Perineal Massage in Pregnancy – Benefits and How to Do It

Perineal massage in pregnancy is a simple technique that helps prepare the tissues between the vagina and anus for the stretching that will occur during vaginal birth. As per the Dona International, the American College of Obstetricians and Gynecologists (ACOG) says that 53 to 79% of women may experience vaginal tears or perineal lacerations during vaginal childbirth (1). It is a gentle and relaxing massage recommended by doctors for pregnant women so that their delivery goes smoothly and the risk of perineal tear or injury during vaginal delivery decreases. Usually performed in the later weeks of pregnancy, it involves gently massaging and stretching the perineal area with clean hands. According to the NHS, many maternity services recommend beginning around 34 weeks, although your doctor or midwife can advise whether it is appropriate for you (2).

What Is a Perineal Massage?

Located between the anus and vagina, the perineum is a muscle used heavily at the time of delivery. During childbirth, this region suffers heavy damage and is stretched or even torn. There are even times when your doctor may have to perform a procedure called an episiotomy. This is when the doctor helps deliver a child by cutting the perineum. The tearing of this muscle is quite painful.

A perineal massage while pregnant is used to help slowly relax the perineum muscle, so it helps increase the muscle flexibility and durability; this can help avoid the need to tear the muscle during childbirth. This massage is strongly recommended for women because it speeds up recovery after delivery.

Benefits of a Perineal Massage in Pregnancy

Doctors recommend the perineal massage for normal delivery due to the numerous benefits it can have on the recovery process. Here are some practical benefits of perineal massage:

• The NCT informs that the perineal massage increases fluidity in the muscles and allows it to stretch easily, which helps make childbirth less painful (3).
• It is known to help the suppleness of the lower cervix region, which in turn helps speed up the recovery time after the delivery.
• The movement of the entire region around the perineum becomes less rigid and, in turn, helps movement and blood circulation.
• The tissues in the region become softer and more flexible, helping ease the delivery while preserving the muscle (4).
• It reduces the chances that you will need an episiotomy (5).
• Decreases the chances of needing assisted deliveries, like the vacuum-assisted birthing method.
• The massage increases the width of the birth canal and decreases the tingling pain during crowning. The increased blood flow caused by the massage also helps ease the baby out of the womb, ensuring fewer complications.

Does a Perineal Massage Really Help Prevent Tearing During Birth?

For centuries, this massage has been practised by many cultures around the world due to its believed ability to stop tearing during birth. Massaging the perineum for 3 or 4 weeks before the date of delivery is believed to stretch the rigid and taut muscles in the region of the anus and vagina. This helps the region develop elasticity that improves the overall chances of preserving the muscle itself. This acts as a preventive measure for tearing during childbirth. The perineal massage also helps stimulate the region and improve blood flow around the perineum, anus and vagina. This not only helps the recovery to these regions but also works towards preparing the actual region for the trauma of childbirth.

Note: Talk to your doctor before attempting the perineal massage, some pregnancies can be complicated and it is always best to get medical advice before commencing any form of activity that may impact the pregnancy.

How to Do a Perineal Massage During Pregnancy?

Before performing the massage, it is important to understand the method and technique required to perform the massage, as well as other key points like when to begin, how often to perform the massage and what you need for the massage itself.

1. When to Start

Doctors recommend the perineal massage in the third trimester. The Cleveland Clinic recommends you perform the massage continuously for 4-6 weeks before the expected due date (6). Ensure you have someone in the room with you when you begin the massage to assist you in case of any emergency. Consult your primary healthcare physician and OBGYN before commencing the massage.

2. How Often to Massage

Perform the massage once in the morning and once in the evening for better results. If the massage feels uncomfortable twice a day, then reduce it to once a day. Do not perform the massage if there is excruciating pain or any other side effects that you experience; in this circumstance, consult your doctor.

A research question published in the British Medical Journal (BMJ) stated that massaging the perineum once or twice a week for about four weeks is enough (7).

3. What You Require to Get Started

Before you begin the massage, here are a few key requirements you need to keep in mind:

• You must have finely trimmed and filed nails.
• Remember to keep a full-length mirror in front of you to find the location of the perineum/
• Ensure you lubricate well. Natural oils like sweet almond, avocado, olive oil, or vitamin E oil can be used. You can also use either KY jelly or vegetable oil. For alternative lubricants, talk to your doctor (8).

4. How to Do the Prenatal Perineal Massage By Yourself

The Government of Ireland’s project-based HSE provides a detailed process for how to do a perineal massage (9). Once the equipment is in place, you can follow these simplified techniques to perform the actual massage:

• Ensure you stretch your legs to the required extent.
• Insert both thumbs into your vagina.
• Using your thumbs, press downward and then pull to the side (this can cause a slight tingling sensation or slight pain. If the pain is excruciating, stop.)
• Hold this press for 2 to 2.5 minutes.
• Using your thumbs and forefingers, rub your perineum for a minute or a minute and a half
• Once this technique becomes comfortable, you can begin to add Kegel exercises to further stimulate the effects of the massage.

FAQs

1. When should I start perineal massage during pregnancy?

Most maternity guidance recommends starting from around 34 weeks of pregnancy. It is generally continued several times a week until birth, depending on your comfort and your healthcare provider’s advice.

2. Does perineal massage prevent tearing during childbirth?

It cannot guarantee that you will not tear, but evidence suggests that massage during the final weeks of pregnancy can reduce the likelihood of perineal trauma requiring stitches and may reduce the need for an episiotomy.

3. Is perineal massage painful?

You may feel stretching, pressure or mild discomfort, but the massage should not be painful. Gentle pressure and adequate lubrication can make it more comfortable; stop if you experience significant pain or discomfort. The NCT says that the pain is usually negligible by the second or third week of massage (3).

4. When should I avoid perineal massage?

Avoid it if you think your waters have broken or if you have a vaginal infection such as thrush or genital herpes. Speak with your maternity care provider if you are unsure whether perineal massage is safe for you.

5. Can I get a perineal massage in 2nd pregnancy?

You can get a perineal massage in 2nd pregnancy, but the statistical result won’t be much compared to the first pregnancy if you gave birth vaginally, as your perineum would have already been stretched due to the first vaginal birth.

It is well known that prevention is the best form of preparation. Starting perineum massage and including other activities that help with natural childbirth, like prenatal yoga, is the best way to prevent complications that can be avoided. Pregnancy can be physically traumatic, so always remember to get sufficient rest and talk to your doctor regularly during and after the pregnancy. It is also recommended that you perform the massage for the first few times after talking to a specialist to ensure proper form and technique, so you don’t hurt yourself or your baby.

A Final Note: Always remember to communicate with your caregivers and doctors about any sensations that feel unnatural during the massage. If the massage begins to feel different after a while, consult your doctor on if it is okay to continue the perineum massages.

Also Read: 

Vagina after Pregnancy
Postpartum Perineal Pain – Causes & Relief
Tips to Cope With Perineal Tears during Delivery

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Sources References

1. Dona International – ACOG: OBs Can Prevent Lacerations During Vaginal Births

2. NHS Cambridge Unversity Hospitals – Antenatal perineal massage

3. NCT – How to do perineal massage: a step-by-step guide

4. NHS Milton Keynes University Hospital – Perineal Massage in Pregnancy – Advice and Information

5. NHS – Episiotomy and perineal tears

6. Cleveland Clinic – Will Perineal Massage Keep You From Tearing During Childbirth?

7. National Library of Medicine – Perineal massage in the weeks leading up to delivery helps some women avoid episiotomy

8. The Department of Health, Western Australia – Perineal massage during pregnancy

9. HSE – Perineal massage during pregnancy