Perineal massage: Your how-to guide
Q: I have heard that I should be doing perineal massage each day in the weeks before giving birth to help avoid an episiotomy. Please tell me if this is helpful and if so, how it is done.
A: There are several methods for doing perineal massage. Two are given here.
First of all, wash your hands. Then find a private place and sit or lean back in a comfortable position. Put a lubricant such as KY jelly, cocoa butter, olive oil, vitamin E oil or pure vegetable oil on your thumbs and around the perineum.
Place your thumbs about 1 to 11/2 inches (three to four centimeters) inside your vagina. Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation. With your thumbs, hold the pressure steady for about two minutes or until the area becomes a little numb and you don't feel the tingling as much.
As you keep pressing with your thumbs, slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Keep this up for three to four minutes. Remember to avoid the urinary opening.
As you massage, pull gently outward (and forward) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin much in the same way that the baby's head will stretch it during birth.
Do this massage once or twice per day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility and stretchiness.
Several research studies have shown this technique to be helpful in preventing lacerations and episiotomy. In 1999, there was an article in the American Journal of Ob/Gyn by Labrecque that evaluated the effectiveness of perineal massage during pregnancy for the prevention of perineal trauma at birth. Women in the experimental groups were requested to perform a 10 minute perineal massage daily from the 34th or 35th week of pregnancy until delivery. The massage consisted of introducing one or two fingers three to four centimeters into the vagina and applying and maintaining pressure -- first downward for two minutes and then for two minutes to each side of the vaginal entrance. Women were given a bottle of sweet almond oil (Rougier Inc., Montreal, Quebec, Canada) to use for lubrication.
Among participants without a previous vaginal birth, 24.3 percent (100/411) from the perineal massage group and 15.1 percent (63/417) from the control group were delivered vaginally with an intact perineum, for a 9.2 percent absolute difference. The incidence of delivery with an intact perineum increased with compliance with regular practice of perineal massage.
Among women with a previous vaginal birth, 34.9 percent (82/235) and 32.4 percent (78/241) in the massage and control groups, respectively, were delivered with an intact perineum, for an absolute difference of 2.5 percent. There were no differences between the groups in the frequency of sutured vulvar and vaginal tears, women's sense of control and satisfaction with the delivery experience.
The authors concluded that perineal massage is an effective approach to increasing the chance of delivery with an intact perineum for women with a first vaginal delivery, but not for women with a previous vaginal birth.
Slow controlled delivery is the key to an intact perineum and reduced incidence of laceration. The baby must not suffer any form of fetal distress and the mother and partner must listen closely to the midwife or health care provider for advice on when to push and when to stop pushing. The extra advantage of performing perineal massage may allow the mother to give birth without an episiotomy or laceration.
