Monday, September 24, 2012

Perineal Massage for Birth: How to do it

Below are some guidelines on performing perineal massage that you can provide to your client and/or her partner:

1. GATHER ITEMS NEEDED: nourishing oils, such as sweet almond oil, Vitamin E, coconut or avocado seed oil. Do not use synthetic, petroleum-based oils such as mineral oil or Vaseline, which leave a water-repellent residue and may ultimately dry out the tissues. Warm the oils first if desired.

2. CLEANLINESS: Place a towel under her bottom, to absorb any dripping oils. She may wish to take a warm bath or put warm moist washcloths on her perineum to help it relax more fully before starting bodywork. Some women may want a mirror so they can see their perineum and be able to visualize what happens as they relax, tighten, or stretch during the process.

3. COMFORT:  She should be comfortable, well-supported in semi-reclining position. Talk about what you are about to do before actually touching, so that you both feel connected and clear about the nature of this practice.

4. ATTUNEMENT: When you are both comfortable and relaxed, place your hands on your partner’s perineum, allowing the palm of your hand to press gently against her outer labia and your fingers to rest on her yoni and pubic bone. This gives her a chance to breathe and relax, getting accustomed to being touched in this way. REMEmber this is not meant to become a sexual time for you the Giver... it is about tending to the Mother.

5. LUBRICATION:  Dip your fingers into the warm oils, and gently lubricate the outside of her perineum. When she says she is ready, re-lubricate your fingers and slowly and gently slide one and then two fingers about 1/2 -1 inch into the bottom of her vagina. Lubricate inside with the oil.

6. KEGELS:Ask her to squeeze her muscles, like a Kegel exercise. If you cannot feel her tightening, she may want to practice strengthening and toning these muscles for birth. Work together for a few moments tightening and relaxing these muscles, having her practice and focus on relaxing them completely in-between squeezes.

7. EXPLORE: Put the fingers in further if she is comfortable. Think of the yoni as a clock, the top, by the urethra where she pees from, is 12:00. The bottom is 6:00.  Press in slowly at 7:00 work your way up toward 11:00 pressing slowly and firmly on the sides. If you find tight areas, help them relax by using gentle pressure and very sliding across the tissue.  Communicate regularly with her to ensure comfortable pressure, speed, and right amount of lubricant.

CAUTION: Do not go all the way to the top (12:00) under the pubic bone where the urinary opening is; avoid rubbing there, which could cause inflammation or introduce bacteria to the bladder. Do not press hard at the bottom either (6:00) at the rectum, unless it feels good to her. Some women have a bulging there, which may be a rectocele, or bulging of the rectum into the vagina.

8. STRETCHING: Repeat on the other side. Press slowly in with the flats of your fingers feeling for tight areas or areas she says she feels tension. Stop and hold pressure in those spots, as she breathes and practices relaxing her perineal muscles. This should not be painful, but she should feel the stretch and relief of discomfort as you hold. Don't move alot back and forth, just simple holding will help relaxation. This is a good time for her to practice breathing into her abdomen and relaxing fully with each exhalation. Visualization may help her relax. Verbally affirm her inner wisdom, and remind her to breathe slowly as she relaxes all of her muscles. Eventually the sensations in her bottom should be reduced. Repeat this exploring, sliding along the smooth tissues with firm pressure, stretching along the walls of the vagina. Explore from 7:00-11:00 on her right side and from 1:00-5:00 on her left side.

9. COMPLETION: When completed, place your palm over the outside of her yoni, fingers resting over top of her pubic bone. Acknowledge and appreciate the work she has done relaxing and opening, and remind her that during birth, she will have the skills to again relax like this to allow the baby to come easily through her.

For more info about touch and birth go to :

Is prenatal perineal massage helpful?

There are different perspectives on the use and benefits perinatal massage... No other mammals do this, so why should we? Well... No other mammals contend with what we as modernized humans do: poor posture, abuse histories, pelvic and menstrual pain, pap smears and other intrusive medical procedures, and with general cultural-patriarchal suppression of natural feminine wisdom. Few women have a healthy relationship with their yoni that reflects awareness, respect, care, not to mention adoration! In America especially, women tend to be disassociated from and ignorant about their pelvic floor.

Prenatal perineal massage offers an opportunity for a woman to become more familiar with her own geography, by experiencing nurturing touch without expectation of delivering sexually to a mate or being intruded on by a speculum. It offers the opportunity to relieve tension and muscular imbalance that she did not even know was there but which may be affecting the alignment of her uterus, or affecting back or hip pain, sciatica, or other discomforts. If  both partners can practice simple presence while exploring sensation, her tense muscles can relax, blood flow and renewed energy will be enhanced in the region, and she may find herself more awake in her pelvic base supporting her spine and abdomen through the changes of pregnancy.This can all help her tissues to stretch more easily at the time of birth.

Studies have also shown that first time moms do benefit from doing perineal massage with a reduced rate of lacerations at birth. A review of 3 trials with 2434 women found that those who did prenatal perineal massage for at least 4 weeks before delivery had an overall reduction of trauma that required stitches. They were less likely to have an episiotomy. Women who had had children previous to this birth reported a statistically significant reduction in incidence of pain at 3 months postpartum.

Cochrane Database Syst Rev. 2006 Jan 25;(1):Antenatal perineal massage for reducing perineal trauma.Beckmann MM, Garrett AJ.