I have done a blog post previously on perineal trauma that can occur at birth, and made some suggestions on how to reduce this risk as much as possible in labour and when birthing your baby. This post is all about something that you can do during pregnancy in preparation for the birth of your baby, to reduce this risk even further. There are no secrets here, as it says on the tin, it involves massaging your perineum (the area between the vaginal opening and the anus). It is a good idea to start doing this regularly, a few times a week from around 34 weeks of pregnancy.
Perineal massage is an evidence-based way to significantly reduce your risk of sustaining a perineal tear that requires suturing, if you are having your first baby. Women who perform perineal massage are also less likely to have an episiotomy performed at birth. An episiotomy is a cut performed at birth between the vagina and the anus to increase the vaginal opening. It is not routinely performed in the UK, as research suggests it is better to allow this area to tear naturally. However, sometimes it is performed if there are signs that the baby is in distress and needs to be born as quickly as possible, or it is occasionally recommended to prevent a more severe tear occurring. An episiotomy is the equivalent of a second degree tear (a tear that involves the vaginal and/or perineal muscle, but none of the anal sphincter), and can be repaired by the midwife or doctor.
Performing the massage
Performing perineal massage does involve engaging with your body in an intimate way. For some people, this will be an unintimidating and relaxing exercise. For others, this may be the first time you have touched your body in this way. It can be a really empowering experience to get to know our bodies and develop an understanding of the sensations you are likely to feel during birth. Some people may choose to incorporate perineal massage into sexual touch, either on their own or with their partner. For others, they may feel more comfortable framing the massage as a non-sexual exercise. It is entirely up to you what you feel most comfortable with. The massage may feel a bit strange to start and take a bit of getting used to, but it should not be painful.
How to do it
- Wash your hands with soap and water and get comfortable. I suggest putting a towel down on your bed and lying down against some comfy cushions with your bottom half bare.
- Have some natural oil such as almond or olive oil to hand, or a lubricant of your choice.
- If doing the massage yourself you should use your thumb. Insert your thumb about 3-4cm inside your vagina. If you have a partner assisting you to perform the massage they should use two fingers.
- Apply firm pressure downwards with your thumb towards your anus. Massage the skin from side to side in a sweeping motion, whilst continuing to push downwards.
- You can also use two thumbs and sweep downwards and outwards. Imagine that your vaginal opening is a clock face. Your thumbs start at 6 o’clock, then stretch outwards and upwards towards 3, applying pressure.
Some clients have told me they found it quite tricky performing perineal massage on themselves during the later stages of pregnancy. Try not to worry if you are finding it a bit difficult to perform the massage 100% effectively. You cannot do it ‘wrong’ as such, it may just take a bit of practice and getting used to!
Thank you to the ever-wonderful Jasmine Hortop for the most amazing perineal gif known to WO-man! Check her work out here… www.jasminehortop.co.uk