What are the Benefits of Perineal Massage during Pregnancy?

The perineum is the area of tissue between your vagina and your anus (back passage). Externally it is the area between the vulva and anus the “bridge of muscle” between the two. However, we are 3 dimensional so internally it extends up the depth of your vaginal canal to your anus. It connects with your pelvic floor muscles, which support your pelvic organs including your bowel.

During birth, the perineum stretches to make room for the baby. Most women (approximately 85%) will sustain a small tear during a vaginal delivery of a baby and approx 1 in 6 will have an episiotomy.

An episiotomy is a surgical cut to the perineum and posterior vaginal wall which is performed by your midwife or obstetrician. This helps widen the canal for the baby to pass through and aims to help prevent what could be a more severe tear.

What are the benefits of perineal massage?

There is evidence to say that a perineal massage softens and stretches the pelvic floor muscles between the vaginal opening and anus to help prevent the risk of tears in vaginal deliveries. 

“Perineal massage during the last month of pregnancy has been suggested as a possible way of enabling the perineal tissue to expand more easily during birth. The review of four trials (2,497 women) showed that perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain. The impact was clear for women who had not given birth vaginally before but was less clear for women who had. Women should be informed about the benefits of digital antenatal perineal massage. “

(Antenatal perineal massage for reducing perineal trauma - Cochrane Review - Beckmann MM, Stock 2013) 

When can I start and how often should I do it?

You should start a perineal massage from when you are 34 weeks pregnant until the birth. Frequency is individual, as it depends on how you respond to it and it also needs to fit into your lifestyle. It should not feel like something that is stressful or a chore (we have enough to worry about!) but it is good to make time for it as often as you can. Most advice recommends daily for approximately 10 minutes or just do it alternate days as you can. 

Preparation for perineal massage: 

Consider your 5 senses to try to help calm your nervous system and reduce anxiety, stress, and tension that you may be holding in the area. 

• Find a comfortable place to do a perineal massage where you will be undisturbed for 15 minutes. 
• Consider having a relaxing bath beforehand or use a warm wheat bag or hot water bottle (not too hot) and place it on the area for 5 minutes before. After a warm bath is also good as the blood vessels in the area are dilated and the perineum may feel softer and more comfortable to touch.
• This is not essential but can really help calm your nervous system - consider lighting candles and have a relaxing pregnancy-safe scent and music that calms you. 
• Get comfortable – I would recommend lying down with the trunk propped up with pillows. If doing it yourself, use a footstool to give you a better angle. 
• Wash your hands and ensure that your fingernails are trimmed to prevent scratching yourself.
• Use an unscented oil e.g., olive oil or sweet almond oil. Alternatively, you can use a water-based lubricant such as YES WB lubrication. 
• If you are doing the massage alone, you may wish to use a mirror to help to see what you are doing. Alternatively, if you are both comfortable with the idea, you may wish to ask your partner to massage you. 

If you are massaging alone, cannot reach, or feel more comfortable using a device other than your fingers, a device such as the Perimom can be helpful. It comes with instructions you can follow.

How to perform perineal Massage:

You may feel some stretching sensations and tender spots during the massage, but this should not be painful. Stop if you experience pain. Be aware your pelvic floor area is likely to be more sensitive than other areas so reduce the pressure and stretch accordingly if you are nervous start away from the area by massaging your inner thighs, legs, tummy and slowly work your way to the more sensitive area. (Avoid the clitoris during the 10-minute perineum massage). 

• Lubricate your thumbs or fingers with your chosen oil/lubricant and insert 2-3 centimetres inside the vagina. 
• Imagine your perineum is part of a clock face 12 o'clock points up towards your clitoris, 3 o'clock being towards your left leg, 6 o'clock your rectum and 9 o'clock your right leg.
• Press your thumbs/fingers gently down between 3-6-9 o’clock. Then move the thumbs or fingers in an upwards and outwards movement; in a rhythmic “U” shaped movement. 
• Try to relax the pelvic floor muscles as much as possible during the massage. This will allow the perineum to stretch more. Use slow deep breaths to help check you're not holding your breath and breathe out slowly if you are.
• The massage can last as long as you wish but try and aim for around five to ten minutes each time. 

When should I not do a perineum massage? 

Perineal Massage should be avoided in the following cases:

If you are in a high-risk pregnancy group
If you have preterm contractions
If you have been diagnosed as being at risk for preterm labour
If you have placenta previa
If you have an active herpes outbreak or other vaginal or sexually transmitted diseases
If you have vaginal bleeding
If you have a risk of placental abruption
If you are pregnant with multiple foetuses when the lower one is in breech presentation.

If in doubt, please contact your midwife or healthcare professional for advice. This article is for informational purposes only and should not be a replacement for individualised medical assessment and care.