What is “perineal massage”
Perineal massage is a type of massage done to the muscles at the entrance to the vagina during the later stages of a pregnancy. It is done to try and prevent tears or the need for episiotomy during a vaginal delivery. The muscles at the entrance of the vagina are called the “superficial pelvic floor muscles” meaning that that are a little closer to the surface than the deeper pelvic floor. Just like anywhere else in the body, muscles tend to form layers, each muscle working closely with another muscle nearby, deeper or nearer the surface.
The superficial pelvic floor, works with the deeper pelvic floor when doing well known “pelvic floor exercises”. The superficial pelvic floor muscles extend from the area around the bladder outlet, the vagina and to the back passage. There are also bands of muscle that extend out towards the “sit bones”.
Over the years, there has been a gradual increase in studies showing that perineal massage before birth is beneficial, helping to prevent more severe tears, less need for episiotomy and less pain.
Why do perineal massage?
Perineal massage consists of massage to the lower half of the vaginal entrance with enough pressure to bring on a sense of stretch to the tissue. An analysis of studies in 2021 (Nupur et al 2021) concludes that those who do perineal massage in the third trimester reduce risk of 3rd and 4th degree tears by 16% and of episiotomy by 13%. Frequency varies according to studies but this review of 7 studies gave results from 2400 participants. Authors conclude that daily massage is more beneficial that a minimum of 3 times a week. Nevertheless, at 3 to 4 times a week, there are still benefits.
‘What are 3rd and 4th degree tears?
These are tears that extend from the vagina to the external anal sphincter (3a and 3b degree tears and to the internal anal sphincter (3c and 4th degree tears). These tears are referred to as “Obstetric Anal Sphincter Injury” or “OASI”.
The goal of all deliveries is to delivery your baby safely and also to prevent these Obstetric Anal Sphincter Injuries. These injuries tend to lead to more problems of incontinence later in life.
How to do the massage:
- Wash hands.
- Think of the vaginal entrance like a circle: the upper half (or front half) is towards the clitoris and the lower half (or back half) is towards the back passage.
- Whether doing the massage yourself or whether partner is doing the massage, insert one or two fingers 2 to 3 cms into the vaginal opening with a lubricant such as olive oil (a colourless pharmaceutical grade olive oil can be purchased in pharmacies or ordinary olive oil fine).
- Apply a sweeping downward pressure around the vaginal opening and/or hold a static pressure along the lower vaginal border and out to the sides.
- Apply enough pressure to feel a mild burning sensation to ensure the perineum is being stressed enough to make changes in the tissue.
- Massage for 5 to 10 minutes from 3 times a week to as much as daily with daily massage showing slightly more benefit than 3 times a week.
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