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

Perineal massage means gently stretching the perineal tissue, the area between the vagina and anus, with one or two fingers. It helps prepare the area for stretching during vaginal birth. You can use your fingers and apply oil to make it more comfortable. Here’s a step by step guide to how to do perineal massage.

Perineal massage reduces the risk of tearing and episiotomy (surgical cuts), improving your chances of giving birth vaginally without causing harm to your perineum.

What is Perineum?

Perineum is the area between the vagina and the anus. It links to the muscles that support your reproductive organs, intestines, and bladder.

The perineum is usually 2-5 cm long and stretches during childbirth to help the baby come out.

What is Perineal Massage?

Perineal massage involves gently stretching and massaging the perineal tissue with one or two fingers. It helps prepare the area to stretch during vaginal or normal delivery. This makes the skin become more flexible, making it easier for your baby to pass through during delivery. You can do this massage on your own at home or with your partner’s help.

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.

Easy Perineal Massage Tips

1. Soak in a Warm Bath

A warm bath before starting can help you relax and soften the muscles around your perineum.

2. Keep Your Nails Short

The skin around your vagina is delicate. Trim your nails to avoid any scratches or discomfort.

3. Find a Cozy Spot

Make sure you’re comfortable before you start. Lying in bed with pillows supporting your back and slightly bending your knees is a great position.

4. Use a Gentle Oil

Apply a natural oil like almond or olive oil to keep the area soft and make the massage easier.

5. Place Your Thumbs Correctly

Gently press your thumbs inside your vagina, moving downward toward your anus and to the sides. Hold for about a minute until you feel a gentle stretch. Take deep breaths to help your body relax.

6. Massage in a U-Shape

Use your thumbs to make a U-shaped movement along the lower half of your vagina for 2-3 minutes. Repeat this a couple of times.

7. Be Consistent

Doing this daily or as often as possible can help make the area more flexible over time. It could take a few weeks to see an improvement.

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 trimmed, and your bladder is empty. Bend your knees and relax in a quiet area. You can use cushions or pillows to support your back.

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 using pillows for support on a bed or sofa.

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.
• Gently press outward, hold for 45-60 seconds, and breathe slowly 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.

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.

Why can’t you do Perineal Massage before 34 weeks?

Studies show that massaging the perineum from 34 weeks of pregnancy can help reduce the risk of tears requiring stitches. It may also lessen the need for an episiotomy (a small cut in the perineum). Perineal massage is generally recommended at this stage to prepare the area for childbirth and lower the chances of tearing.

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 get used to perineal sensations.
• Reducing tears means fewer stitches, lower infection risk, less pain, and less bleeding.
• It eases burning and stinging as the baby’s head is born.
• It may reduce the need for stitches after delivery.
• It lowers the risk of long-term perineal pain after childbirth.
• After childbirth, perineal massage helps protect the perineum and may reduce the risk of urine leakage in new mothers.

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.

Take Away:

How to Do Perineal Massage:

The most effective way to massage the perineum are in the shower or while lying down. Use lubricant or natural oil for massage.

This is how to do Perineal Massage:

• Insert one or two fingers or thumbs 3-5 cm into the vagina.
• Gently move side to side and downward for about five minutes.
• You may feel a slight burn, but it should fade.
• Hold the stretch for 45-60 seconds before releasing.

Avoiding perineal massage is crucial if you have an active vaginal infection.

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.