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What if I told you that you could reduce your risk of vaginal tearing during delivery in 5 minutes a day during the weeks leading up to birth? It sounds too good to be true, but research has shown that it is true, indeed!
According to recent research, most vaginal births are associated with trauma to the perineum. In fact, 4 to 8 out of every 10 births result in a vaginal tear, with roughly 2/3 of women who tear requiring stitches. It doesn’t have to be this way.
[This article has been medically reviewed by Merci Treaster, PT, DPT, and owner of The Pelvis Pro. Find her on Instagram @thepelvispro.]
The good news is that research proves that perineal massage reduces the risk of perineal trauma, as well as ongoing pain after delivery.
So why aren’t most expecting moms doing perineal massage? For most, the answer is simple: they don’t know how to do it or about its benefits!
We’re here to solve that problem, mama.
We have answers to all your questions, plus a step-by-step guide, diagrams, charts, recommended oils, and even a forthcoming video to give you all the details you need about how to do perineal massage!
What is Perineal Massage?
In women, the perineum is the section of skin located between the vaginal opening and the anus. It’s a sensitive, erogenous area, and it’s connected to muscles that play an important role in daily life. It plays an especially important role in childbirth.
Why does the perineum tear during labor?
Vaginal tearing is common during childbirth and can occur in 4 different degrees of severity.
According to the Mayo Clinic, “Vaginal tears during childbirth, also called perineal lacerations or tears, occur when the baby’s head is coming through the vaginal opening and is either too large for the vagina to stretch around or the head is a normal size but the vagina doesn’t stretch easily.”
Historically, an episiotomy, in which a doctor cuts the perineum to assist in labor, was used to prevent tearing. This practice has become less common as research now shows that episiotomies don’t prevent tearing or improve healing.
How does perineal massage help prevent tearing?
The goal of perineal massage is to slowly and gently stretch the tissue around your vaginal opening so it will be more elastic when it’s time to push out your baby.
The American Pregnancy Association says we can lessen our risk of vaginal tearing during labor and delivery by practicing perineal massage during the last 3-4 weeks of pregnancy.
This is a sponsored article on behalf of Fairhaven Health, meaning I have been compensated for this article. All the content included is my honest opinion and has been medically reviewed for accuracy. I only work with brands and recommend products I personally use and love.
Perineal stretching and perineal massage are the same thing, referring to the stretching of the tissue and muscles in your perineum. Careful perineal stretching during the last 3-4 weeks of pregnancy can decrease your risk of severe tearing during labor, according to the American Pregnancy Association.
How to do Perineal Massage
So you’re convinced it’s worth the 5 minutes a day to reduce your risk of tearing, but the logistics of how to do perineal massage seem confusing? Good news, friend! It sounds a bit intimidating, but perineal massage is actually VERY simple.
Seriously, take 5 minutes to learn what to do. It’s worth it. We’ll give you a step-by-step guide below.
When to start Perineal Massage
Most practitioners recommend beginning perineal massage 3-4 weeks before baby is expected to arrive.
Dr. Peter Rizk, MD, MA, FRCOG, FRCS, HCLD, FACOG, FACS (so many letters!) is Professor and the Head of Reproductive Endocrinology & Infertility at the University of South Alabama is a medical advisor for Fairhaven Health, who makes the best perineal massage lubricant on the market–but more on that later.
“I encourage my patients to do perineal massage starting at 34 weeks of pregnancy.”Peter Rizk, MD, MA, FRCOG, FRCS, HCLD, FACOG, FACS
This allows our bodies ample time to gear up for labor, even if it happens early.
What to use for Perineal Massage
When getting ready to perform perineal massage, you’ll just need a few simple things:
- BabyIt Perineal Massage Gel
- Clean hands or sanitary gloves
- If you have trouble reaching with your hands, you can also use a pelvic wand (we love the one from Intimate Rose) or the Peri Mom perineal massager
Yep. That’s all! I told you this was simple, right?
Who can do Perineal Massage?
Perineal massage can be performed by a partner for ease of access, but that’s not actually necessary.
I often hear moms say they’re uncomfortable asking their partners to help perform perineal massage. If this is you, no worries–you can actually do it yourself!
We’ll give you instructions for doing it both ways: alone, or with help from a partner.
And of course, you don’t have to do it the same way each time! You could perform perineal massage yourself some days, or have your partner help when they’re available.
Can I use Coconut Oil as Perineal Massage Oil?
If you spend much time hanging out on pregnancy forums, you might see recommendations to use coconut oil, or even olive oil, vegetable oil, almond oil, or sexual lubricants. The claim most moms make is that there’s no reason to pay for a specific perineal massage product when you could use a household product that does the exact same thing.
What we want these moms to know is that these common household products don’t actually perform the same function, and they pose risks that a perineal massage gel does not.
The most obvious risk is irritation, which no one wants to deal with around their vagina, especially with childbirth on the close horizon. Many of these oils contain free radicals, which increase the risk of inflammation and irritation.
Also, using these common oils has been shown to increase the risk of vaginal infection. Clinical studies have also found that some of the recommended oils, such as almond oil, can increase the risk for preterm labor. So, let’s steer clear of that, k?
So what should you use?
We recommend BabyIt Perineal Massage Gel by Fairhaven Health. It’s the first product designed specifically for perineal massage, and it takes all of mama’s vaginal healthcare concerns into consideration. And, it’s paraben-free and free of other harsh preservatives.
It’s also isotonic, meaning its salt concentration matches the salt levels of the cells in your perineum. This is why it’s a better choice than sexual lubricants, which are hypertonic and can irritate or damage the perineum.
In short, BabyIt provides the mild, balanced hydration your perineum needs and deserves.
Breathing during Perineal Massage
Just like when you’re exercising, being careful with your breath is important during perineal massage.
According to Merci Treaster, PT, DPT, and owner of The Pelvis Pro, it’s important to breathe deeply during perineal massage, taking full, 360-degree diaphragmatic breaths.
To practice these breaths, sit up straight and take a slow, deep breath, pulling the air deep into your diaphragm. For a 360-degree breath, you want to feel expansion in your belly, sides, and back, as you breathe in, and softening as you breathe out.
According to Treaster, when breathing properly, your pelvic floor will naturally lengthen on inhale and shorten on exhale. Think about lengthening your pelvic floor with each inhale to help prepare your perineum for stretching.
Step-By-Step: How to do a Perineal Massage
Now that you’re prepped and ready, here’s what you need to do, including perineal massage diagrams to guide you easily through the process.
1. Clean hands or put on sanitary gloves
So this one is an absolute no-brainer. Wash your hands, or better yet, wash your hands AND wear gloves. You don’t want any bad bacteria anywhere near your vagina.
2. Find your preferred position
I often hear expecting moms ask, “How am I supposed to reach to do this myself?!” But I promise it’s possible!
There are 3 positions most moms prefer for comfortably performing perineal massage by themselves. You can also ask your partner to perform the massage for you.
Standing with 1 Leg Raised
Most moms perform this position in the shower using either a shower stool or bench.
Stand flat on one foot while raising the opposite leg onto a higher surface. Then, reach behind your back to easily reach your perineum.
Most moms use this position in bed, lying at a gentle recline propped on bed pillows.
Using a support underneath you for stability and safety, squat with your legs against the wall or in a high-backed chair. Please be sure you’re well supported.
Sit carefully on your sitz bones with a straight back. Carefully widen your legs, and reach around the underside of your belly to access your perineum.
Reclined with Partner Support
Sit on the bed and gently recline onto propped pillows or a raised bed. Ask your partner to sit across from you.
Once comfortably reclined, bend your knees gently. Your partner can sit across from you, facing you, and also with bent knees. This position should allow your partner comfortable access to your perineum.
3. Lubricate your fingers with BabyIt Perineal Massage Gel
4. Using lubricated fingers from both hands, place the forefinger or thumb (whichever is most comfortable) about 1 inch into each side of your vaginal opening. where the muscles form a tight, U-shaped rim.
Your goal is to make this firm tissue stretchier before childbirth. By improving muscular flexibility, you’ll decrease resistance in your perineum during labor.
Pro Tip: Be careful not to clench your pelvic floor during perineal massage. If your core is firing, so is your pelvic floor, so breathe and relax both. Take deep, 360-degree diaphragmatic breaths as you slowly massage.
5. Slowly massage from the sides to the back of your vaginal canal, near your rectum, and then back to the sides. Repeat.
Your goal is to stretch and widen the U-shaped rim at the back of your vaginal canal.
6. Massage slowly for 4 to 5 minutes.
Pro Tip: If you feel an overwhelming burning sensation, decrease the intensity of your massage. If you feel a slight burning sensation, you’re doing it right!
7. Repeat daily.
Why should Perineal Massage cause slight burning?
The biggest pushback we hear regarding perineal massage is that it isn’t a relaxing massage in the way we generally think of massage.
If performed properly, perineal massage is mildly uncomfortable.
The goal of perineal massage is twofold–to improve the elasticity of your perineal muscles to easily stretch during labor, and to prepare your body for the burning sensation that will occur during the transition stage of labor.
Not to be cliche, but mama–feel the burn! It’s a tremendously important part of this process.
By learning to relax and breathe through the burning sensation before labor, you will decrease your risk of tensing your perineal muscles when you feel the same burning sensation during labor. And tensing those muscles while pushing the baby out increases your risk of perineal trauma.
Perhaps that’s why, despite the burning sensation, “Over 75% of women who were taught the correct method for [perineal massage] said they planned to use it in their next pregnancy and 87% said they would encourage their friends to use the technique.”
These statistics from a study published in the medical journal The Lancet demonstrate just how useful perineal massage can be.
And don’t worry–the discomfort only lasts for the first week or two!
How often should you do Perineal Massage?
Now that you know how to do perineal massage, practice it daily in different positions to determine the one that is most comfortable for you.
You’ll notice that, as the weeks progress, the massage becomes more and more comfortable. This is a good sign. A decrease in the burning sensation or feelings of discomfort indicates that you’re learning to relax as your perineum stretches, which is exactly the effect you want to support your perineal muscles through labor.
Perineal Massage Pregnancy Expectations
It’s essential to manage your expectations during perineal massage, as it isn’t the most comfortable experience of your life. That said, it also shouldn’t be painful.
If you experience pain during perineal stretching, you’re likely stretching too much or too hard. This can cause you to clench your pelvic muscles as a response, giving you the opposite of the result you need.
Instead, expect perineal massage to be uncomfortable, including a burning sensation that will help prepare your body for the “ring of fire” many parents describe feeling when baby’s head crowns during delivery.
In terms of managing expectations, knowing what you’re preparing for is key. Yes, this experience is uncomfortable. But it also allows you to practice breathing deeply and relaxing your muscles through the discomfort, which can lead to an infinitely more pleasant and manageable experience during labor and delivery.
Perineal Massage FAQs
A pregnant person can perform perineal massage alone or with the assistance of a partner. Using the thumb or index finger from both hands, along with an appropriate lubricating gel, insert fingers about one inch into the rear sides of the vaginal canal (near the anus.) Slowly massage the tissue, stretching it slightly, for 4-5 minutes.
If you experience an uncomfortable burning sensation while performing perineal massage, you can feel confident you’re doing it correctly. Extremely painful burning is a sign that you’re using too much pressure, while no burning sensation indicates you aren’t effectively stretching your perineal muscles.
People performing perineal massage with a partner typically prefer sitting across from one another on a bed or flat surface, with the pregnant person at a slight recline with her knees bent. If you’re performing perineal massage on yourself, you can do it in any of 3 positions: 1. Sitting at a slight recline with knees bent; 2. Standing with one leg up on a stool or bench; 3. Squatting on a box or chair with legs separated.
Partners can perform perineal massage by sitting across from the pregnant person and inserting their clean fingers one inch into the rear sides of the vaginal canal, near the anus. Be sure to use proper lubricant. Slowly massage the perineal tissue, stretching it slightly, for 4-5 minutes.
According to research out of Australia, perineal massage leading up to labor and delivery reduces the risk of perineal trauma and ongoing perineal pain.
There are tools that can help you more easily access your perineum for perineal massage. We recommend the Intimate Rose Pelvic Wand.
Did you experience tearing after 3-4 weeks of perineal massage?
Katy Huie Harrison, PhD, is an author, mom, recurrent miscarriage survivor, & owner of Undefining Motherhood. She lives in Atlanta with her husband (affectionately known on the internet as “Husband,”) son (Jack), and dog (Charlotte). She believes our society puts too many expectations on women that make womanhood and motherhood restrictive. Her goal is to shift the paradigm about what it means to be a woman and mother, giving all women a greater sense of agency over their own lives. You can find Katy and her work featured in places like CNN’s Headline News, Romper, Scary Mommy, Demeter Press’s Motherhood and Social Exclusion, & more.