Informed Choice

How to do perineal massage

The perineum is the area of skin and muscle between your vagina and anus. That’s the bit that has to stretch to around 10 cms diameter to enable your baby’s head to pass out of it.

The perineum should naturally stretch during the birth to allow your baby’s head and body to be born. But sometimes it can tear. Around 85% of women will sustain a tear during birth – and around 2/3 of those women will need stitches.

Can you avoid a tear?

Perineal massage during pregnancy helps to gradually soften and stretch the vagina and the perineum in preparation for birth.

It seems to particularly help first time mums.

Research has shown that massaging the perineum from around 35 weeks of pregnancy reduces the amount of tears that need stitching and reduce your chance of needing an episiotomy – the cut sometimes made through the  perineum to help the baby be born. Midwives and doctors should not be doing routine episiotomies anymore in the UK.  An episiotomy is performed if you need an assisted birth using forceps, although with a ventouse (suction cup) this isn’t always necessary.

But perineal massage has also been shown to reduce perineal pain in the months after birth for women who have had more than one vaginal birth. The evidence also suggests that women having their first baby, women 30 years and older and women who have had episiotomies before, can particularly benefit from perineal massage. Perineal massage can also be beneficial to women who are planning a first vaginal birth after caesarean (VBAC)

So although recent evidence seems to suggest that it may not be so beneficial for 2nd time mums, I personally feel that getting in touch with your body, and the sensations produced by birth may be healing and encouraging for many women.

Why do it?

  • It helps to gradually soften and stretch the perineum ready for birth.
  • It helps you get to know your body and gets you ready for the sensations of pressure and stretching that you feel as your baby’s head is being born.
  • You’ll feel less scared about those sensations and will be able to relax and open more easily.
  • Do it with your partner and it gets the oxytocin flowing

When should I start and how often should I massage?

  • Start from 35 weeks
  • Do it 2-4 x per week – some evidence suggests too frequently does not confer much or even any benefit. See links below.
  • Do it for 5 mins each time

Get Prepared

  • To start with use a mirror and look at your perineum.
  • Wash your hands and have a wee – get comfy.
  • Positions you could try include semi-sitting, squatting against a wall, or standing with one foot raised and resting on the bath, toilet or a chair. But you could probably get comfy on a bed with some pillows, propped up.
  • Do it after a bath to start with which may help you feel more relaxed
  • Olive oil works well.

perineal_massage2How to Do it.

  • Lubricate your fingers well to allow your fingers to move smoothly over the perineum and lower vaginal wall.
  • It’s probably easiest to use your thumbs.
  • Your partner could use both their index fingers.
  • You’re aiming to place the fingers or thumbs about 2 inches (5cm) into the vagina (up to the second knuckle) But you might want to start a little at a time if it feels uncomfortable or you’re not keen on the sensation.
  • It may feel quite tight to begin with but will relax over time.
  • Using your two thumbs press downwards in the direction of your anus so that you feel a stretch of the muscles surrounding the vagina and the vaginal tissues.
  • Once you feel this downward pressure,  sweep your thumbs from side to side in a rhythmic U shape movement.

While you’re doing it

  • Allow yourself to relax as much as possible.
  • Sink into the feeling and let your muscles unwind.
  • Practice your slow, deep breathing.
  • Massage the outer skin of the perineum between the thumbs and forefingers.

If this brings up issues for you then speak to your midwife. We all come to birth with different experiences from childhood or as we grow as women. It is much better to start a dialogue with your care providers before labour and birth so as they can be aware of your needs and support you to make decisions that empower you.

Further information and research:

Cochrane evidence review into antenatal perineal massage

Is there any benefit to perineal massage?  A good look at the evidence with explanation. 

A Midwife’s Guide to an Intact Perineum


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