Perineal massage, by Kirsty Gallacher

I hope this finds everyone well and enjoying a little bit of sunshine! I know we Brits have a habit of going on about the weather but it's great to be out and about and I've bumped into so many familiar faces from classes, with buggies and new babies...

We had a bit of excitement at one of the recent Wednesday evening classes, with Cathryn's waters breaking (just after practising the 'birthing breath'!), and I'm very happy to be able to let you all know she had a lovely baby boy. Congratulations not only to Cathryn but to all of you who have slowly 'disappeared' during June!


So, this blog has the info I've been promising on perineal massage...

enjoy :-)


Also, details of the next Preparation for Birth workshop (if you're wondering about whether to do this or the next one, keep in mind that we won't be running another till mid September).


Perineal Massage Using Yoga Breathing

You can prepare the base of your pelvic floor area, known as the perineum, so it can yield and stretch more easily during the birth of your baby. The perineum is the area between the back of your vagina and your anus. There is some research evidence to show that antenatal perineal massage can help stretch this area sufficiently to avoid tearing and reduce the need for an episiotomy. You can begin any time during the last eight weeks before your due date. (Discuss this with your midwife or doctor if you have genital herpes or vaginitis, as the massage can worsen these conditions and it might be best to use the breathing method without inserting your thumbs into the vagina.) One method to prepare this area is through breathing and another is through gentle massage. For the best results use the massage and breathing combined as it will help you learn to relax the pelvic floor muscles while they are being stretched, as will happen during birth – and this takes practice!


Getting Ready

Begin by emptying your bladder and getting into a comfortable position. You can sit on your bed propped up by pillows or on the toilet. A warm bath or applying a hot flannel to your perineum can help relax the area, get blood circulating and soften the tissues.


Do some pelvic floor exercises (as we do in class). Breathing in, tighten the pelvic floor muscles, toning them. Feel where these muscles are and feel their strength. Breathing out, slowly release these muscles. Do this several times before progressing to the massage. If you're not doing the massage, spend 5 minutes a day on this pelvic floor work instead.


Use good quality, natural oil (sunflower, olive, wheat germ, almond, or vitamin E oil), and massage into the area using gentle stroking without pressure to encourage the blood flow. Learn to differentiate between the vaginal and anal tissues, as it will be the vaginal tissues which get most stretched during childbirth. If you had any tears or a cut in a previous birth, focus particularly on these areas.

Massage and Breath Combined

Here you use your fingers passively, simply as a focus to breathe against. The stretching comes from within the tissues themselves on the out breath. Insert 2 fingers into the vagina up to the first knuckle. With practice you'll probably find that you can progress to the second knuckle. Now press firmly but gently against the back wall of the vagina and stretch towards your spine. Continue like this, breathing deeply and trying to feel the involvement of the muscles under your fingers each time you breathe out. Gradually lengthen the out-breaths and feel how the pelvic floor relaxes even more – keep using the out-breath to consciously release the muscles and feel the stretching coming from the tissues. Do not massage the front part of the vagina near the urethra and clitoris – just the posterior part, as this is the area that really needs to stretch during the birth. Try to keep your fingers passive against your breathing, and avoid 'manual' attempts to stretch mechanically. Use the breathing and massage combined for about 5 minutes daily. Think of this preparing of your perineum as something like stretching a balloon. At first it may seem like nothing is happening. Then your perineum, like the rubber of a balloon, starts giving and stretching with ease. You'll find that with regular practice an amazing amount of stretching takes place. When you become aware of extra space you can begin to exert a little more pressure with your fingers and bring the stretch slightly out to the sides in a 'sling' or 'u' shaped movement.


If you want, you can try tensing the muscles just to feel how uncomfortable the perineal stretching is when the muscles are tight and tense. This is good reminder of how important it is to learn how to release the pelvic floor muscles when your baby is being born during the second stage of labour. It's also a good reminder to keep the mouth and jaw soft and relaxed, just as they need to be during labour and childbirth. Keep in mind the connection between your mouth and jaw and your pelvic floor – if they are loose, your pelvic floor will be loose too and can stretch more easily. Try it and see.


Finish off with a few more pelvic floor exercises, remembering that the tightening on the in-breath helps to keep the muscles well toned and the releasing on the out-breath teaches you how to relax the muscles while your baby is being born. And finally, it's said that the more you pre-stretch before birth, the better you will return to your 'original shape' afterwards.