Perineal Massage

The perineum, also known as taint, is the area between the vaginal opening and the anus, and it is connected to the pelvic floor muscles. The perineum is an elastic tissue that can expand and contract, and it includes skin and muscles. During labor, specifically when the baby’s head is coming out, the perineum stretches significantly, and tears and cuts in different degrees may occur, starting with minor skin tears, including more severe tears that may contribute to the pelvic floor muscle weakness.

If the delivery room staff assesses that a large tear may occur or that the fetus may be in distress and to facilitate a rapid delivery, they may decide to perform an episiotomy. An episiotomy is intended to widen the vaginal opening and alleviate the crowning of the head with a controlled incision. Prior to performing an episiotomy, the patient’s consent is required.

Therefore, it is understandable that one of the concerns before childbirth is the consequences of the stretching of the perineum. If you share this concern, it is important to note that there are actions you can take to prepare your body for labor in this regard, and your partner may contribute to this process.

To prepare your body for the anticipated stretching during labor, you can perform a perineal massage during the last few weeks of pregnancy, thereby enhancing its elasticity. The massage can help reduce the risk of significant tears during labor and the risk of an episiotomy, particularly among first-time mothers. Studies have demonstrated that the key benefit of second- and third-time delivery among women who had a perineal massage was that they reported reduced pain in the area after labor.

Ultimately, the best perineal massage is performed at the last stages of labor. When the baby is at the birth canal, it moves forward slightly, stretching the perineum. It then moves back slightly up the birth canal and then moves down again. This process helps to loosen the tissue and prepare it for the baby's birth.

When to start performing a perineal massage

It is recommended to start the massage at the 34th week of pregnancy, 3 times a week, for 5 to 10 minutes.

How to perform a perineal massage

1. Preparations: buy a gentle oil that suits perineal massage. The appropriate oils have a pleasant and gentle texture, and they improve the elasticity of the skin. Pour a little oil into a bowl. Ensure that your hands are clean and your nails are trimmed.
2. Make time: find some quiet and peaceful time so you can dedicate yourself to the process.
3. Empty your bladder.
4. Find the right area: using your fingers, locate the perineum (you can use a mirror) and imagine the area as a clock, with 6 o’clock being the point nearest to the anus.
5. The massage stages: apply an amount of oil to your thumb and gently insert the first joint of the thumb or two fingers into the vagina opening, aiming towards the anus. Begin the massage by making stretching movements towards the sides and upwards, starting at the 3 o'clock position and moving towards the 9 o'clock position. Upon reaching the 6 o'clock position (in the direction of the anus), apply gentle pressure downward. Repeat this motion approximately 20 times in each direction in a rhythmic and gentle motion.

A massage performed by your partner

When a partner is giving a perineal massage, they should follow these stages and maintain clean hands and trimmed fingernails. Place your finger in the vaginal opening and gently insert it to a depth of 2-3 centimeters from the opening. Move your finger to the 3 o'clock position and move towards the 9 o'clock position. Upon reaching the 6 o'clock position (in the direction of the anus), apply gentle pressure downward. Repeat this motion approximately 20 times in each direction in a rhythmic and gentle motion.

It is essential to massage slowly and gently and ask your partner whether the touch is comfortable and pleasant.
On the Internet, there are videos that demonstrate how to perform the massage yourself or with your partner and watching them before you start is highly recommended.

Perineal massage tools

There are a variety of perineum massage tools on the market. Each tool has specific purposes and techniques. If you want to purchase such a tool, it is recommended that you consult with a healthcare provider to assess whether it is appropriate for your individual health needs and stage of pregnancy. Then, to minimize the risk of injury to the pelvic floor muscles, it is advisable to consult with a midwife or a physiotherapist who has been trained in the field and obtain their recommendations and instructions for proper use.

When not to perform a perineal massage

In spite of the benefits of perineal massage, there are instances in which it is not recommended to perform a massage:

• If you have an active vaginal infection or a recurrent vaginal infection (for instance, herpes or vaginal fungus).
• If you are experiencing preterm contractions, shortening of the cervix, or complications of pregnancy that make perineal massage contraindicated (as instructed by your physician).
• If you have vaginal bleeding, a placenta previa, or a low-lying placenta.
• If the massage causes you pain or discomfort.

When there is a doubt, it is essential to consult a medical professional before initiating a massage.