Why perineal massage is so important and a simple HOW-TO guide
Everyone is naturally concerned with the pain of labour and also the potential damage that could happen to the pelvic floor during childbirth. However, it is important to realise that very few women experience severe damage to this area. The pelvic floor is designed to stretch but also tear and repair. It is an incredibly vascular region of the body. One of the number one ways to prepare your body (and mind) is through simple perineal massage and stretching. Perineal massage, although perhaps a bit confronting, is always a huge confidence booster for mums (and partners) who give it a try. When practised daily from 36 weeks on it is proven to reduce both the rate of episiotomies (cutting by an obstetrician or midwife to increase space in the pelvic floor) and perineal pain postpartum. (See Cochrane Review) Perineal massage also helps to reduce fluid retention in the vaginal space, prepares the body for its natural opening and can potentially help reduce the chance of tearing. It is a great way to build confidence in your body’s natural abilities as well as find the connection to sensations of stretching and even learning ‘where’ to push during the second stage of labour. Here are 3 simple ways you can prepare your pelvic floor for childbirth.
How to perform perineal massage
1. Manual perineal massage (alone or with your partner)
After hands are washed add a little bit of coconut oil to the area and your fingers. Insert one finger into the vagina, just up to the first knuckle. Now imagine your vagina is an old fashioned clock – with the urethra or pubic bone as 12 o’clock and the tail bone or anus area as 6 o’clock.
With your exhalation gently press downwards and backwards toward the tailbone / 6 o’clock and release – repeat six times. Then, gently press towards 4 o’clock and then 8 o’clock, six times each.
It is good to come back to the exercise every 3-5 days and you will be able to notice that as you relax more the area becomes both elastic and more comfortable to stretch.
You could build up to using two fingers, two knuckles deep and perhaps start to hold the stretching position for a little longer at 4, 6 and 8 o’clock. Mums can guide partners when to hold on the stretch so they can practise breathing into the area, rather than holding it tight, and becoming more comfortable with burning and stinging sensations.
Mums can also do this on their own with one foot up on a chair or the toilet after a shower or a bath, using their own fingers and reaching around, entering from behind. You can alternate legs and use alternate fingers if your back gets sore. With your partner, you could lie back on some pillows semi-reclining and knees relaxing open.
2. Manual perineal massage (with a physiotherapist)
Some people prefer to get help from a physiotherapist and at She Births® we actually recommend all of our mums visit a womens’ specialist physiotherapist during their pregnancy for a general assessment. The physiotherapist can do a digital exam (using their fingers) and not just an ultrasound (which is only partially effective) and help you understand the natural tone of your pelvic floor muscles.
Most Australian women are hyper-tonic (overactive) in their pelvic floor muscles surprisingly. By checking in pregnancy you will also have a baseline to refer back to because it is very helpful to revisit the physiotherapist at least one more time at the 6-week postpartum mark.
The physiotherapist will be able to direct you with releasing and tell you if you are holding more on one side than the other and also give specific exercises either to strengthen or release. Learning to release is probably the most important part of your pelvic floor preparation.
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3. Perineal stretching (using an Epi-NO)
The final way you could prepare your pelvic floor is by purchasing an EPI-NO online. Generally about $100. They can be used for two pregnancies, but not shared between women.
The EPI-NO is a small device that you insert into your vagina and inflate according to a protocol and then gently practice pushing out.
EPI-NO says it is important to blow the balloon up to 8-10cm dilated before birth and practice pushing out this size. However, myself and most physiotherapists will agree that it is more important to only blow up to where you are comfortable, say 5-6cm and no more.
Remember you do not have the hormones yet that will be at peak levels in your body very soon in labour, for the 10cm push!
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