Perineal massage: preparing for birth

The perineum is the area of skin and muscle between the vagina and anus. During a vaginal birth, the perineum stretches as your baby moves through the vagina and their head begins to crown.

It is common for the perineum to experience some degree of tearing during birth. While tears cannot always be prevented, research suggests that regular perineal massage during the final weeks of pregnancy may reduce the likelihood of significant perineal trauma and the need for an episiotomy (a surgical cut made in the perineum), particularly for women having their first vaginal birth.

Perineal massage is a simple technique that you can learn during pregnancy. It involves gently stretching and massaging the lower part of the vaginal opening and perineum to help you become familiar with the sensations of pressure and stretching that may occur during birth.

When should you start perineal massage?

Perineal massage can generally be commenced from around 34 to 35 weeks of pregnancy and continued regularly until your baby is born.

You can perform the massage yourself or ask your partner to assist. Taking a warm bath or using a warm pack on the area beforehand may help you feel more relaxed.

Before beginning, make sure your hands are clean and warm. You can use a suitable water-based lubricant, Vitamin E cream, or olive oil to make the massage more comfortable.

How to perform perineal massage

Find a comfortable position where you can easily reach your perineum. You might sit on a bed or chair with your knees bent and apart or stand with one leg supported on a chair.

1. Wash your hands and make sure your nails are short and smooth
2. Apply a small amount of suitable lubricant to your thumbs and the perineal area
3. Gently insert your thumb approximately 2-3 centimetres into the vagina. If your partner is assisting, they may find it easier to use their index and middle fingers
4. Gently press downwards and to each side of the lower vaginal opening until you feel a mild stretching sensation
5. Hold the stretch gently and massage the lower part of the vaginal opening in a slow, sweeping arc from side to side
6. As you become comfortable, gently massage the tissue downwards and forwards. This mimics some of the stretching that occurs as your baby’s head is born
7. Continue for approximately three minutes, keeping the pressure gentle and comfortable

You may notice a sensation of stretching, tingling or mild burning. This should not be painful. If you experience pain or significant discomfort, stop and speak with your midwife or doctor.

Avoid massaging around the urethra (the opening where urine passes) to help reduce the risk of infection.

What are the benefits of perineal massage?

One of the benefits of perineal massage is becoming more familiar with your body and the sensations you may experience during birth.

For some women, understanding and being aware of what stretching and pressure in the perineal area feels like may help them feel more relaxed and confident when their baby’s head is crowning.

There is also evidence that perineal massage during pregnancy may reduce the likelihood of perineal trauma requiring suturing, particularly for women having their first vaginal birth. Some evidence also suggests it may reduce ongoing perineal pain following birth.

However, perineal massage does not guarantee that you will avoid a tear or episiotomy. Every birth is different, and whether a tear or episiotomy occurs depends on a range of factors.

Supporting your perineum during birth

Your preparation during pregnancy is only one part of caring for your perineum.

During labour and birth, your midwife may use techniques to support the perineum as your baby’s head is born. Applying a warm, moist compress to the perineal area during the pushing stage may help to relax the skin and muscles as your baby is crowning.

Making informed choices about your birth

Understanding what happens to your perineum during birth can help you feel informed and prepared for the experience.

If you are considering perineal massage, talk with your doctor or midwife before you begin. They can help you determine whether it is appropriate for you.

This also gives you an opportunity to talk about your wishes, ask questions and understand the circumstances in which an episiotomy or other intervention may be recommended.

Remember that having a tear or needing an episiotomy is not a sign that you have done anything wrong. Sometimes these interventions are necessary to support the safe birth of your baby.

When should perineal massage be avoided?

Perineal massage is not suitable for everyone. You should not perform perineal massage:

• before 34 weeks of pregnancy
• if you have vaginal bleeding
• if you have been diagnosed with placenta praevia
• if you have active genital herpes
• if your doctor or midwife has advised you to avoid vaginal examination or intercourse for another medical reason.

Always speak with your doctor or midwife before starting perineal massage, particularly if you have any concerns about your pregnancy.

Your midwife and doctor are there to support you, answer your questions and help you make informed decisions about your care and your preferences for birth.