When you’re learning about perineal massage, how to do it, and it’s purpose, it can seem a bit weird at first. It was for me. But the advantage of having done so can be far greater in the long run than most mothers realize.
Benefits Of Perineal Massage
If you think about it, perineal massage is basically stretching. You’re reaching ‘down there’ as comfortably as you can to stretch your muscles and tissues so they’re used to it.
It’s like stretching any other part of your body. It’s a little uncomfortable when you’re in the thick of it, especially when you’re not that flexible.
But after consistent effort, you find it’s easier to do, and you feel better because of it. You’re not as tight in those areas and can better move your body as part of its natural functions.
The idea and hope is the same here-by doing perineal massage (perineal stretching) you’re getting it ready for stretching around that baby’s body during birth. Makes sense, valid from many perspectives, and logical.
However, the thing about perineal massage is that there is conflicting evidence as to it’s documented benefits. I have found three studies, among others, that support differing outcomes.
℘ A study published in 2006 by the Journal of Maternal Fetal Neonatal Medicine, by the University College Dublin School of Medicine, showed that perineal massage didn’t help keep women’s perineums intact at birth. Though it did say those women had better recoveries with pain and sexual circumstances afterwards. (More on that later.)
℘ A study published in 2008 by the Israel Medical Association Journal, by the Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, supported neither outcome, showing that perineal massage neither increased nor decreased the support of the perineum.
℘ A study published in 2012 by the Archives of Gynological Obstetrics, by the Nursing and Midwifery School, Tehran University of Medical Sciences, DID show a positive result for mothers undergoing the practice, especially during labor as well.
So the science isn’t very clear. That’s the hard part about all these things.
But the benefits that DO appear, they are the start of a better chain of outcomes for the mother, such as…
- flexibility of tissues
- lower risk of tearing during childbirth
- fast post-partum healing
- lower levels of pain in recovery
- ability to resume sexual intercourse sooner
- less pain associated with resuming intercourse
….which are A LOT better than possibly having all the opposite effects like:
- no extra elasticity of tissues
- same personal risk of tearing during birth
- possible lengthier time healing post-partum
- can have a more painful time during recovery
- longer period of time before resuming sex
- pain and difficulty during intercourse
So even though it’s hard to know the chances of perineal massage working well for you, it may be worth the effort if it comes to having a better recovery.
In the moment of pushing out that baby, tearing really doesn’t seem like a determining factor of your actions because everything can seem so intense and you reach a point where you just want to get it over with. It’s everything that happens afterward that you are more likely to deal with, but haven’t thought about.
So it becomes YOUR CHOICE. It may not make a difference no matter how much you do. But it also can make a world of difference-there’s just no way to know for sure. It doesn’t hurt to try.
My Factors For Increased Success
There are, however, a few circumstances that have been shown to increase the odds towards success with perineal massage. Those include:
- if you’re never torn before
- if you haven’t had an episiotomy before
- if this is your first delivery
- if you’re over age 30
- being consistent with it
If you have scar tissue (like I do) ‘down there,’ your tissues are already naturally weakened. Scar tissue doesn’t have the same elasticity and ability to stretch like original tissue, it’s just physiology. The body does its best to repair damage. But some things are just never fully the same.
That DOES not mean that you can’t have benefits from doing perineal massage even if any of these characteristics apply to you.
I had level three tairs with both my first and second deliveries. I didn’t do perineal massage with either of them. But, they also were both posterior deliveries. So I can never know if having done perineal massage would have helped or not.
But this time around I have a midwife, and she STILL recommends doing the perineal massage, even if my chances of benefit are slimmer than most. It’s because I want a better recovery. If things end up the same this time around, I’ll know that I probably won’t need to try again. I just can’t know unless I try and seem how things work out.
When You Shouldn’t Do Perineal Massage
If you try and have increased pain beyond the expected ‘stretching’ feeling, stop and discuss with your practitioner if this is still a good option for you.
You also shouldn’t do so before your third trimester. Your body and belly is still growing significantly that the greater weight to bear hasn’t come to the surface yet. There’s kind of a magic line that you cross that isn’t very clear about how just feel overall. You’ll realize one day that your just big, it’s not really fun anymore, and the pressures added onto your pelvic area are closer to their peak level of sustaining.
Then it’s time to start perineal massage because your body isn’t going to change as dramatically as before. (Learn more about your trimesters and pregnancy weeks here.)
Also, don’t attempt this if you have any sort of vaginal infection-yeast or bacterial, it doesn’t matter. If you have itching, irritation, don’t even want to be penetrated because of how you feel, it’s not wise to do so in this case either.
How Do I Actually Do It?
Image courtesy of Pinterest
Okay, now we’re down to the nitty-gritty. You can do this yourself or have your husband do it for you. It may be too difficult for your to reach sometimes.
- Wash your hands and trim your nails. Dirty hands can just lead to an infection which you DON’T want. Longer nails can scrape and poke in places you find uncomfortable too.
- Use a personal lubricant. KY gel, vitamin E oil, your own vaginal lubricant, olive oil, stretch oil etc. DON’T use mineral oil, baby oil or petroleum jelly. (I use olive oil.)
- Make sure you’re comfortable. Sitting up, slightly reclined seems to work the best. Prop up your legs with knees bent so that you’re open-like the squatting position, just back in a chair.
- Massage with your thumbs…. (or just one if it’s easier)
- Insert them a few inches into your vaginal opening.
- Press evenly downward towards your rectum until you feel a slight burning and stinging pressure.
- Hold that stretching for a few minutes.
- Then pull down and out against the tissue on the sides of your vaginal opening, working your way down to your rectum, in half circular motions.
- Do for at least 10 minutes. Going for longer periods of time doesn’t necessarily better your odds. With most deliveries, when a baby is crowning and the peak of perineal stretching (ring of fire) happens, it doesn’t last that long.
- Be consistent. Then you can repeat daily or a few times a week as your comfortable with it. There’s nothing in the literature that supports which frequency of occurrence is best.
Here’s a few extra tips that may help even more:
- Be gentle. If you’re too rough and end up hurting yourself (which you’d probably have to try pretty hard to do), it won’t provide additional benefit.
- Use a mirror. Try propping up a mirror in front of you the first few times so you can see if your applying pressure to and stretching the right areas. Sometimes what we feel isn’t exactly what we think is happening.
- Watch TV. Ten minutes can seem like a long time. When you’ve got the hang of it, make time go by faster and more enjoyable by watching something. Prop up your iPAD or laptop in front of you and watch a 20 minute episode or something. It’s easier to track your time and relax. I usually watch Downton Abbey.
- Use it during labor. Although the motions aren’t exactly the same, your midwife will be able to support your perineum at certain labor stages and better enhance your chances of not tearing.
- Add essential oil to your lubricant. Helichrysum essential oil is believed to help your perineum function better during the stress and tension of childbirth.
Remember that every mother’s body is different-by race, skin type, tissue structure, healing abilities, etc.
Every baby is different for all of the same reasons-how they’re positioned, how they come out, their size, etc.
It’s impossible to know exactly how your perineum is going to handle your natural birth because of these variables. But if you’re eager to encourage the best circumstances possible to spare you months of additional pain in your body’s restoration, then implementing perineal massage is a positive factor for you.
>> Here Are The Essential Oils For Your Labor <<
Sometimes it’s just about the mindset too. If you’re choosing to do perineal massage, you’re likely choosing a number of natural things to also benefit your birth that all adds up together. And that’s worth it.
Have you done perineal massage?
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Vitaliy says
Sarah, you are one of the bravest women I know. You tackle subjects in this topic that most people wouldn’t dare. I know nothing about childbirth except the basics. How long did it take you to study all of this?
When my wife or girlfriend will be expecting, you better believe this will be the blog I visit!
Oh, Vitaliy, you’re one of my favorite people. 🙂
I sure didn’t learn all of this overnight, even during my first pregnancy alone. It’s been a long work in progress learning what I have. There are still tons of things I want to know more about and people tell me I should just plain be a doula or a midwife. Some gals think I AM a midwife.
Well, whenever you get that lucky lady to settle down (whomever she may dearly be), I would love to help you guys with whatever. Best!
Shivaram says
I read your article about perineal massage during baby birth. This is really a valuable article for pregnant mom’s and you have covered quite a valuable message which helps all the pregnant women to know more. As an information seeker, this has helped me in acquiring a new dimension of knowledge.
Thank You Shivaram. Let me know if you have any questions and feel free to share with others.
Hi Sarah,
I haven’t heard of Perineal massage before and I wish I have. Honestly, I had some tears during delivery and the fear of this makes the decision to have a second child harder.
What my doctor suggested was Kegel exercises, but I wasn’t very consistent doing them, so I couldn’t tell. I think consistency is key in everything.
I suggest you read some more on Kegel exercises if you haven’t yet.
Best wishes!
easy pregnancy exercises easy post and I do them daily while I drive to and from work.
If you do end up having more children, try perineal massage that time and see if it helps make a difference for you. A lot of the birth positions for trying to keep a baby NOT posterior during labor will help reduce the odds of tearing as well.
I’m doing and plan on doing a number of things with my third birth here soon that I didn’t the first two times, and it’s mainly to reduce tearing too. Feel free to subscribe so you can see if things worked for me.
The hard part is though, once you’ve torn, you’re more likely to tear again. But the odds are always in your favor when you prepare. Thanks Daniela!
Daniella says
Hi Sarah,
I love your content, it is so helpful for pregnant women and couples. To be honest I wish I could have read this article when I was pregnant of my two children , it would have be much easier for me. I remember that I took the epidural for my baby boy and the bladder cord was wrapped around his throat and things got complicated, so we had to get him out by vacuum.
I definitely think that give birth naturally is the best thing you can do for your baby and for the mom!
Thank you for this nice and informative blog
Things happen beyond our control and it’s never your mistake that those things do happen, like having the cord wrapped around baby’s head. With my first boy , we ended up using the vacuum too because he just hadn’t moved farther down in over an hour.
Thank you for visiting and feel free to share! Thanks Daniella.
Aiden says
Hey Sarah,
Not the article I was expecting to appear before my eyes haha but nonetheless eye opening.
I have 2 children and being a man I guess you don’t appreciate the flexibility of the vagina.
My kids mother got cut on her first child (not mine), the baby was stuck and out came the scalpel, perhaps if more women knew about this (and it worked 100% of the time) then a lot of women would suffer a lot less during pregnancy.
I’ve also heard that water births are good for relaxing down there?
There are a couple of different reasons why a baby is stuck or a mother tears, even after doing perineal massage, such as having a posterior baby , pushing too hard, and all about a mother’s positioning while her baby is descending down the birth canal.
Water births are excellent for helping deal with pain and increasing calmness and relaxation. There are so many factors in play, but keeping up with all the positive options builds a backbone of defense against a painful recovery .
Thanks for your comment, Aiden!
Cyril Almond says
Well i am a fella, so this is not really my field. But in my time of chiropody i often cared for the feet of pregnant women. i did notice that some of them recovered quicker than others. they would be pleased that they did. I used to get them to do some foot exercise. Like coming up on their toes. to get an arch back in their feet. One thing i like about your good site. Is that you have been there and worn the tee shirt. i would think that future mum”s would take notice of you. God Bless Cyril
Thanks for your comment, Cyril. I haven’t had trouble with my feet during my pregnancies, but I know some women do. You’ve inspired an idea for another post that may be helpful. God Bless you and yours as well.
Wendy says
I really love the idea of The Birth Relaxation Kit for women who are expecting. I used meditation and relaxation techniques when I had my kids. I think it is great that there is a kit created just for helping mom relax and there is also stuff for the partner as well.
That’s excellent that those things worked well for you Wendy. I know the Birth Relaxation Kit does wonders for many mothers. And yes, the fact that there are excellent helps in there for the birthing partner makes it tremendously useful from multiple angles.
If you’d like to share your birthing story you can do so on our Stories page. It really helps new mothers that are a bit anxious and uncertain about their decisions. We can help them know they’re not alone. Thanks!
Leo Emery says
Hi Sarah,
We don’t have children - yet. We figure if we can keep the dog alive first - then we can move on to kids someday - kidding - LOL
We are thinking about it. Big decision
But to me this makes kinda makes sense.
So if I have this right, doing this helps ease the birth and hopefully prevent tearing?
Great post I found out something new and I am definitely bookmarking this for future reference.
Cheers
Leo
Hi Leo. We were the same way, got a dog first for a few years and figured it would ‘break us in’ to taking care of another life form. 🙂
Yes, you understand correctly. Doing perineal massage has been shown to help a woman reduce the risk of tearing during childbirth. It’s no guarantee, but may be worth the effort. In the moment of birth, honestly, she can’t feel the tearing very distinctly amidst all of the other intense feelings going on. But it’s the aftermath of healing from it and dealing with the pain that is the hard part.
Let me know if that day comes for you and your loved one. I would be glad to help. Thanks for your comment.
Leo Emery says
Thank you, we’ll definitely take you up on that. We’ll probably need all the support and help we can get.
Cheers
I look forward to it, Leo. Have a great day!
simon says
Great website here my wife is currently pregnant,some of the tips you have listed in your content are really going to help her out,thankyou so much,i shall be bookmarking your site for her to return to at ease…
Great content…
Glad that I was able to help, Simon. Let her know I’m here for her. Best!
William says
In all my days I have never heard of this before I wish we heard of this when we were having our second child they took a pair of scissors and cut her that way, so she was pretty sore afterwards. I like the way you described all the steps to do and the additional tips.Would this perineal massage work for a very small woman on her first time?
Fortunately, episiotomy (cutting) is much more rare these days because tearing heals better.
Research shows that YES, perineal massage works better for first time mothers who have never given birth. Even if she is small framed, the benefit is still the same as well. Great question! Have a nice day William.
Ada says
Interesting read! And funny sometimes, for me…I admit I haven’t thought about this before! But I am all for natural birth, I hope to be able to do that when I’ll have my children, some day.
Great site! Keep it going!
You WILL be able to do it because it’s what you’re meant to do, Ada! Be sure to stop by when that days come. Best!
Theresa Widby-Rockett says
Wow, I have never heard of this before. My only child was born back in 1989 and this would have been great information to know. Any technique that has a possible chance of preventing tearing is worth the effort to learn and to practice before your child is born.
The great thing about this technique is it only takes ten minutes a day. Your husband or significant other might just think you are crazy, but the reward would be awesome. Many women, like me, never even consider tearing as something additional to recover from which is quite painful. When my daughter starts to think of having a baby, I will make sure she is aware of this information and this technique.
It IS painful to recover from Theresa, you’re absolutely right. It’s one of those things we don’t think about, especially alongside the other things we don’t expect after having just given birth.
Great to pass this along to your daughter. Every little bit helps. Thanks!