What is the perineum?

The perineum is the space between the opening of the vagina and the anus. Typically, the perineum is between 2-5 centimetres long. The perineum stretches during childbirth to allow for the baby to be born. Most people don’t think about their perineum unless it becomes uncomfortable, or during pregnancy and when preparing for birth.

What is perineal massage?

Perineal massage is a technique which can be used during pregnancy to help to stretch the perineum so there is less risk of tears when the baby is born, especially with a first birth. Perineal massage also helps to stretch the skin and prepare you for the sensations of burning, stinging and stretching, which can happen when the baby’s head is being born.

Some women find it easier than others to massage their perineum, and it can be helpful to have a partner’s support. It’s important to remember that you have the right to choose what is right for you and your body. Not all pregnant women want to massage their perineum.

When is it safe to start perineal massage?

The general guidelines suggest starting perineal massage at around week 35 of pregnancy and doing it a couple of times per week, right up to when the baby is born. The best time to massage your perineum is when you are relaxed and have time. At first it may feel uncomfortable, and you may not be sure you’re doing it the right way. However, with practice, you will become more familiar with your body and the feeling of massaging your perineum.

How can perineal massage help during birth?

Perineal massage helps to prepare the vaginal outlet for the stretching and pressure sensations that happen as the baby is being born. It also helps to prepare the perineum during late pregnancy, and it may encourage elasticity and reduce the risk of tearing during childbirth.

Perineal massage has also been shown to help women feel more comfortable and recover more quickly following their baby’s birth. This can help to support bonding and help you to care for the baby more easily.

How do I do perineal massage?

You can do perineal massage when you’re lying down or in the shower. It helps to use a vaginal lubricant or a natural oil. Avoid using nut-based oil if you have known allergies. It’s also best to avoid using baby or mineral oils or petroleum jelly.

• Gently insert your thumbs or 1-2 fingers, 3-5 cm into your vagina.
• Firmly sweep your thumbs in a downward and side-to-side motion for 5 minutes.
• You may feel a burning sensation, which will lessen over time.
• Hold the stretch for 45-60 seconds and then release.
• Do not massage if you have active genital herpes or a vaginal infection.

Ask your maternity care provider for more information about perineal massage.

Getting started with perineal massage

Start each perineal massage by:

• going to the toilet and emptying your bladder
• washing your hands well
• finding a relaxing place where you can perform the massage — it’s important you feel relaxed so you get the maximum benefits
• getting a mirror and positioning this so you can see your perineum

Some women find it helpful to sit on the toilet or make themselves comfortable on their bed.

It may help to have a warm bath or shower, or to use a warm compress on your perineum, for 10 minutes before you start.

How often should I do perineal massage?

Ideally, aim to do perineal massage once or twice each week from 35 weeks of pregnancy. Doing it more often than this may reduce the protective benefits. There are still benefits from doing it once or twice per week.

Can my partner help with perineal massage?

If you and your partner feel comfortable, then it’s fine to ask for their support. Most women consider their partner’s involvement in perineal massage as positive. If your partner is helping you, make sure they have clean hands and use either their thumbs or 1-2 index fingers insider the lower part of your vagina.

It is important to communicate clearly with your partner about how much pressure is comfortable for you without causing too much discomfort or pain.

When should I not do perineal massage?

Perineal massage is generally safe. However, there are some conditions where it is not recommended. You should not massage your perineum if you have a low-lying placenta (placenta praevia).

Don’t massage your perineum if you have an infection, including vaginal thrush, herpes, or any open cuts or infection on your hands or fingers. It’s easy to transmit microorganisms into the vagina and uterus, which is why it’s important to only massage your perineum if your hands are clean and the skin is intact.

If you have had previous perineal surgery or your waters have broken, it’s a good idea to speak with your maternity care provider before starting perineal massage.

Should I do any other exercises to prepare me for birth?

During pregnancy, the pelvic floor muscles help to support the baby and need to be relaxed when the baby is born. Pregnancy hormones, extra weight and changes to the muscles and ligaments in the pelvis all cause strain, which can lead to weak pelvic floor muscles and incontinence.

Like any muscle in the body, pelvic floor muscles can be strengthened and trained with regular, targeted exercise. It can be helpful to see a physiotherapist or continence nurse during pregnancy to learn how to do pelvic floor exercises correctly.

It can also be useful to join a pregnancy exercise class, for example, yoga, Pilates or swimming.