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Antenatal Perineal Massage

Published: April 26, 2022

Congratulations on your pregnancy! You're probably beyond excited to bring your little human into the world and already have the nursery and your hospital bag prepared and organised. 

But did you know you can also prepare your body for birth? You might want to add antenatal perineal massage to your to-do list, as this therapeutic massage performed in the 4-6 weeks leading up to labour helps increase blood flow, mobility of the tissues and teaches your body to get used to the sensation of stretch in this area, while relaxing the pelvic floor muscles. 

Who should do it and why? 

Pregnant women who are preparing for a vaginal delivery, ideally from 35 weeks onwards can do this massage. There is high quality evidence suggesting that antenatal perineal massage significantly reduces the rate of episiotomies and perineal tears, especially 3rd and 4th degree tears. Evidence also suggests women who did antenatal perineal massage had reduced second stage of labour (the pushing part) and their babies had improved Apgar scores at 1 and 5 minutes. It is likely these scores improved due to less foetal distress, secondary to reduced intervention and pushing time.

Speak with your midwife or women's health physio if you have any concerns or are unsure how to get started. 

Quick anatomy lesson.

First, let’s orientate ourselves with our anatomy. In the image below, imagine the vaginal opening as a clock, with 12 being the top, and 6 being the bottom, towards the anus. The perineum is the area of skin and muscle between the vaginal opening and the anus. The massage should be performed in the area of 3 to 9 o’clock.

Step-by-step how to:

  1. Lay back with pillows behind your upper body to prop yourself up. The first time you do this you may like to have a mirror handy to visualise where you are working. Ensure to have your lubricant handy – you can use anything you’ve used in the past, or specially made perineal massage oil.
  2. Insert your thumb approx. 1-2cm into the vagina, with the pad facing down to the perineum at 6 o’clock. If you find it hard to get to the area of your perineum, then you can have a partner do the massage for you.
  3. Start with a “warm-up”: Gently apply some pressure downwards, and sweep down and out to 3 o’clock (one quadrant of the clock). Return back to 6 o’clock and repeat. You may find you can do from 3 to 9 o’clock in one sweep, or you may have to do a quadrant at a time. Repeat the sweeping motion approximately 10 times. Remember to keep your pelvic floor relaxed.
  4. Then start with some pressure holds: Return back to 6 o’clock and apply some downwards pressure towards the perineum  – you should feel a comfortable stretch, not pain. Hold this stretch for 30-60 seconds, and then repeat at each number on the clock-face, from 3 to 9.
  5. You can do this with two thumbs at once – eg one thumb on 5 o’clock, and one on 7 o’clock, then moving outwards.

The whole process should take about 5-10 minutes. Remember the goal is to keep your pelvic floor and body relaxed throughout. Try to do this 3-4 x a week in the 4-5 weeks leading up to your due date.

If you need any help, book in with Fiona who can help you to learn the technique and provide you with an approach individualised to your needs. While massage doesn't guarantee you won't tear during labour, it may help explain some of the sensations you may feel as your baby enters the world. 

 

 


References: 

Abdelhakim, A. M., Eldesouky, E., Elmagd, I. A., Mohammed, A., Farag, E. A., Mohammed, A. E., ... & Abdel-Latif, A. A. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International urogynecology journal31(9), 1735-1745.

Elsebeiy, F. I. (2018). Comparison of the effects of prenatal perineal massage versus Kegel exercise on labor outcome. IOSR J Nurs Health Sc7(3), 43-53.

Nessa Organics (2021, March 18). How To Massage Your Perineum Before Birth & After AND Tips For Vagina Recovery. Nessa Organics. https://www.nessaorganics.com/blogs/nessa-hub/recovering-from-a-vaginal-birth-pre-post-perineal-massages