How To Do Perineal Massage!
Know you want to try this and just want to get started, but don’t know what lube to use?
Perineal massage—it’s one of those simple yet powerful tools to prepare for birth that can help ease your delivery experience. It might not be the first thing on your mind when you’re getting ready to meet your baby, but as you get closer to your due date, you might think… huh… is there something I am forgetting? Something I should be doing?
This gentle massage can be a game-changer for reducing the risk of tearing during birth. So let’s dive into this sometimes awkward tool to make your birth experience as smooth and empowering as possible.
What is Perineal Massage?
Perineal massage is a gentle massage technique that targets the perineum, the area between your vagina and anus. By stretching and massaging this tissue in the weeks leading up to birth, you can increase the flexibility and elasticity of the area. This helps prime the tissue for the stretching it will go through during childbirth, potentially reducing tearing.
Many people ask me about episiotomy- the evidence no longer supports the use of episiotomy so ask your privder about their rates!
Why Do Perineal Massage?
For many people, the idea of tearing during birth is a common concern. My advice is to go into birth EXPECTING to tear. 90% of first time birthers will have some type of tear.
Perineal massage IS NOT a guarantee that you won’t tear, but research DOES suggest that it can reduce the likelihood of severe tears, especially for first-time mothers. Benefits include:
Improved elasticity and flexibility of the perineal tissue, making it easier for baby’s head to pass through.
Increased awareness of sensation in the perineum, which can help you respond more effectively during birth- so you know where to push!
Potential reduction in postpartum discomfort if tearing is minimized or avoided.
When to Start Perineal Massage
You can begin perineal massage as early as 34-35 weeks, though starting around 36 weeks is also common. Aim to practice it 3-4 times a week, ideally for about 5-10 minutes per session. It’s a gentle reminder to your perineum- “Hello! You are going to have to stretch a LOT soon… so let’s practice!”
How to Do Perineal Massage
Here’s a simple guide to help you get started with perineal massage:
Get Comfortable: Find a quiet, private space where you can relax. You might want to sit on the edge of the bed or stand with one leg propped up. Some people prefer doing perineal massage in the shower or after a warm bath, as the warmth helps relax the muscles and tissues.
Prepare Your Hands and Tools: Wash your hands thoroughly, then apply a natural, unscented oil like this or this … or lube (I also like this one for return to penetrative sex after birth!) to your fingers. This will help reduce friction during the massage.
Locate the Perineum: Place your thumb(s) about 1-2 inches inside your vaginal opening. Press them gently downwards toward your rectum and to the sides until you feel a slight stretch or tingling sensation.
As a PT… I’m concerned about your body mechanics ALWAYS… so if this sucks for your shoulder, try having your partner do it. Even though it isn’t sexy… it’s something you can laugh about together. They would insert a finger and press down to stretch the perineum… you will communicate with them about your level of pain and you will BREATHE… maybe put on a meditation- if you want my perineal meditation just ask me for it!
Begin the Massage: Using a “U” motion, gently press downward and then outward in a sweeping motion, stretching the tissue. Hold each stretch for about 1-2 minutes, gradually increasing the pressure over time as it becomes comfortable.
Focus on Breathing: As you massage, take deep, slow breaths and inhale so deep that it allows your pelvic floor to descend and release. This can help you get used to the sensation of stretching, and the use of your breath as a tool… which will be beneficial during birth.
Tips for Making Perineal Massage Easier
Take it slow and be gentle: This shouldn’t feel painful. If it does, ease up on the pressure, breathe deeply, or stop for a moment and try again.
Partner support: Some people find it helpful to have a partner do the massage, read above under “3” if you might attempt that.
Don’t stress about it: Not everyone finds perineal massage easy or even doable, and that’s okay. If it’s uncomfortable or not something you want to continue, remember there are other ways to prepare for birth. Focus on what feels best for you.
Are There Alternatives to Perineal Massage?
Yes! If perineal massage isn’t for you, consider:
Pelvic floor exercises: Practicing relaxation as well as strengthening exercises (with FULL RANGE OF MOTION… you should NEVER be just doing kegels willy nilly without guidance!) can help prepare you for birth.
Warm compresses during labor: During the pushing phase, applying a warm compress to the perineum has been shown to help with tissue stretching and relaxation. You can always, always, always ALWAYS ask your provider to provide a warm compress… and you can put that in your birth plan!
Perineal Massage in Your Birth Plan
If reducing the risk of tearing is important to you, consider discussing it with your care provider and including it in your birth plan. Midwives and doulas can help apply warm compresses and gentle massage during delivery to ease perineal stretching as your baby crowns.
… What’s the bottom line?
Perineal massage is a gentle, proactive approach that may give you a bit more control and comfort as you head into the final stretch of your pregnancy journey. Remember, you’ve got options, and this is just one way to help prepare your body for the amazing work of birth. It is NOT required. Whether you try perineal massage or explore other ways to support your pelvic health, it’s all about finding what feels best for you.
Wishing you all the strength and ease on this beautiful journey toward meeting your baby!
Love,
Emily
