage might feel awkward and uncomfortable at first, but the more you practice it the easier it will become.
If you’re looking for more resources to help you prepare for childbirth, one of the most powerful things you can do to help equip yourself for a successful vaginal birth is to take a childbirth education class (like this one, which I took and loved).
Just 5 minutes a day can help your body prepare for a vaginal delivery with less tearing, trauma and pain.