So, what is my “Perineum”?
Your perineum is the area between your vaginal opening and your back passage. During a vaginal birth your pelvic floor and perineum undergoes a HUGE amount of stretch. Because these tissues stretch so much during birth it is common to experience a perineal tear during a vaginal delivery. In fact, perineal tears are super common and up to 70% of women will experience a perineal tear of some sort during delivery.
How can I reduce my risk of perineal tears?
There is a high level of evidence to suggest that perineal massage during pregnancy can reduce your risk of perineal trauma in first time birthing women. Women who received antenatal perineal massage had significantly lower incidence of episiotomies and perineal tears, particularly third- and fourth-degree perineal tears (tears involving the back passage muscles). Perineal massage allows for better wound healing and less perineal pain post birth. Perineal massage has also been shown to reduce the second stage of labour. How amazing!
When can I start and how often should I do perineal massage?
You can start it from 34 weeks. You only need to do perineal massage 1-2 times per week for it to be effective, but you can certainly do it more if you like. It is better to ensure you are doing it correctly, rather than more frequently.
How do I do it?
Firstly, a nice lubricant is essential. I love Weleda Perineal Massage Oil. Place one or both your thumbs into your vagina (you may wish to start with one if this is more comfortable). Push towards the back until you feel a strong stretching sensation. Hold for 30 seconds, then repeat 2-3 times in different spots. Build up to holding the stretch for 2 minutes straight. After this stretch you can massage the perineal area in a U-shape from 3-9 o’clock. You can do it sitting on the toilet, or in side-lying with pillows between to your knees to create space to reach your perineum. Your partner can also assist. It is important you are doing it correctly to get the full benefit of perineal massage, so if you are unsure reach out to your women’s health physiotherapist. We can demonstrate it on a pelvis model, on yourself or even show your partner how to do it correctly.
Is there anything else I can do to reduce my risk of tearing and prepare for labour?
Releasing and stretching your perineum and perineal muscles can help improve the stretch in your tissues, as well as your tolerance to the sensation of stretch. Your physio can help guide you with this. Learning to relax your pelvic floor and transitioning your pelvic floor exercises to a ‘down training’ focus in the last 6 weeks of pregnancy is also super valuable. “Paradoxical pushing” (where you tighten your pelvic floor instead of relaxing during pushing) can increase the likelihood of a longer second stage of labour (and therefore more chance of pelvic floor issues afterwards). Your women’s health physio can check your pushing technique (with ultrasound or palpation) to ensure you are able to relax your pelvic floor muscles correctly and correct any issues prior to labour. Having good flexibility throughout all your pelvic muscles is also important (cue Han’s amazing pilates). Your physiotherapist can also advise you on specific stretches for your own body.
You can also use perineal massage during labour, and a warm compress to your perineum can reduce the risk of perineal trauma. Speak to your birth team about this.
If you think you need some specific or individual guidance about perineal massage or anything related to your pelvic floor, pregnancy or birth, please reach out or you can see me at:
Please note: There are some contraindications for perineal massage so always speak with your health care provider to check it is suitable for you.
Reference: Abdelhakim, A., et al. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International urogynecology journal, 31(9), 1735–1745.