The perineum is not the most flexible part of the body, yet during childbirth it stretches to its limit, and often beyond, so the baby’s head and shoulders can safely emerge through the vaginal opening. For many new mothers, this can result in an uncomfortable perineal tear that requires care and time to heal.
80% of first-time mothers who give birth vaginally, without prior perineal massage, are known to experience perineal tearing, 70% of which require sutures. However, this discomfort can be avoided, or largely eased, by practicing perineal massage during the last few weeks of pregnancy.
Read on to learn more about perineal tearing and how you can prevent it with our step-by-step guide to perineal massage during pregnancy.
What Is the Perineum and Where Is It Located?
The perineum is a thin layer of skin located between the anus and the vagina. It is home to a collection of connective tissues, muscles, and membranes that provide support for the pelvic floor, bladder, bowel, sex, and childbirth. When the perineum is weak or injured after childbirth, bowel movements, urination, and sex can become uncomfortable.
What Happens to The Perineum During Childbirth?
As babies pass through the vaginal canal, the pelvic floor muscles, vagina, and perineum must stretch together to allow the newborn’s passage out through the vaginal opening. Depending on the baby’s size and the mother’s pelvic structure, the stretched perineum can sometimes tear, particularly for first-time mothers.
Perineal tears can range from minor skin tears to deep tears that affect the sphincter muscle and rectal lining to the point that suturing is required. Indeed, perineal tearing is so common in first-time mothers who don’t perform perineal massage that medical experts have categorized the tears according to severity.
First and Second-Degree Perineal Tearing
First and second-degree perineal tears are typically mild, affecting only the perineal skin or the vaginal muscles. Sutures are not usually required for first and second-degree perineal tears and they can fully heal within a few weeks of giving birth.
Third and Fourth-Degree Perineal Tearing
Third and fourth-degree perineal tears are more severe, typically splitting through the sphincter muscle and rectal lining. These tears require sutures and can take months to heal after delivery. Unfortunately, long-term complications like dyspareunia (painful sex), incontinence, painful scar tissue, and pelvic organ prolapse can also arise after third or fourth-degree perineal tears heal.
The Advantages of Perineal Massage Before Childbirth?
Regular perineal massage after week 34 of pregnancy can significantly reduce the severity of perineal tearing. Given that this part of the body experiences intense stretching during the last stages of labor, some minor perineal skin tears may still occur. However, third and fourth-degree perineal tears can generally be prevented with correctly performed and regular perineal massage
When severe perineal tears are prevented, long-term complications like pelvic prolapse, incontinence, and pain with intimacy are also avoided.
Perineal massage can also introduce first-time moms to a mild version of the stinging sensation commonly experienced during childbirth. Although it’s a less intense feeling than childbirth, stretching the perineal and vaginal muscles through massage can prepare new mothers to remain calm and continue breathing when they encounter the more severe stretch during the last stages of labor.
A lack of awareness about this stinging sensation can result in new moms pushing too hard and giving birth too fast to relieve the discomfort. This often results in severe third or fourth-degree perineal tears.
All in all, less postpartum pain and complications from perineal tearing mean new moms have more time to bond with their babies and care for themselves.
Can Perineal Massage Prevent an Episiotomy?
An episiotomy is when a surgical incision is made on the perineum. In the past, an episiotomy was performed to enlarge the vaginal opening and prevent third or fourth-degree perineal tears. Then research showed that performing an episiotomy actually worsens perineal tears, and the complications afterward, rather than prevent them.
These days, an episiotomy is only done when either the baby or mother is in distress during childbirth and a quick delivery is required. This can happen when expecting mothers push too hard, too little, or birth too fast.
However, research reveals that expecting mothers who regularly practiced perineal massage before childbirth experienced fewer episiotomies.
Are There Cases Where Perineal Massage Should be Avoided?
Although safe for most, perineal massage is not recommended if you have a vaginal infection, high blood pressure, a small cervix, or have experienced bleeding during the second trimester.
Your OB/GYN would typically discuss any of the above well before the 34th week, but it’s always wise to check that none are evident before beginning the perineal massage.
Perineal Massage: How to Do It
It is recommended that perineal massage is performed up to 4 times per week for 5 minutes each from week 34 of pregnancy. If your OB/GYN recommends a massage for longer than 5 minutes, trust their advice. Each perineum, just like each body, is different.
It’s best to use a fragrance-free, water-based, personal lubricant to avoid any disturbances to the vaginal pH that could result in an overgrowth of bacteria and cause a vaginal infection.
Before beginning the massage, it helps to take a warm bath or apply a warm compress to the perineum to soften the perineal tissue and relax the muscles. This can make the perineum more pliable, and the massage more comfortable and effective.
Step-by-Step Guide to Perineal Massage During Pregnancy
- Make sure your hands are freshly washed with warm water and unscented soap
- Find a comfortable position either lying down or sitting up (if sitting support the head and shoulders with pillows)
- Apply some water-based lubricant to the perineum and one of your thumbs
- Then place your lubricated thumb into the vagina as far as your first knuckle
- Gently press the thumb down toward the rectum until you feel a slight stinging sensation.
- As the perineal skin and tissues stretch, learn to breathe through the feeling and relax
- Then, in a U-shaped motion, sweep the thumb slowly left and right, maintaining gentle pressure to stretch the skin and feel the slight stinging sensation as you sweep.
- Bringing the thumb to rest on the left, push it toward the rectum, and hold the stretch for 45-60 seconds breathing constantly in a relaxed manner
- Then sweep the thumb to the right, push it toward the rectum, and hold the stretch for 45-60 seconds while breathing
- Repeat to the left and right for a total of 5 minutes
After trying perineal massage with one hand, many women refer to use both thumbs simultaneously. Starting in the middle of the perineum with both thumbs, one is swept and held to the right for 45-60 seconds, while the other stretches the left side.
What If You Can’t Do a Perineum Massage Because Your Pregnant Belly Gets in The Way?
If you’re not able to reach your perineum at 34 weeks pregnant, you’re not alone. The uterus and the babies growing within them can be quite large at 34 weeks and in these cases, a Pelvic Massage Wand can perform a perineal massage for you.
What is a Pelvic Massage Wand and How Does it Work for Perineal Massage?
A pelvic massage wand is designed to improve pelvic health by massaging tight pelvic muscles and scar tissue and relaxing deep pelvic trigger points. They are also recommended for perineal massage after week 34 of pregnancy and are used with lubricant instead of the thumbs.
Although they were initially recommended for women who found it difficult to reach the perineum due to their growing uterus, many women prefer using the wand for perineal massage over their thumbs.
The medical-grade silicone massage wands from Intimate Rose are particularly popular due to their life-like feel and gentle vibration settings. Feedback also indicates that these pelvic massage wands provide a deeper tissue massage and a more effective perineal massage than using the thumbs.
Pelvic massage wands can also be used for postpartum recovery to improve blood circulation around perineal scars and episiotomy incisions and reduce the build-up of scar tissue around them.
Conclusion
Perineal massage after week 34 of pregnancy is highly recommended to avoid severe perineal tears during the last stages of labor. Minor perineal skin or vaginal tears can still occur during childbirth, however, regular perineal massage is known to prevent third and fourth-degree perineal tears and more importantly, the complications that can ensue afterward.
Along with preventing severe perineal tearing, regularly massaging the perineum with well-lubricated thumbs or pelvic massage wand can prevent pelvic organ prolapse, postpartum incontinence, and uncomfortable scar tissue that can cause discomfort during sex.
References
Pregnancy, Birth & Baby - Anatomy of pregnancy and birth - perineum and pelvic floor - https://www.pregnancybirthbaby.org.au/anatomy-of-pregnancy-and-birth-perineum-pelvic-floor
Royal College of Obstetricians & Gynaecologists - Perineal Tears During Childbirth - https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/perineal-tears-during-childbirth/
Cochrane Library - Antentatal perineal massage for reducing perineal trauma - https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3/full
National Library of Medicine - Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial - https://pubmed.ncbi.nlm.nih.gov/30941442/
