About Perineal Massages

Perineal massage is recommended by some women's health care and childbirth experts to make the skin and muscles surrounding the vagina and rectum more supple in preparation for childbirth. The idea is that massage, done either in the weeks leading up to childbirth or sometimes during the pushing stage of labor, reduces the risk of tearing of the vagina and rectum, lessens the need for an episiotomy--an incision between the vagina and rectum--and lessens pain in the perineum as the baby passes through.

Function

• To perform prenatal perineal massage, the pregnant woman sits in front of a mirror in a semi-reclined position with her knees bent and apart, similar to traditional supine birthing position. Placing her thumbs inside her vagina, she presses down on the perineum, toward the rectum until she feels a gentle stretching sensation. She continues to very gently stretch the perimeter of the vaginal opening with her thumbs, in down and outward direction, mimicking the action of the baby's head emerging. The use of a water-based lubricant like KY Jelly is recommended.

Effects

• External perineal massage may also be done during the pushing stage of labor, as the baby's head crowns. The additional pressure of massage may ease the mother's discomfort. Massage may also help the mother control her pushing efforts so that the baby delivers more slowly, and tearing of the perineum is minimized. However, perineal massage cannot guarantee an episiotomy-free birth. Only when the baby's head crowns will the physician or birth attendant know if the vaginal opening is sufficient.

Considerations

• Critics of perineal massage cite the fact that the hormones produced by the body during pregnancy relax connective tissues and muscles enough that deliberate stretching of the perineum is unnecessary. They further cite that many women complain of looseness of the vagina after childbirth and therefore may wish to refrain from deliberately stretching that area.

Theories/Speculation

• Studies of perineal massage are not overwhelmingly convincing either in favor of, or in opposition to the practice. Some research data shows slight effectiveness of perineal massage in the last weeks of pregnancy. However, study data does not seem to indicate that perineal massage during labor reduces perineal tearing or episiotomy. Some childbirth experts conclude that while lubricating and rubbing, the skin may have little mechanical effect, regularly manipulating the perineum helps the mother learn to control her muscles so that she can better control her pushing efforts during birth, thus reducing unnecessary tearing.

Warning

• Before beginning a perineal massage routine, an expectant mother should consult her obstetrician. The doctor will assess the mother's risks for preterm labor and any other potential complications of pregnancy. Perineal massage is contraindicated when vaginal infections are present. Bruising, abrasion or other injury to the perineum are not normal side effects of perineal massage and warrant medical attention.