Perineal massage is an activity that can accomplish several objectives: create a more elastic perineum and ease baby’s passage (and mom’s comfort during that passage); help mom become comfortable with her body’s function; and get dad involved in the birth preparation.
Some moms may prefer not to do perineal massage. It is a personal choice. Moms who do elect to practice perineal massage seem to increase the likelihood of avoiding a tear.
Perineal massage should be started about 6 weeks before due date and should be done daily. A lubricant such as olive oil, almond oil or vitamin E oil reduces friction during massage as well as increases suppleness of mom’s tissue. Supple, elastic tissue does not equate with stretched out, loose tissue. A ballerina who can do “the splits” does not have loose, flabby tissue and muscle tone; rather she has worked at stretching her muscles and toning her tissue. If I were to try to do the splits today, there is a 99% likelihood that I would tear my ligaments in my groin. If I practiced for six weeks, stretching each day, by the end of that time, I would probably be able to gently lower myself into the “splits” position. So it is with birthing a baby. “Practicing” the baby’s birth by doing perineal massage mom’s likelihood of tearing her muscles and tissue during birth. Perineal massage does not create a flaccid vaginal wall; rather it increases mom’s awareness of muscles control and the tone of those muscles.
It is best to have mom’s husband help her with the massage, although it is possible for mom to do the perineal massage alone. A mirror is helpful for mom if she is going to do the massage herself (but not absolutely necessary). Fingernails should be short and a fresh pair of disposable latex gloves can sometimes be eaiser on mom’s vaginal area than rough hands (wash hands before beginning). Positions for perineal massage are: semi-sitting, squatting against a wall or standing with one foot raised and resting on tub, toilet or chair. Pour chosen lubricant over the fingers and thumbs rather than dipping hand into oil. With oiled fingers, rub oil into perineal area.
If mom is doing massage alone, the thumbs will probably be easier to use. Dad can use his index fingers. Place the thumb or index fingers inside the vagina (up to the second knuckle); move them upward along the sides of the vagina in a rhythmic U or sling-type movement. This movement will stretch the vaginal tissue, the muscles surrounding the vagina and the skin of the perineum. Mom can also massage by rubbing the skin of the perineum between the thumb and forefinger. The vaginal and perineal sensations will be of tightness, at first, but as the weeks progress, daily massage will relax and stretch the tissue.
As dad is doing the massage, mom should concentrate on relaxing her muscles as she feels pressure. As dad becomes more comfortable massaging, he should increase the pressure just enough to make the perineum begin to sting from the stretching (just as it does when baby’s head is born.) Mom and dad should continue massage for at least five minutes and should consult with their care-giver if they have any questions about the massage.