September 1, 2009

Perineal Massage

I am often asked about the usefulness of perineal massage for expectant mothers. To be completely honest, I haven’t heard much feedback about it either way. I decided to investigate the question a bit more and see if there was any hard data on it.

Let’s start at the very beginning to get everyone on the same page. The true perineum is called the Central Tendon. It is the center point at which almost all the muscles of the superficial layer of the pelvic floor converge. However, most people broaden this area and refer to the skin and muscles between the vaginal opening and the anus as the perineum. Perineal massage is a massage of these muscles for the purpose of creating more “stretchiness” and flexibility to the area. It can cause some stinging sensation which is believed to help the mother become familiar and comfortable with the intense stinging that occurs as the baby’s head is crowning. Perineal massage can also be a good opportunity for the mother to learn how to relax the pelvic floor muscles.

One of the main reasons that women are drawn to the idea of perineal massage is to lessen the likelihood for tearing or the need for an episiotomy. 40% to 85% of all women who give birth vaginally will tear. About two thirds of these women will need stitches. There have been several studies conducted about the effectiveness of perineal massage. One study out of the Department of Obstetrics and Gynaecology, Watford General Hospital, Hertfordshire, UK came to this conclusion antenatal perineal massage appears to have some benefit [reduction of 6.1%] in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above. Another study co-authored by Frank Anderson, MD, MPH, an assistant professor of Obstetrics and Gynecology at the University of Michigan Medical School also produced favorable results in support of perineal massage. The data shows that there is a greater likelihood of the perineum staying intact for first time mothers. However, Anderson does explain that a multipara (a mother already having birthed one child) has a higher chance of re-tearing if she had torn in from previous births or had an episiotomy. This is because the scar tissue is weaker, thicker, and not as pliable as normal tissue due to lack of blood supply. It is interesting that both studies note women over 30 years old benefit more from perineal massage. Anderson believes this could be due to older tissues being stiffer than younger tissues.

One area where I found a difference of opinion was on the determination of negative side effects. The majority of the articles I read stated that there were no side effects to perineal massage. However, one article quoted a nurse midwife as saying “she would caution a woman against perineal massage if she has a history of preterm labor, premature rupture of membranes, a vaginal infection, if the massage induces contractions, or even if the procedure simply makes her sore or uncomfortable.

I think most women would agree that keeping their perineum intact is a pretty high priority during childbirth. Beyond perineal massage, it is recommended to do kegel exercises regularly. Kegels help strengthen the pelvic floor muscles, improve circulation to the perineum, and create an awareness of how to relax the pelvic floor muscles. One other recommendation for helping your perineum stretch is to either labor or birth in water (the water softens the muscle tissue) or ask your care provider to apply warm, wet compresses to the perineum as the baby’s head starts to crown.

For those interested in trying perineal massage, here are some easy to follow instructions:


*It is recommended to start 6 prior to your due date
*It is recommended to use a water soluble lubricant for this massage such as KY jelly, olive oil, almond oil, vitamin E oil or pure vegetable oil. Do not use baby oil, mineral oil, or petroleum jelly.
*Place your thumbs about 1 to 1.5 inches inside your vagina (see figure). Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation.
*Hold that position for 1 or 2 minutes.
*With your thumbs, slowly massage the lower half of the vagina using a “U” shaped movement. *Concentrate on relaxing your muscles. This is a good time to practice slow, deep breathing techniques.
*Massage your perineal area slowly for 10 minutes each day. After 1 to 2 weeks, you should notice more stretchiness and less burning in your perineum.
*Partners: If your partner is doing the perineal massage, follow the same basic instructions, above. However, your partner should use his or her index fingers to do the massage (instead of thumbs). The same side-to-side, U-shaped, downward pressure method should be used. Good communication is important be sure to tell your partner if you have too much pain or burning!

Happy Massaging!




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