What is perineal massage and how does it help?

One of the things that our mums-to-be worry and ask us about in our MummyNatal classes is whether there’s anything they could do during pregnancy or labour to avoid tearing. Whilst every woman, baby and birth are unique, and there is no way of telling whether vaginal tearing will or won’t happen, it is a certainly a possibility. There are however factors that can play a part in helping a woman achieve a positive outcome in this sense (i.e. no vaginal tearing!)

But first of all, let’s take it a step back.

What is vaginal tearing?

vaginal tear is a spontaneous laceration to the perineum, which is the area between the vagina and the rectum. It can occur towards the final stages of the second phase of labour when the baby is being born. With the head being the biggest part of the baby’s body (and often the first one to come through the birth canal), the vagina has to stretch considerably to allow for the baby’s head to be born. Of course, that’s exactly how a woman’s body has been designed to work, so the tissue can and will stretch, but it is possible that tearing occurs in the process. And this isn’t just a possibility for first-time mothers – the birth of subsequent babies can cause tearing as well.

How bad is it?

The good news is that because a vaginal tear is a cut that occurs spontaneously, it’s often a lot better than an incision made by a doctor during the birth (i.e. an episiotomy). However, there are 4 different degrees of vaginal tears, with the first degree being the least serious type. A first-degree tear may require a little suturing but doesn’t involve muscle laceration. A fourth-degree tear, on the other hand, is quite deep and can extend right through the rectal lining. These tears aren’t very frequent, but when they occur, they require repairs that involve closing multiple layers of tissue.

Although each experience will differ and vary according to the position and severity of the tear, when a tear occurs a new mum can expect some discomfort during the initial postpartum period. This could be particularly noticeable when sitting down, going to the loo and even coughing or sneezing. With the more serious types of tears, full recovery and disappearance of any symptoms could take up to a few months.

How can I prevent a vaginal tear?

We know that giving birth in an upright position, which reduces pressure on the perineum and vaginal floor, can help. But we also find that when a mum is more ‘in tune with her body’ during the pushing phase of labour, she will feel and know when to push and when to pause. This will minimise the risk of experiencing a tear (and especially a serious one) because allowing the right amount of time to birth the baby also gives the vagina the opportunity to stretch slowly.

A warm compress or giving birth in water is also thought to help prevent tearing – as the temperature increases blood flow to the area, while the compress/water act to provide counter pressure as baby is birthing.

Exercise in pregnancy can also encourage optimum blood flow to the area, improving circulation and skin/tissue elasticity. This is another reason why the birth ball exercises we practice in our MummyNatal classes include so much focus on the pelvic area, and so are fantastic in helping women prepare for their birth!

But there’s something else that mums-to-be can do during pregnancy to minimise the likelihood of a tear happening, and that’s perineal massage. There is no hard and fast rule here, but a good time to start doing this is from around 4-6 weeks before your estimated due date, a couple of times a week.

We asked MummyNatal founder Steph Beaumont, who is pregnant with her 5th child, to tell us a bit more about perineal massage.

“Perineal massage is probably one of the least glamorous tasks on the list to prepare for childbirth, but it’s worth finding out a little bit about as an option open to you. Out of four of my children, I have torn with three of them during birth. I didn’t with number four, and was astounded at what a huge difference it made to my comfort, postnatally!

For me, being aware of different ways to minimise tearing became important to me, mainly due to the experience of tearing badly with my first baby. It was so painful for so long afterwards, and I couldn’t hold or feed my baby for hours after they were born, due to the discomfort and then the repair work needed. While this had an obvious physical impact, it also really affected me emotionally, and it still does to some extent today, something which I didn’t quite realise the significance of at the time.

There is no way to know for sure what it was that made the difference for my fourth birth, the one where I didn’t tear. Birth position certainly makes a BIG difference but it’s not always the only factor, as I still tore with my third child, even though I was in water, in an upright position, and following the sensations of my own body.

However, I also suspect that birthing my fourth without a midwife present, was a part of it. I was much more focused and in tune with my body as my fourth child was being born, because I had to be! I had my hands on my baby’s head the whole time he was crowning, and I think it gave my body the direct feedback it needed to take that part more gently and let everything stretch and expand.

In addition, what I do through MummyNatal as part of my work for The Natal Family has given me great belief in my ability to birth, so even without a midwife present (which had not been the plan) I wasn’t fearful or worried, just calm and focused. This in itself makes a huge difference too, as being calm and relaxed in mind, also corresponds to what happens in the body, and my state of mind allowed for my body to be relaxed at this point too, rather than tense. This is important as it is easier for relaxed tissues to expand and stretch, than tissues which are being held tense and taunt.

That all said, I think there is great benefit in perineal massage – in getting used to that sensation of the stretch (ready for the similar sensation of baby’s head) and practising being able to relax as you feel that kind of sensation, rather than tense in fear. Perineal massage is really valuable preparation for this, and it also helps to make those tissues more supple and stretchy.

We must remember that perineal massage doesn’t just involve rubbing suitable oil/gel on the perineum, but it’s about actually inserting your thumb/fingers into the vagina next to the perineum, up to about the knuckle, and stretching the perineal tissues. I do this by moving my thumb in a U shape motion.

You can do this standing up, or laid in bed – however feels most comfortable to you. Admittedly, perineal massage is not the sexiest activity ever, but that said, some couples do this together, as later in pregnancy, it can also be more difficult for mum to reach on her own!

Personally, as it can’t cause any harm and can only help, it is something I am committing time to this pregnancy! However, if it is something which does make you feel uncomfortable it is not an ‘essential’, and there are lots of other ways, as already discussed, you can also use to help prepare the body. In addition to perineal massage, I am also doing birth ball exercises during pregnancy, planning to use water to birth in, to birth in an instinctive and upright position, to work with the natural sensations of my body at that point, to stay calm and focused, and to use my own hands to the baby crowning for that direct feedback again.

Perineal massage is one option open to us as pregnant women, in preparing for our birth, and like any option, it’s definitely worth finding out more about!”

Had you come across perineum massage before? Did you or would you try it?

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