One of the often worried about but less talked about topics of labour and birth is what happens to your perineum and how it may feel. It can leave you feeling anxious and coming up with all kinds of ideas of what can happen and what your bits will look like after you’ve had your baby. So let’s put aside the myths you have heard and your worries and talk about it honestly.
So firstly – what is your perineum? – Good question! It’s the area between your vaginal opening and your rectum (back passage). It includes the skin and your pelvic floor muscles. Your pelvic floor muscles act like a hammock to support organs such as your bladder, bowel and uterus. Throughout most of your life, you probably will not give your perineum a second thought. However, during pregnancy, your perineum will take on a greater significance as you prepare for childbirth.
During childbirth, the perineum stretches tremendously to accommodate your baby’s birth. The skin of the perineum usually stretches well, but it may tear or graze which can cause discomfort and pain. Whilst it is common for most women to experience some degree of perineal tear during childbirth, it is slightly more common with a first vaginal birth than in women who have had a vaginal birth before.
At least one third of women in the UK and US have perineal tears that need stitches. About three in 100 women having a vaginal birth have the more severe perineal tears.
Though common, the good news is that you can also do a few things to help reduce the risk of tearing! If you’ve never given birth vaginally before, massaging your perineum towards the end of your pregnancy can reduce your risk of episiotomy. It may also reduce your risk of tearing. Even if you have had a baby before, perineal massage can help to reduce discomfort in the months after the birth.
Perineal massage is a way of helping to prepare the perineum for childbirth, making it more flexible so it can stretch more easily during labour. Massaging the perineum might reduce the chances of a tear or an episiotomy during labour and reduce perineal pain afterwards. This is particularly the case for women giving birth vaginally for the first time.
Research has shown that perineal massage from 35 weeks onwards until your baby is born may reduce your risk of tearing. It is particularly beneficial for first-time mothers.
What is Perineal Massage
Perineal massage involves massaging the area between the vagina and bottom during late pregnancy. Some women massage their perineum themselves, while others prefer to get their partner to help.
As discussed already, it’s best started in your third trimester – usually around 35 weeks. Always discuss with your midwife beforehand – they’ll be able reassure you that it is safe for you to start and give you tips too. For those who have given birth before, it is safe to massage your perineum if you have a scar from a previous birth. But if you have a vaginal infection such as thrush, or any unexplained discharge, check with your GP or midwife before trying it.
During our antenatal classes, our midwives discuss in detail how to carry out perineal massage as well as a range of other mind and body techniques to prepare for labour and birth. We also cover perineal care in the postnatal period, from how to help healing, preparing ‘Padsicles’, what to avoid and what else can aid your recovery.
How to do Perineal massage
Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
You need to be relaxed during the massage, so it’s important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees.
Use a lubricant like vitamin E oil, almond oil or olive oil.
Put your thumbs about 2.5cm to 4cm just inside the back wall of your vagina. You might find it easier to use a mirror the first few times. Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breathe deeply.
Gently massage the lower half of your vagina using a U-shaped movement for 2-3 minutes. Repeat this 2-3 times.
Repeat daily or when possible
It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area.
The important thing is to find a routine that works for you and stick to it. Perineal massage shouldn’t hurt, though it may feel quite uncomfortable, particularly at first. If you are finding it painful, especially after you’ve been doing it for a few weeks, your GP or midwife can help to check your technique.
When you’re heavily pregnant, it can be difficult to do perineal massage yourself. If your partner is willing, they can do it for you. The process is the same, although they may find it easier to use their fingers, rather than thumbs.
After you’ve been doing perineal massage for a few weeks, you may notice the skin and muscles around your vaginal opening becoming looser. This is a great sign that the massage is working!