The Truth About Perineal Massage

At some point during my first pregnancy, I read about perineal massage. What I remember reading was something like ‘Get out the olive oil and massage with firm and increasing pressure. Or, try dimming the lights and ask your partner to do it.  Who knows where it will lead!’  I can tell you that it led to nowhere nearly as exciting as that exclamation mark would have you believe.

What is it?

Perineal massage, if you’re unfamiliar with the idea, is the gentle stretching of the tissues between the vagina and the anus in the last weeks of pregnancy. The idea is that this will condition and prep the tissues reducing the chances of trauma to the area during birth.  Scroll down for the complete ‘how-to.’

What does the evidence say?

Clients often ask me if they should be doing perineal massage and if it is beneficial. Anecdotally, it certainly seems to be a great idea. Women report that there was less burning during crowning (when your baby’s head stays visible without going back inside). Up until quite recently, however, the clinical research was inconclusive. There is a bit more evidence in its favour now but the studies aren’t big and the conclusions are a bit soft – they say that perineal massage is probably a little bit helpful to some women expecting their first baby and found that women who practiced perineal massage were less likely to have an episiotomy. It also says that women who massaged reported less pain in the few months postpartum.

What else might help?

If you have a midwife, the chances of you getting an episiotomy are already significantly lower than if you have an OB.  Midwives are generally quite patient when it comes to allowing the tissues to stretch gradually and allowing your baby’s head to proceed slowly (yes, I wear my bias on my sleeve). Additionally, there are a few things that can de done during birth to reduce the risk of trauma to your perineum, things that were not done in the studies about perineal massage such as holding a warm, damp cloth up against your perineum as it stretches and applying gentle counter pressure. If you are considering a water birth, you get both of these things hands-free and your chance of tearing drops right down.

So, should you do it?

Here’s my two cents:  There is no harm in doing it (presuming you have checked with your midwife or doctor and they have not said there is a reason you shouldn’t do it). There is a chance it will help prep your tissues for the big day.  There is no guarantee it will.  

The way I see it, the greatest value of regular perineal massage is the opportunity it gives you to practice relaxing your body during uncomfortable and new sensations (see the last point in the how-to below). The other upside is that it might help you feel you are doing something in those last weeks as you wait.

All that said, if you don’t want to do it, or if you want to do it but keep forgetting. or you’re just too tired, don’t sweat it.  You go ahead and spend your pants-free time without guilt or worry and doing whatever you want.

Here’s the how-to:  

Before doing this, check with your health care provider to make sure there isn’t a reason you should not be doing perineal massage. If you get the go-ahead, here’s what you do.

• Pick your lubricant – any edible oil should do the trick. Try olive oil, jojoba oil, coconut oil, vitamin E.  You can also use a water-soluble lubricant like KY Jelly.
• Make sure your hands (or your partner’s) are clean, nails trimmed.
• Sit back in a slight recline position on a towel (that oil gets messy). (aside: my favourite set of instructions were the ones that thought it necessary to say you should set yourself up somewhere private.)
• Put a bit of oil on your perineum and your fingers and thumbs.  If you’re doing it yourself, you might find it easiest to use your thumbs. If your partner is doing it, he or she can use index fingers.  
• Start with one thumb or finger and insert into your vagina about 3-4 cm.  Next, press gently and firmly down towards your rectum (sort of a down and out motion). Hold in that position until you feel a slight stinging or tingling. It shouldn’t burn, though. This might take around two minutes.  And it feels even longer than two microwave minutes.
• Now, here’s the part where you really have to humour me. While this is going on, practice relaxing your body.  Your whole body from your face, to your shoulders and arms, and down. Make yourself soft everywhere.
• If you think of your vagina as a clock (who doesn’t?) and pushing straight down is 6 o’clock, move your finger/thumb back and forth from 4 o’clock to 8 o’clock while maintaining some pressure.
• Ok, now try the same thing with two fingers/thumbs. Once you get to the tingling part, move your fingers in opposite direction between 4 o’clock and 8 o’clock.  Gradually increase the pressure as you get used to the stinging sensation.

Advice varies between doing perineal massage 3-6 times a week, 5-10 minutes at a time, from about 34 weeks onward.

About Kama Lee Jackson, B. J., BHSc. (midwifery)

After earning her BA of Health Sciences degree as a midwife, Kama turned in her pager and launched Bloom, her passion project. While teaching prenatal classes at Riverdale Community Midwives, she found women were feeling unsure about themselves, the ‘system’, the birth process, and life with a baby. She is changing that for her clients and helping them to believe in their own strength.