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The What, Why, and When of Perineal Massage

Not going to lie-in my many years of being an L&D nurse, this topic was the one that would definitely get an eye roll from me! BUT now that I know the rationale and benefits of perineal massage, it really makes sense and can be beneficial.


The perineum is the area between the vagina and anus. This is the area that usually tears during a vaginal delivery. Most moms will tear, lacerations are normal and sometimes unavoidable. Episiotomies are a conversation for another time!!! The performance of perineal massage is thought to make the perineum tissue "more stretchy", therefore allowing it to stretch and not tear as badly.


The real rationale, and the one that makes more sense to me, is that by performing this massage, it allows you to feel the burning of the perineum (the ring of fire) and learn how to relax and allow for your baby's head to stretch the perineum naturally and not tear as badly from delivery. The more practice you have in teaching yourself to relax and not tense against the burning, the more successful you will be in controlling your pushes and your baby's head during delivery.


As with anything, please consult your provider before performing!!!!


Perineal massage is usually performed after 34-36 weeks. The general instructions are as follows:

  1. (Optional) Take a warm bath or shower or use a warm compress on your perineum to increase blood supply and soften the tissues.

  2. Make sure your nails are clipped and filed smooth.

  3. Wash your hands.

  4. Sit comfortably in a semi-reclined position in a quiet place. Lean back on pillows, bend your legs, and spread your knees open.

  5. Put a drop or two of oil or gel on your thumbs and perineum.

  6. Place your thumbs about 1 to 1½ inches (to or just past your first knuckle) inside your vagina. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling. (It shouldn't hurt, however.)

  7. Hold this position for a minute or two.

  8. Now slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Massage up and down in a U shape (from 9 o'clock to 3 o'clock, if you imagine a clock face), while gently pressing outward. Keep this up for three to four minutes.

  9. Finally, massage the tissue that you're holding between your thumb and forefinger back and forth for about a minute.

For partners: Follow the instructions above but use your index fingers instead of your thumb to massage from one side to the other, gently pressing downward.


DO NOT:

  • overdo it!! You can cause damage to the perineal tissue!

  • put pressure on the urethra. Major infection risk!!

  • perform if you have any active infections (especially vaginitis, HPV, and Herpes)!!!

  • perform until consulting with provider!!!

Perineal massage is performed with an oil (coconut, sweet almond, vitamin E, or with a vegetable oil, such as olive or avocado). Water-soluble lubrication may be used, but it can cause irritation to the tissue after multiple uses. Ask your midwife or provider may have a recommendation on what to use.




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