Birth Preparation Exercise

Perineal Massage

Perineal massage is the gentle stretching and massaging of the perineum (skin between the anus and vagina) during the last few weeks of pregnancy. This has been shown to reduce the incidence of episiotomy and perineal tears requiring suturing during childbirth.

However, in one study women who performed 10 minutes of perineal massage daily had a higher incidence of second degree tears, though this difference was not significant. By three months post partum there was no difference between women who used perinal massage and those who did not.

Research outcomes disagree on the effectiveness of perineal massage used during childbirth. Other factors that more consistenetly predict an intact perineum are pushing position during labor, pushing efforts and prolonged second stage. However, if nothing else, perineal massage does seem to reduce the rate of episiotomy (perhaps because the practitioner is busy doing massage?) even if it does not consistently reduce the rate of perineal trauma.

Perineal massage does not "lengthen" the tissues of the perineum. It is believed to increase the stretch in two ways. First, perineal massage is done with a cold pressed oil, which lubricates the tissue making it softer, more supple and improving its flexibility. This makes it easier for the tissues to stretch as the baby is born. Second, perineal massage familiarizes the mother with the stretching sensations she will feel as the baby is born. This helps her learn to keep her perineal area relaxed during the stretching of crowning. Keeping the perineal area relaxed may help prevent tears.

For this exercise, you will try perineal massage. Commit to practicing three or four times over the next week before you decide if this will be part of your birth preparations.

How to do it:

Perineal massage can be done by the mother or her partner. The mother should be in a comfortable place, sitting or reclining in a way that gives access to the skin around the vagina. It can be done for up to 10 minutes a day during the last four weeks of pregnancy. In the systematic review, perineal massage began at 34 weeks and was performed for 4 mintues 3 to 4 times per week, or once daily for 10 minutes (it is possible that women who perform this more frequently have a larger reduction in pain).

Wash hands thoroughly. Ensure there are no sharp or long nails that may scratch the mother.

Locate the perineum, directly below the vagina. It is the skin between the vagina and the anus. Apply some cold pressed and pure oil (such as olive oil) to this skin.

Place the thumbs at the base of the vagina, allowing them the slide inside the vagina (to about the first joint) moving some oil with them. Using gentle but firm pressure, move the thumbs from the base of the vagina up the side walls as if you were making a "U". Return the thumbs to the base of the vagina, and repeat procedure.Alternately, you could insert 1 or 2 fingers about 5 cm into the vagina and sweep from side to side.

As the mother becomes more comfortable with the stretch, you may increase the amount you stretch the skin.

References

Dame, J. and Neher, J. (2008). Does antepartum perineal massage reduce intrapartum lacerations? The Journal of Family Practice, 57(7): 480-481.

Geranmayeh, M., Habibabadi, Z.R., Fallahkish, B., Farahani, M.A., Khakbazan, Z., and Mehran, A. (2012). Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Archives of Gynecology and Obstetrics, 285(1): 77-81.

Karacam, Z., Ekem, H., and Calisir, H. (2012). The Use of Perineal Massage in the Second Stage of Labor and Follow-Up of Postpartum Perineal Outcomes. Health Care for Women International, 33(8): 697-718.

Mei-dan, E, Walfisch, A., Raz, I., Levy, A., and Hallak, M. (2008). Perineal Massage during Pregnancy: A Prospective Controlled Trial. Isreal Medical Association Journal, 10(7): 499-502.