If you’re pregnant, you’ve probably heard of perineal massage. There’s loads of information out there on perineal massage and its effectiveness for reducing perineal damage or stitches during birth.

But does it really work? Here’s some information to help you decide if it’s for you. Rebecca Dekker at Evidence Based Birth has written a really clear, easy to follow summary of the current evidence around perineal massage. You can read it here. She concludes that perineal massage during pregnancy does reduce the risk of episiotomy (we’re not sure why), thereby reducing the risk of trauma and stitches for first-time mums.????????????????????????

Perineal massage for women who have already given birth at least once doesn’t seem to have the same benefits. But the studies did show that these mums had reduced chance of perineal pain at 3 months postpartum. As for how often we need to be doing perineal massage during pregnancy, researchers really haven’t reached a consensus. However it seems that even massaging twice a week does confer significant benefits for mums.

So what should you do? Well at Gentlebirth we’re all about ‘stacking the odds in your favour’, in other words using all the tools available to us. Perineal massage is one tool that that reduces your risk (if you’re a first time mum) of perineal injury. Other tools available to you are: spontaneous pushing, upright positions in labour (did you know that you’re 21% less likely to have an episiotomy if you give birth in an upright position? ), warm compresses on your perineum (this appeared to reduce the risk of 3rd and 4th degree tears in the research) Lastly, Aasheim in a 2011 Cochrane review, suggests that using breathing techniques may be important.

In our Gentlebirth workshops we tell our mums “when you get to that stage where you feel like – ‘I’ll just push the baby out and have it over and done with’, your Gentlebirth angel will be on your shoulder telling you “just breathe remember how you practiced.”

So how is it done?

1. Set the scene

You want to be able to relax into the stretch when the time comes, so by practicing in a relaxing, comfortable environment, you’re creating positive associations with that ‘stretchy’ feeling! Light candles, use your aromatherapy oils, run a bath and do your massage in the lovely warm water or put on your favourite music. You can even use your labour play list if you’ve created one. You may feel comfortable asking your partner to do the massage for you but if you don’t, that’s okay too!

2. Wash your hands

As I mentioned, the main risk with perineal massage is infection, but you can minimise this by washing your hand well before and after your massage and avoiding the urinary and anal openings during it.

3. Get out your oil!Aromatherapy

Aviva Romm, in her book ‘The Natural Pregnancy’ suggests using a plain vegetable oil, a mild massage oil or an oil that is specifically made for perineal massage. Mary Tighe (a fellow gentlebirth instructor) makes a lovely blend which she sells on her website. She has also kindly made her recipe available on the gentlebirth mums Facebook group.  Aviva Romm also includes some information on making your own oil and advice about what herbs you could include. Some mums use evening primrose oil but there isn’t any evidence that it improves outcomes. Some mums also take evening primrose capsules but again, there is no evidence that it improves outcomes for mums and babies and it is not recommended for use before the very late stages of pregnancy.

4. Get in the bath!

Or sit comfortably, supported by pillows if you need them, so that you can reach your perineum. Then you can insert your fingers (using your oil as a lubricant) about an inch into the vagina on either side.

5. Stretch

Move your fingers gently apart to allow a gradual stretch of the vaginal tissues. Keep that gentle stretch going until you feel a tingling sensation.

6. Try to relax

Slow down your breathing (particularly your out-breath) and picture your vagina opening slowly and easily to allow your baby to be born.

7.Hold the Stretch

You may find that if you continue to hold the stretch, the tingly sensation will reduce and the area may feel numb. This is normal. At this point, you can release your stretch.

8.Repeat

Do this several more times, focusing on allowing your body to relax completely as you hold the stretch. It should not feel painful but it may feel a little unusual!

???????????You can start your perineal massage at about 34 weeks and continue up to the day your baby arrives! And don’t forget, use all your tools to stack the odds in your favour for a calm, confident, gentle birth.

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