How to Perform Perineum Massage

Perineum massage is the gentle stretching and massaging of the perineum (skin between the anus and vagina) during the last few weeks of pregnancy. It is usually begun at 34 weeks for approximately 10 minutes per day. It can be performed by the mother or a partner. Studies have shown it to reduce the incidence of episiotomy and perineal tears during childbirth.

It is performed with a lubricating oil that facilitates the massage, which increases the elasticity of the tissue. This increased elasticity allows the tissue to stretch and thus reduces the likelihood of tearing during the birth process.

An additional bonus of perineal massage is that it helps a woman understand what muscles she is using for birth so that she can more easily relax these muscles during the actual delivery. As we've covered previously, the more relaxed the mother is, the better the birth experience she has.

It is easier to remember to perform this technique daily if it becomes part of an established daily routine such as when bathing or before bed.

Technique for Perineum Massage:

• Wash hands thoroughly. 
• Trim nails to remove sharp edges. 
• Apply the lubricant of your choice to the perineum (olive oil, KY jelly, sweet almond oil, vitamin E, etc) 
• Place the thumbs into the base of the vagina up to the first joint, making sure they are well lubricated. 
• Using gentle but firm pressure, move the thumbs from the base of the vagina up the side walls as if you were making a "U", but remembering to avoid the urethra. 
• As you feel a tingle or stretching, hold the position until it subsides and then continue upward. 
• Return the thumbs to the base of the vagina, and repeat.

Remember to go slowly and be gentle. If you are too rough, you can cause irritation or infection. As you progress with perineal massage, you can introduce Kegel exercises into your routine as well.

For further information on the effectiveness of perineum massage, you may reference the following articles:

References

Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub2.

Labrecque M, Eason E, Marcoux S, Lemieux F, Pinault JJ, Feldman P, Laperriere L. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):593-600.

Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):76-80.

Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD000081. DOI: 10.1002/14651858.CD000081.