Perineal Massage for Labor Preparation

Many women giving birth experience some sort of trauma to their perineal tissues. This is not surprising, considering that a 6-10 pound little person has spent minutes or hours pushing her or his way against a woman’s delicate innermost mucus membranes. If the baby descends too quickly or if the mother pushes too forcefully, it is possible that these tissues will not stretch adequately and they may tear.

Studies are inconclusive as to whether prenatal perineal massage helps decrease perineal tears at birth. They do seem to indicate, however,  that it will help a first time mom, or a woman who had previous episiotomy, to birth with less risk of tearing. Birth is a process that progresses more smoothly when a woman has familiarity and ease with her perineal area, and perineal massage can facilitate this when initiated up to 6 weeks before the expected delivery time. Additionally, internal pelvic floor massage can create more balance in the pelvic bowl and in all those muscles that support and influence baby's position in the womb. Better baby position equals more ease for birth.

The following benefits, contraindications and techniques can be practiced by a mother and willing partner.

Benefits
Five to ten minutes of daily prenatal perineal massage, beginning around 35 weeks of gestation, can provide the following benefits:

• Help a woman to become more accustomed to stretching and pressure sensations, enabling her to relax more easily when stretching during delivery.

• Help release constricted perineal musculature, enabling tissues to stretch more easily.

• Allow a partner to be intimately involved with his or her mate in birth preparations.  
      
• Give the woman an opportunity to encounter and work prior to birth with possible emotional issues related to perineal trauma or abuse.

• Produce a shorter duration of the pushing stage of birth for some women if psychological and emotional issues were addressed during prenatal perineal massage.


Precautions  
Observe these precautions when doing perineal massage:

• Avoid rubbing on the urinary tract opening to prevent inflammation of the urethra or introduce infection-causing bacteria to the urinary tract.

• Use caution and excellent communication with women who have a history of sexual abuse, as emotions or memories could be triggered during some perineal massage.
 
• Always clean the hands and fingernails well before and after the massage. Keep fingernails cut short to avoid injuring the perineal tissue.

Contraindications
Perineal massage should not be performed if the following situations exist:

• The woman has vulvar varicosities, active genital herpes lesions, yeast infection, or any active vaginal trauma, infection, or sexually transmitted disease.
• The woman does not want to have the massage.
• The person massaging is uncomfortable with the procedure and unable to support the woman’s sensations, requests, or responses.
• The woman is experiencing preterm labor. If she is, avoid perineal massage until she is at 38 weeks gestation to avoid any chance of uterine stimulation or introduction of foreign bacteria that could cause infection and stimulate contractions.
• If a woman is on bed-rest for any high-risk condition, she should contact her primary care provider to determine whether and when perineal massage is appropriate.

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