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Approximately 85% of women will have some degree of perineal tear during a vaginal delivery.
What is the Perineum?
The area of skin between the anus and the posterior part of the external genitalia.
Massaging the Perineum has been shown to experience less birth trauma by:
• Increasing the area’s ability to stretch
• Reducing the need for an episiotomy
• Reducing the number of natural tears that may occur during a vaginal delivery.
Please note that perineal massage should only be completed from 35 weeks gestation onwards – there is no benefit starting before this.
Women who have had a previous vaginal delivery do not experience a reduction in birth trauma, however they do report less pain from their perineum at three months post-partum (after their baby is born).
What else can you do to prevent the likelihood of tearing your perineum?
• Upright posture such as kneeling, sitting or squatting (gravity assisted) during the second stage of labour rather than supine.
Patient on back with knees slightly bent.
Sitting or kneeling:
Patients’ weight supported by buttocks and thighs, knees bent, feet flat on bed or floor.
Patients’ weight on feet, knees bent.
How to massage the perineum
For pictures, please see link:
• A good time is during or after a bath or shower as the blood vessels in the area are dilated. This makes the perineum softer and more comfortable to touch.
• We suggest using a small amount of unscented, organic oil (for example almond or olive oil) or unscented personal lubricant (eg Yes or Sylk) to lubricate the area and make the massage more
comfortable. Do not use synthetic or scented oils (e.g. Vaseline or baby oil).
• Ensure you are in a comfortable supported position in a safe, secure environment where you are unlikely to be interrupted. You may find using a mirror helps initially.
• Place one or both thumbs within the back wall of the vagina, resting one or both forefingers on your buttocks. Pressing down a little towards your back passage (rectum), gently massage by moving your thumb(s) and forefinger(s) together upwards and outwards then back again.
• You should experience a stretch-like feeling which will be similar to the feeling you will have when you birth your baby. Aim to continue for 5-10 minutes at a time.
• With time you will be able to apply more pressure towards your back passage as the tissue becomes more elastic and easier to relax.
• We recommend that you do not do perineal massage if you have thrush or vaginal herpes.
Study findings for the effects of perineal massage
The most recent Cochrane review of evidence looking into studies of antenatal perineal massage to prevent birth trauma (2013) found that:
• Women who performed perineal massage showed a reduction in perineal trauma requiring suturing (stitching)
• Perineal massage reduced the risk of needing an episiotomy
• Women who performed massage the most frequently were less likely to report pain.
• Perineal massage is safe and is deemed as acceptable by pregnant women.
There is no increased benefit to doing perineal massage more than 3.5 times per week – we therefore recommend that you massage 3-4 times per week.
Terms and Definitions:
Spontaneous Perineal Trauma: Natural trauma to the perineum, not induced by episiotomy.
Episiotomy: Surgical enlargement of the vulvar orifice for obstetrical purpose during birth.
Laceration: The process or act of tearing tissues.
Acknowledgments: Women’s Health Physio team at Oxford NHS Trust.
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