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PERINEAL MASSAGE (PRE AND POSTPARTUM)

Tearing during childbirth is a common occurrence among vaginal births and values of spontaneous tearing (no episiotomy) range from 44-79%.[1] Consistently, studies have shown that tearing is more common during first vaginal births and rates increase with use of instrumentation, such as forceps or vacuum.[2]

Tears can be classified as first, second, third, and fourth degree tears. First degree tears involve only the skin, while second degree tears involve both the skin and the perineal muscles. Third degree tears involve the anal sphincter, while fourth degree tears involve the anal sphincter and tissues. Third and fourth degree tears happen in 0.25% to 1.25% of vaginal births. [3]


An episiotomy is a surgical incision made through the perineum to enlarge the vaginal opening during vaginal birth and this procedure is based on the belief that it will prevent serious perineal tears. A recent systematic review found there were no beneficial maternal or neonatal outcomes.[4] On the other hand, this guarantees perineal trauma and sutures (stitches).


Perineal massage in pregnancy is thought to reduce tears in vaginal births. Studies show that it reduces tears by about 10%, but only with first time vaginal births.[5] However, it can be used as a biofeedback technique so that expectant women know what a stretching perineum feels like, in a non-threatening way, and they know where to push during birth.

Postpartum perineal massage can break up scar tissue, soften hardened tissues, and decrease postpartum perineal pain.[6] Do not perform perineal massage if you have active infection or active herpes lesions.


Instructions:

Position yourself in a comfortable position that you have easy access to your vagina. Examples include lying reclined on your bed, standing with one leg up on chair, or seated on the toilet. I suggest you use a mirror to observe the tissues first.

1. Insert 1-2 lubricated fingers (or thumb) about 1 knuckle deep into the vagina.

2. Apply some downward and outward pressure starting at 3 o’clock and work in a horseshoe shape, maintaining this pressure, until 9 o’clock. Now perform in the opposite direction, starting at 9 o’clock and moving toward 3 o’clock. Repeat 5-10 times. Note: tenderness or burning is likely to be felt but no significant pain should be produced. While massaging this area, focus on your inhalation reaching all the way down to your pelvic floor/perineum, further relaxing and softening the tissues.

3. If you notice areas of increase resistance you can add sustained pressure and hold this pressure for 2 minutes until the tenderness subsides and tissues soften.

4. Alternatively, you can use your thumb and pointer finger so grasp the perineum while gently rolling your thumb and finger back and forth.


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[1] Soong, B. and M. Barnes (2005). 'Maternal position at midwife-attended birth and perineal trauma: is there an association?' Birth 32(3): 164-169; Dahlen, H. G., C. S. Homer, et al. (2007). 'Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.' Birth34(4): 282-290.


[2] Aasheim, V., A. B. Nilsen, et al. (2011). 'Perineal techniques during the second stage of labour for reducing perineal trauma.' Cochrane Database Syst Rev(12): CD006672.


[3] Byrd, L. M., J. Hobbiss, et al. (2005). 'Is it possible to predict or prevent third degree tears?'Colorectal Dis 7(4): 311-318. ; Groutz, A., J. Hasson, et al. (2011). 'Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.' Am J Obstet Gynecol 204(4): 347 e341-344.


[4] Hong, Jiang et al. (2017). ‘Selective versus routine use of episiotomy for vaginal birth.’ Cochrane Database Syst. Rev.: CD000081.


[5] Beckmann, M. M. and A. J. Garrett (2006). 'Antenatal perineal massage for reducing perineal trauma.' Cochrane Database Syst Rev(1): CD005123.


[6] Eogan, M., Daly, L., O'Herlihy, C.(2006). The effect of regular antenatal perineal massage on the postnatal pain and anal sphincter injury: A prospective observational study. Journal of Maternal-Fetal and Neonatal Medicine, 19(4), 225-229.

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Cobourg, ON K9A 1C2

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Disclaimer:  This website contains information for educational purposes only and is not intended to diagnose or treat any medical condition.  Please consult your physician, or other qualified health care provider, before making decisions regarding your care.