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How to do Perineal Massage: During Pregnancy, Labor and Child Birth

Dr. Kavitha Lakshmi Easwaran

Dr. Kavitha Lakshmi Easwaran

MBBS- M.D.

Obstetrics And Gynaecology

There is no doubt that this proverb holds when it comes to perineal massage, “Prevention today, peace of mind tomorrow”.Among all the various things you could be anxious about, you’re scared about tearing “down there” as you approach the end of your pregnancy.

It may be possible to prevent bruising and ripping by paying a little more care to this area in the last few weeks of your pregnancy, which will help with your postpartum recovery.

By reducing the risk of tearing and episiotomy (surgical cuts), perineal massage improves your chances of giving birth vaginally without causing harm to your perineum.

What is Perineum?

The area between the rectum and the vaginal entrance is called the perineum, forming the back part of the birth canal. During labor, this region undergoes significant stretching and is prone to tearing. 

The vagina also expands to accommodate the baby’s passage and typically returns to its usual size after delivery. However, the perineum, or pelvic floor, is less elastic than the vaginal tissue, making it more susceptible to tears during Childbirth.

What is Perineal Massage?

A technique called perineal massage, otherwise known as prenatal massage or maternity massage is used to gently stretch the perineum during pregnancy, which can lower the chance of tearing after Childbirth, especially for first-time mothers.

The gentle massage promotes elasticity and flexibility in the perineal tissues, supporting their natural relaxation and expansion during delivery. In addition, the stretching sensation of a perineal massage offers a chance to practice breathing, making women feel more at ease and secure during birth.

During pregnancy, a perineal massage can help you get ready for delivery. The birth canal’s forming tissues are gently stretched throughout pregnancy by perineal massage.

How does Perineal Massage help with Childbirth?

In the course of vaginal delivery, 40–80% of women will have some degree of tearing. About two-thirds of tears will need to be stitched.

The skin and muscles surrounding the perineum can stretch more readily during Childbirth if regular perineal massage is started by week 35 of pregnancy. This can lessen the likelihood of tearing or the need for an episiotomy, which is a cut made to the perineum to widen the vaginal opening for the baby to be born.

Your chances of having a more natural birth and a quicker recovery are increased if you learn how to stretch the perineum using perineal massage.

When Should You Begin Perineal Massage During Pregnancy?

Massage the perineum every one to two days starting at week 34 of pregnancy if it is comfortable. This can be done by either you or your partner. Take time to try to relax when giving the massage. 

After receiving approval from your gynecologist, begin daily perineal massage for up to five minutes until the time of delivery. 

Benefits of Perineal Massage

Perineal massage from week 34 of pregnancy can reduce the likelihood of significant tearing or the necessity for an episiotomy in women giving birth for the first time vaginally. Perineal massage has other advantages, such as:

  • It helps you become comfortable with the sensations of your perineum.
  • Preventing tears during delivery requires fewer stitches, as it lowers the risk of infection, eases perineal pain, and minimizes bleeding.
  • As your baby’s head is being born, it can help to reduce burning and stinging feelings.
  • It helps to cut down on the number of stitches required after delivery.
  • It reduces the likelihood of prolonged postpartum perineal pain.
  • After giving delivery, perineal massage helps preserve the perineum, which lowers the risk of postpartum urine incontinence, which is the involuntary leakage of urine in new mothers.

How to do Perineal Massage?

The following is the step-by-step guide to how to do perineal massage.

Step 1:

Be Prepared:

Before you begin, make sure your hands are clean, your fingernails are clipped, and your bladder is empty. Bend your knees and relax in a quiet area. You can use cushions or pillows to support your back.

pregnant women preparing for perineal massage

Step 2:

Find a Comfortable Position:

Make yourself comfy before starting the massage. For more accessible access to the perineum, consider sitting on the toilet, standing in a warm shower with one leg on a stool, lying back in the bathtub with one leg on the side, or propping yourself up with pillows on a bed or sofa.

Find a comfortable position to do perineal massage

Step 3:

Start the Massage:

As much as you can, try to relax throughout the massage.

  • Apply a small amount of oil to the lowest portion of your vaginal opening and perineum for comfort.
  • Insert one or two fingers (or your thumbs) about 3-4 cm inside your vagina and press down toward your anus to begin the massage. A mild burning or tingling sensation may occur, which is normal.
  • Press outwards to the sides and hold the stretch for 45-60 seconds, taking slow, deep breaths to relax your muscles.
  • Massage in a U-shaped pattern, applying gentle downward and outward pressure.
  • Add more lubricant as needed and continue the massage for 5-10 minutes.
How to do perineal massage step by step

Step 4:

Stick to Your Routine:

Make time for this practice every day or as frequently as you can. Since the blood vessels in the area are naturally dilated after a bath or shower, this is an excellent time to massage the perineum because it will be softer. Additionally, this promotes relaxation.

relax after perineal massage

Should My Partner Be Involved in Perineal Massage?

If a partner is giving you a perineal massage, follow the exact basic directions mentioned above. However, your partner should rub you with their index fingers instead of their thumbs. 

The method should include U-shaped, side-to-side movements combined with light downward pressure. Good communication is crucial, so make sure to let your partner know if you feel too much pain or a burning feeling.

When Should I Avoid Perineal Massage?

Perineal massage is generally safe but should be avoided in certain conditions. 

  • Avoid perineal massage if you have a low-lying placenta.
  • Avoid getting a massage if you have any infections, such as herpes, vaginal thrush, or open wounds on your hands. 
  • Avoid getting a perineal massage if you have high blood pressure during pregnancy.
  • If you have had prior perineal surgery, speak with your healthcare provider before beginning a perineal massage.

Bottom Line:

Pregnancy will cause numerous changes to your body. As you get ready for labor and delivery, it’s a good idea to include regular perineal massage in your treatment plan. If you have any questions or concerns about tears, schedule an appointment with our best gynecologist.

Frequently Asked Questions

Why can't you do a Perineal Massage before 34 weeks?

Unless advised by your doctor, you should refrain from performing perineal massages before 34 weeks of pregnancy. Your body is still adjusting before this point, so beginning too soon could be uncomfortable or ineffective. It's best to start between weeks 34 and 35 since it helps your body get ready for delivery, which lowers the chance of tearing and the necessity for an episiotomy.

How to Massage your Perineum before Birth?
  • Get ready: Place your legs apart and support your back while you sit. For a softer perineum, massage after taking a bath. Apply a lubricant like oil to start the massage.
  • Massage: Until you experience a tingling sensation, apply constant downward pressure toward the back canal. Try applying downward and outward pressure in a U-shape.
  • Salads: Massage for four to five minutes per day.
  • Relax: During the massage, take deep breaths to help your muscles relax.
What is Perineal Massage during Pregnancy?

The perineal tissues are kept flexible by this light massage, which gets them ready to naturally stretch and expand during birth. Additionally, it allows you to practice breathing through the piercing feeling of perineal stretching, which many women believe encourages them and keeps them calm during birth.

How to do Perineal Massage for Normal Delivery?

    Perineal massage helps stretch the tissues in your perineum, preparing your body for a normal delivery. Follow the below-mentioned tips:

  • When to start: Start massaging the perineum four weeks before delivery.
  • How to do it: Insert a lubricated finger and press steadily downward and outward in a "U" form.
  • How long: Massage for 5–10 minutes once a day.
  • What to feel: It's natural to feel a little tingly or burned. You can do it with your partner.
  • Comfort & more exercises:To be ready for labor, attempt pelvic floor exercises and use more lubricant if necessary.
  • Stop if it hurts: Speak to your doctor if you experience pain.

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