Perineal massage in pregnancy aims to help soften and increase the elasticity of the perineal tissue in preparation for birth 鈥� also helping you to become familiar with your body.听
The perineum is the area of tissue between the vagina and anus (back passage), consisting of skin and underlying muscles. During birth, the perineum lengthens and stretches to make room for your baby.听
Tears听to the vulva, vagina and perineum during birth are听common 鈥� and can range from small tears of the skin to those involving the muscles of the back passage. Around 9 out of 10 first time mothers will sustain some form of perineal tear听when birthing their baby, and of these,听around two thirds will require repair. Smaller tears are more common than larger ones 鈥� most heal well and do not cause long term problems.听
Tears听to the perineum, in the majority of cases,听cannot be prevented.听However听efforts can be made to听minimise听them听鈥撎� and听perineal massage can help.听
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What听are the benefits of perineal massage?听听
Research has shown that those who practice perineal massage were less likely to:听
- Sustain a tear that requires stitches听
- Require a cut (Episiotomy) at the time of birth听
- Sustain a tear听that extends to the back passage听
- Report ongoing perineal pain at 3 months following birth听听
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Evidence is clearer on these benefits for those giving birth vaginally for the first time. No difference听has been shown in the likelihood of instrumental delivery or sexual satisfaction as a result of perineal massage.听
Some people are not familiar or comfortable with touching their bodies in this way听鈥� and that鈥檚 ok.听听
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Other supportive strategies to reduce the likelihood of severe perineal tears include:听
- Application of a warm compress against the perineum听(by the midwife)听during delivery听
- Birthing in an all听fours, kneeling or side-lying position where possible听
- Controlled delivery of your baby through communication with your听midwife/obstetrician and perineal support at the time of birth听
Your preferences can be discussed with your midwife in pregnancy and in labour.听
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How is perineal massage performed?听听
Massage can be performed from 35 weeks of pregnancy 鈥撎齛 frequency of听around 3-4 times per week has been shown to provide the most benefit. It can feel uncomfortable to begin with but should be stopped if you feel pain.听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听
To begin:听
Make yourself comfortable 鈥� you may wish to sit propped up with pillows for support, on the sofa or your bed.听听
Use an unscented oil e.g. olive oil or sweet almond oil. Water based lubricants such as K-Y Jelly are also suitable.听听
If you are massaging听alone听you may wish to use a mirror. Your partner can also perform the massage for you if you are both comfortable with this.听
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1)听Wash your hands and ensure听finger nails听are trimmed 鈥� a warm bath can help relax you and your muscles.听
2) Place lubricated thumbs (or fingers) into the vagina, pressing downwards towards the anus and outwards into the vaginal walls. Apply sustained pressure, enough to feel a stretching sensation for around 1 minute. Remember to breathe and relax your pelvic floor muscles.听
3) Moving in an upwards and outwards movement, now gently massage the perineum in a rhythmic 鈥淯鈥� shape for up to 3 minutes.听听
This can be repeated 2-3 times, with a single massage session lasting up to 10 minutes. Listen to your body and avoid continuing through pain.听听
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Please note there is a lack of evidence for pelvic floor training devices and as such we are unable to recommend their use for perineal protection.
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Maternity single point of access: 01423 557531
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Further resources, including information on pelvic floor muscle exercises, postpartum wound healing and useful images:听听
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Evidence used to support the production of this information:听听
Beckmann M. M., and Stock O, M (2013) Antenatal perineal massage for reducing perineal trauma.听Cochrane Database of Systematic Reviews听2013(4), CD005123. Available at:听.听
Abdelhakim, A. M., Eldesouky, E.,听Elmagd, I. A., Mohammed, A., Farag, E. A., Mohammed, A. E., Hamam, K. M., Hussein, A. S., Ali, A. S.,听Keshta, N. H. A., Hamza, M., Samy, A., and Abdel-Latif, A. A. (2020) Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.听International听urogynecology听journal,听31(9), pp. 1735鈥�1745. Available at:听听