When we talk about Perineal massage it always evokes a range of reactions! Some people want to know every detail whilst some are totally shell shocked. Below are some of the comments I have had recently, hopefully we can chat through some of these topics now. So, grab a cuppa and let’s talk all about the perineum...
However you feel about perineal massage it is important to trust your own beliefs and emotions prior to starting the technique. It is not going to be something that’s for everyone. It’s important you understand the technique and the benefits and then you can make a choice that’s right for you.
“I will do ANYTHING to limit the chance of me tearing!”
“I just don't like the thought of
touching down there!”
“I have never even looked down there”
“My husband will do it for me”
“I will never let my husband do that!!!!”
“I don't know where I am meant to be pressing!?!?”
What is Perineal Massage?
Perineal Massage is a technique to stretch the perineum to prepare it for the stretch it undergoes during labour and birth. The Perineum is the area of skin between the vagina and the anus and is the part that may tear or be cut (episiotomy) during labour. The idea is that slowly stretching this area before we give birth may prevent trauma of the perineum.
Benefits
1) Perineal stretches when done regularly can help to gradually stretch the skin and pelvic floor muscles in preparation for the stretch of the perineum during birth.
2) Many ladies have never looked, felt – or even know where the perineum is. By having the opportunity to regularly look and feel the area it can help improve your body awareness and giving you time to get acquainted with the area for birthing.
3) Having the opportunity to regularly feel what a perineal stretch feels like will give you some experience to draw upon during labour. Having better awareness – or proprioception as we call it – may make it easier for you to allow the pelvic floor to stretch and relax during pregnancy. Most pelvic floors tighten up and clench in moments of stress and pain so it’s useful to practice your breathing techniques with this stretch applied in a controlled environment prior to labour.
Risks
It is best to get advice from your midwife and/or consultant if you are a high risk pregnancy – for example…
Vaginal Bleeding
History of preterm birth
Incompetent cervix
Active infection
Vaginal thrush
Urinary tract infection
Genital herpes
The Evidence
A Cochrane review of four trials (2497 women) showed that perineal massage undertaken by the woman or her partner was associated with an overall reduction perineal stitches and episiotomy.
These findings were significant for women who had given birth vaginally before but was less clear for those who had. There was unfortunately no statistical difference when looking at the incidence of third and fourth degree tears. (Beckmann, Stock 2013)
How do you do it?
When to start
From 34/35 weeks pregnant – the advice is to do it regularly, every other day if you can manage it
First Step - Getting Familiar.
This tends to be easier for people that are familiar with looking and feeling around the perineum and vagina. If you are not comfortable with this then I would recommend just starting with getting a mirror and making yourself familiar with your anatomy.Try and find the perineum, vagina, urethra and clitoris. Some ladies prefer to feel around in the bath.Try and explore what you are comfortable with and what makes you feel less uncomfortable.Does any aspect make you feel anxious? Do you think it would also make you feel anxious during the labour?If so speak up- and chat it through with your physio/midwife/consultant before the birth.
Once you are comfortable … Starting the Stretch
Wash you hands well and make sure you have short fingernails.
Relax somewhere where your feel private and comfortable.
Sit with your knee bent up, some ladies squat against a wall, or some ladies will sit on the toilet or stand and put one leg up on the bath or toilet. You may even want to start doing the exercises in the bath or shower. Whatever works for you – and be aware it might take a few tries to work out the best position with an ever growing bump!
If you are stretching on “dry land” Having a hot bath or shower before will help soften the tissues, if not you could always try a hot compress before.
Lubricate your thumbs ( we always recommend Yes, Sylk or Replens)
If you are going to do it yourself use your thumb ( if a partner is doing this for you they can use their finger).
Put your thumb 3-4 cm into the vagina. Press down towards the anus.
Hold for about 1-2 minutes until you feel a slight stretching burning sensation, similar (although less intense) to the sensation of a crowning baby’s head.
Practice some deep breaths whilst feeling the stretch or burning sensation .
Repeat this process but pressing more to each side of the vagina.
Using your thumbs, slowly massage the lower half of your vagina using a U- shaped movement (from 3 o’clock to 9 o’clock). This should not be painful.
Massage the perineal area slowly for up to 10 minutes .
You can also do gentle massage on old scar tissue, episiotomy scars or perineal tears. In fact it works really well.
If you feel you pelvic floor is tightening against your thumb. Real focus on you breathing, breath in through your nose, and as you feel out through your mouth try to count to 3/4/5 or 6 if you can imagine it – and try and imagine your pelvic floor melting away from your finger.
Be Kind to Yourself
Its unlikely to go perfectly well the first time, you may not be able to find a comfortable position, your thumb might get sore, you may just feel as if you pelvic floor is tightening, you may feel embarrassed or some ladies have even felt like it feels “disgusting”.
My advice would be – stick with it. Try little bits at a time and speak to someone. If you really don’t feel comfortable then don’t worry - there are lots of other bits of advice to avoid tearing so speak up.
Please do email Gemma@specialisedphysiotherapy.com for any advice or to talk further :) or any comments on things that worked for you I would love to hear from you!