Perineal massage is a technique used during late pregnancy to manually prepare the perineum, the area of skin and muscle between the vagina and the anus, for childbirth. The practice involves gently stretching and massaging the tissues to increase their flexibility and elasticity. The primary goal is to help this area stretch more easily during delivery, thereby reducing the risk of significant perineal trauma. Studies have shown this preparation can lower the likelihood of severe perineal tears, such as third and fourth-degree lacerations, which often require extensive stitching and prolonged recovery time. The massage also aims to reduce the need for an episiotomy, a surgical cut made to enlarge the vaginal opening during birth.
When to Begin Perineal Massage
The timing for starting the practice is specific, with most healthcare providers recommending a start date around the 34th to 36th week of pregnancy. This window is based on scientific trials that have focused on the benefits of massage during the final weeks before delivery. Beginning the massage earlier than the 34th week has not been shown to provide additional benefits in preventing perineal trauma. It is always wise to discuss the appropriate starting time with a midwife or doctor before beginning any new prenatal practice.
Recommended Frequency and Duration
The question of how often to perform perineal massage is central to the practice, and consistency is more beneficial than extreme duration. Current recommendations suggest performing the massage three to four times per week, or every other day, to achieve the most significant benefits. While some sources suggest daily practice, research indicates there is no additional advantage to massaging more frequently than three to four times a week. Each individual session should last approximately five to ten minutes in total.
Within the 5 to 10-minute session, the focus is on maintaining a gentle, sustained stretch for specific periods. This typically involves holding the stretch for one to two minutes at a time, interspersed with gentle back-and-forth massaging motions.
Essential Steps for Proper Technique
Preparation and Positioning
Before beginning the massage, wash hands thoroughly and ensure fingernails are trimmed to avoid scratching the delicate tissue. Finding a comfortable position is next, with a semi-reclined or semi-sitting position often preferred, using pillows to support the back and keep the knees bent and apart. Some individuals find it helpful to perform the massage after a warm bath or shower, as the warmth can help relax and soften the perineal tissues.
Lubrication
Proper lubrication is necessary to prevent friction and aid the stretching process. Recommended options include natural oils like almond oil, olive oil, or sunflower oil, or a water-soluble personal lubricant. Avoid synthetic products such as mineral oil, petroleum jelly, or baby oil. Apply the chosen lubricant generously to your fingers or thumbs and the perineum itself.
Self-Massage Technique
For self-massage, the thumbs are typically used, inserted about one to two inches inside the vagina, resting the other fingers on the buttocks. The motion begins with applying gentle but firm pressure downward toward the rectum, feeling a stretching sensation. This downward pressure is then maintained while sweeping the thumbs outwards to the sides in a slow U-shape, targeting the lower half of the vaginal opening. The goal is to hold this stretch, which may cause a mild burning or tingling sensation, for up to one minute at a time while focusing on relaxing the pelvic floor muscles.
Partner-Assisted Massage
If a partner assists with the massage, they should follow the same technique, but typically use their index or middle fingers instead of thumbs. Clear communication about the level of pressure and any sensations of discomfort is necessary during partner-assisted massage. Throughout the session, the gentle, U-shaped motion should be repeated for the full duration, reapplying lubricant as needed to maintain a smooth massage.
Situations Where Massage Should Be Avoided
While perineal massage is beneficial for many, there are specific medical situations where the practice should be avoided. Any active vaginal infection, such as a yeast infection (thrush), genital warts, or an outbreak of genital herpes, is a reason to pause or not begin the massage. Continuing the practice with an active infection risks spreading the infection or worsening the symptoms.
The massage should also be avoided if there is any condition causing vaginal bleeding during the second half of pregnancy, such as placenta previa. If a healthcare provider advises against the practice due to signs of pre-term labor, severe blood pressure issues, or cervical shortening, follow that recommendation. If there is any uncertainty about beginning or continuing the massage, consult with a healthcare provider.