Antenatal Perineal Massage

Place your thumbs about 1 to 11/2 inches (three to four centimetres) inside your vagina. Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation. With your thumbs, hold the pressure steady for about two minutes or until the area becomes a little numb and you don't feel the tingling as much.

As you keep pressing with your thumbs, slowly and gently massage back and forth over the lower half of your vagina, working the lubricant (use any good massage oil or lotion to avoid friction burn) into the tissues. Be sure to give extra attention to any scared areas from previous births, as scared tissue will not be as pliable as undamaged tissues. Keep this up for three to four minutes. Remember to avoid the urinary opening.

As you massage, pull gently outwards (and forwards) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin much in the same way that the baby's head will stretch it during birth.

Do this massage once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility and stretchiness. .

Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial.

Shipman MK, Boniface DR, Tefft ME, McCloghry F.

Department of Obstetrics and Gynaecology, Watford General Hospital, Hertfordshire, UK.

OBJECTIVE: To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery. DESIGN: A randomised, single-blind prospective study. SETTING: Department of Obstetrics and Gynaecology, Watford General Hospital. PARTICIPANTS: Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995. RESULTS: Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P = 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P = 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P = 0.024 and P = 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30. CONCLUSION: Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.

Women's views on the practice of prenatal perineal massage.

Labrecque M, Eason E, Marcoux S.

Department of Family Medicine, Laval University, Canada.

OBJECTIVE: To determine how women who practised perineal massage during pregnancy assessed the technique. DESIGN: Observational study within one arm of a randomised controlled trial. SETTING: Five secondary and tertiary care hospitals in the Province of Quebec, Canada. PARTICIPANTS: Among 763 women randomised to the massage arm of a clinical trial of perineal massage during pregnancy, 684 (90%) who completed a questionnaire after delivery. MAIN OUTCOME MEASURES: A 20-item questionnaire completed a few days after birth. The first 18 questions elicited opinions using a 6-point Likert scale. Based on a factor analysis, 17 of these questions were classified into four categories: acceptability of perineal massage (8 items); preparation for birth (4 items); relationship with the partner (2 items); and effect of massage on delivery (3 items). Scores of each scale varied between 1 (highly negative assessment) to 6 (highly positive assessment). The last two questions asked whether women would perform the massage in their next pregnancy and whether they would recommend perineal massage to another pregnant woman. In addition, 262 also provided comments about their experience in the daily diary provided to record compliance during the trial. RESULTS: On average, perineal massage was felt to be quite acceptable [mean (standard deviation) 4.09 (0.93)]. Pain and technical problems reported during the first week or two of massage tended to disappear after a few weeks. Women's assessment of the effect of massage on preparation for birth [4.34 (1.08)] and on delivery [4.18 (1.37)] was positive. Women's views about the effect on their relationship with their partner were either positive or negative [3.54 (1.74)] and were proportional to the partner's participation with the massage. Most women said they would massage again if they were to have another pregnancy (79%; 95% CI, 76%-82%) and would recommend it to another pregnant woman (87%; 95% CI 84%-90%). CONCLUSION: Overall, women's assessment of prenatal perineal massage is positive.