As you head into your third trimester, you might be wondering how you can prepare your body for the rest of your pregnancy and birth itself. If you are planning a vaginal delivery, one strategy that is often recommended for birth preparation is perineal massage.
The perineum is the space between your vagina and anus. During birth, the perineum stretches significantly, and it’s also the area where you are most likely going to tear! Perineal massage stretches the tissues of the perineum, and aims to mimic the sensation of your child’s head during delivery. This allows an easier passage of your little one's head during delivery. In addition to this, recent studies (Abdelhakim et al 2020) support that perineal massage significantly reduces many risk factors, including:
3rd and 4th degree tearsÂ
EpisiotomyÂ
Anal incontinenceÂ
Length of second stageÂ
As you can see, there are so many benefits of doing perineal massage!Â
It is generally advised to start perineal massage at around (or after) 34 weeks of pregnancy. I always recommend women to come in to be shown perineal massage around this time so that they know what it should feel like, as well as what to do.
How to do perineal massage:Â
Firstly, get yourself into a comfortable position.Â
- Standing: one foot propped up onto a stool or higher surface. By far my favourite recommendation if you’ll be doing it solo!Â
- Sitting: on the toilet with the toilet seat up so that you have access to your perineum.Â
- Lying on your bed: prop yourself up on some pillows. A great position if your partner is going to be helping you with perineal massage.
Wash your hands thoroughly and use lubricant. Use your thumb up to the first knuckleÂ
Work between 3-9 o’clock, pulling out and down in a sweeping motion towards the anus. You can either:Â
- Work each side individually in a ‘C’ chapped motions on each sideÂ
- Work between the two points in a ‘U’ shape
Pressure should be firm. It might be uncomfortable (but tolerable - work within your range!).Â
Perform 2-3 times per week for 5 mins each time.Â
What else can I do to prepare my pelvic floor for vaginal delivery?Â
Downtrain pelvic floor musclesÂ
Practice pain management strategies (this can be during perineal massage! It’s a good time)
Practice birth positionsÂ
Increase mobility in other areas of your body to help create space and reduce tension
DISCLAIMER: This is general information and advice only. Please seek advice from your medical practitioner and pelvic health physiotherapist before starting perineal massage.Â
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 journal, 31, 1735-1745.
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