Perineal massage is massaging of the pregnant mama’s pernineum (area around the opening of the vagina). Perineal massage is most effective at stretching the perineum to help mentally and physically prepare for labor in first time mamas. Often times perineal massage is recommended starting the last month of pregnancy and ideally starting earlier at week 34. Perineal massage is recommended 1-2 times per week for 5 minutes each time. As much as we all want to think that more is always better, research actually shows that 1-2x a week is the happy medium and there are no added benefits of doing it more frequently.

How To Perform Perineal Massage

First, talk to your provider to determine if it is safe for you to perform perineal massages. Some contraindications include rupture or leaking of membranes, spotting/recurrent vaginal bleeding and indications that the womb may not be structurally normal. Once you get the green light, decide if you want to perform the perineal massage or if you want your partner to help. Next, wash your hands and trim your fingernails!

Once you’re physically ready, find a comfortable position that allows you to reach your perineum. For some this is squatting on a chair with your knees spread or using a stool to support one leg while other fortunate people are able to reach simply by sitting propped up. The position doesn’t matter as long as you are comfortable. Next up, pick your lubricant of choice making sure you have enough but not too much (a rough guess is ~1 tsp but to each their own). Start by massaging the lubricant into your perineum and using your thumb and index or middle finger, insert your fingers into the vagina up to the first knuckle.

Once inserted, gently massage and stretch the vaginal walls apart (sides and towards the anus). You can press your fingers away from each other and hold the position while breathing and relaxing the muscles. Now, the goal of perineal massage is to GENTLY stretch the perineum so while there may be pressure, please do not go to the point of pain! To prepare for labor if there is pressure or discomfort, you can also practice breathing and progressive relaxation to help.

Benefits of Perineal Massage

Perineal massage prior to labor may reduce the likelihood of episiotomies and perineal trauma that requires stitching during childbirth. There were no differences in likelihood to have first, second, third or fourth degree perineal tears.

Perineal massage during the second stage of labor by a healthcare provider resulted in fewer mamas having third and fourth degree tears and more women with intact perineums.

For mamas who have birthed before, there was a significant reduction in pain at three months postpartum.

This one isn’t backed by research, but using perineal massage as a feedback tool can be a great way to help you connect and communicate when done with your partner. Often times the partners are overlooked during pregnancy and massage can be a great tool to help them feel connected and helpful to their partner.

Lubricants, Because They Ain’t All the Same

Lubricants serve a dual purpose as they make perineal massage more comfortable (hello, not stretching dry skin) and also hydrate the tissue. But not all lubricants are the same. Here are a couple of my go-to lubricants for all things perineal health:

1. Coconut oil - I prefer Skinny & Co. as their coconut oil is cold-processed and doesn’t lead to altering the vaginal flora like other highly processed coconut oils

2. Good Clean Love - organic, water-based lubricant that is free of petrochemicals, parabens, or glycerin

3. Desert Harvest - 100% all-natural aloe-based lubricant

Got questions? Don’t hesitate to reach out and ask! I hope you find this info helpful, and I can’t wait to hear from you!

References:

1. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3/full?highlightAbstract=withdrawn%7Cperineal%7Cperin%7Cmassage%7Cmassag&fbclid=IwAR1TbGsOxDXoqG8eaRMOsCM56v9mmDyD2YrI1wiHnaHvF_tbUAbcWoVz6m0

2. https://www.aafp.org/afp/2014/0301/p335.html

3. https://www.cochrane.org/CD006672/PREG_perineal-techniques-during-second-stage-labour-reducing-perineal-trauma

4. https://www.ncbi.nlm.nih.gov/pubmed?term=16437520

5. https://www.ncbi.nlm.nih.gov/pubmed/11368136