The Truth about Perineal Massage, What the Evidence is Saying About its Benefits, & How to Do It!

Firstly, what the heck is a perineal massage!

Perineal massage involves gentle stretching and massaging of the perineum, the area between the vaginal opening and the anus. A lot of people who come to see me for pregnancy prep believe that the benefits of perineal massage come only from softening the tissues in and around the vulva & vagina… but it’s so much more than this! Keep in mind folks, we’re never going to be able to soften and stretch the tissues as much as the cervix needing to dilate to 10cm in diameters! We are SOOOO NOT STRETCHING YOUR Vaginal Entryway to 10cm dilated… Yikes! The way I like to explain how perineal massage helps… is that it offers an opportunity to practice calming the nervous system and thus pelvic floor muscles (PFM) in preparation for a baby to pass through em! The pelvic floor muscles need to remain relaxed and flexible for baby to pass easily. The pressure & stretch generated in a perineal massage is somewhat like a simulation to help the mind and body ready for the potential pressure and discomfort it may feel for when the ‘real deal’ happens!

Let’s be real for a moment. Can doing Perineal Massages straight up PREVENT & PROTECT from any tearing at the vulva? I’m sorry peoples… but unfortunately, it’s a no. And if any healthcare practitioner says otherwise, I’d run the other way! So Jane, what’s the big whoop then? Should I even bother with perineal massages…. I’d answer this with a BIG FAT… YES! Based on a 2020 Meta-Analysis, perineal massages can help with the following…

1. **Reduced Incidence of Episiotomies**

Perineal massage is linked to a remarkable 21% reduction in the incidence of episiotomies, a surgical procedure to widen the vaginal opening during childbirth, as indicated by the risk ratio.

2. **Lower Risk of Perineal Tears**

Expectant mothers practicing perineal massage benefit from a 21% lower risk of perineal tears during childbirth.

3. **Specific Reduction of Risk in getting Severe Tears **

Perineal massage demonstrates particular efficacy in reducing the risk of severe third- and fourth-degree perineal tears.

4. **Improved Postpartum Comfort**

Beyond the delivery room, perineal massage contributes to better wound healing and reduced perineal pain, enhancing overall comfort during the critical postpartum recovery period.

5. **Shorter 2nd Stage**

Antenatal perineal massage significantly shortens the duration of the second stage of labor, making it a valuable tool for optimizing the birthing process.

6. **Better APGAR scores at 1 & 5min**

Perhaps one of the most compelling findings is the significant improvement in Apgar scores at both 1 and 5 minutes, underscoring the positive influence of antenatal perineal massage on neonatal well-being.

7. **Reduced Risk of Anal Incontinence**

The study data indicates a noteworthy reduction in the risk of anal incontinence among women who embraced antenatal perineal massage; Uhm.… yay!

So how do we do the dang thing?

1. **Choose the Right Time:**

Begin perineal massage around the 34th week of pregnancy, twice a week… for every week leading up to the big day, to allow sufficient time for the tissues to adapt and become more pliable & to train the nervous system and PFM for birth.

2. **Gather Supplies:**

Use your favourite lube to lubricate the perineal area and reduce friction. Cut your nails so that the whites aren’t showing. Wash your hands with unscented soap. Or purchase a perineal massage wand. Grab pillows if you’re practicing the massage on your bed/couch.

3. **Find a Comfortable Position:**

Sit or recline in a comfortable position with support for your back. Or do a ‘Captain Morgan’ on the side of the bathtub. Another popular place to do the perineal massage is a warm bath. You may try more positions, even your birth positions, if you have a partner willing to help.

4. **3 Emojis to Explain Perineal Massage Techniques:**

Start with gentle pressure, gradually increasing as the muscles become accustomed. Focus on massaging all parts of the vaginal entryway especially from 2 O’clock to 10 O’clock (if you visualize the entryway like a clock) for about 10 minutes. I like to teach three simple but effective techniques for perineal massage… and think of these EMOJIs as you’re practicing:

☀️ - the rays of the sunshine technique…. apply pressure perpendicular to the entryway of the vulva… like drawing rays of a a sunshine from 1-11 oclock. Breathe 3-5 deep breaths with each ‘ray’ drawn.

☮️ - the peace sign massage… apply pressure with two fingers to the lower 45 degree angles stay here 1-2 minutes to either corners of the PFM

😊 - 5x the smile massage… apply perpendicular pressure to 1 oclock, and drag your finger all the way along to 11 oclock on the other side of the vulvar entryway. Repeat this 5x… going back and forth counts only as ONE REP!

5. **Be Mindful of Breathing:**

Practice slow, deep breathing to enhance relaxation during the massage; relaxation of the PFM, your mind, your body, You can also practice low tone humming, mooing, ugly sighing as you’re performing your perineal massage! Play music, do a PFM body scan meditation (YouTube: Body Scan with Jane), or get the diffuser going… whatever works for you to enhance your comfort level and calm.

Perineal massage is not just a physical practice but a journey of empowerment and self-care during pregnancy. With its evidence-backed benefits, it stands as a valuable tool for expectant mothers (ESPECIALLY FIRST-TIME MAMAs) looking to optimize their birthing experience. By embracing perineal massage and incorporating it into your prenatal care routine, you embark on a path towards a more positive, comfortable, and empowering childbirth.

Mostly Written by Jane Bai, with some help from ChatGPT (gasp).