Perineum massage is an old practice that has some debate around it. Some moms and midwives swear by it, and others are opposed. I will give you some direction here, and you can see if it feels right for you. I do feel like perineal stretching can increase your confidence in your body’s ability to stretch and open for your baby.
Many women don’t do any peri massage, so whether you have the confidence or not, your body knows what to do, and your perineum will stretch and open as much as it needs to.
There are certain situations where there is an increased chance of tearing that is just impossible to control like a big baby or for a first time mama or a first vaginal birth. That being said, there are ways you can prepare.
Perineum massage is meant to help your body get ready for your baby to be born. It’s much like stretching a balloon before blowing it up. This helps to increase the elasticity of the perineum, allowing for baby to fit through with minimal stress or trauma in that area. A good time to start perineum massage would be around 37 to 38 weeks.
Mix any of the following in a 15 mL bottle and fill to top with FCO
Using clean hands, put your thumb (or have your partner do this) about one to one and a half inches inside your vagina. Press gently but firmly downward toward your rectum. You may feel a little discomfort, or maybe even tingling. A little discomfort is fine, but burning is not. These tissues are extremely sensitive and may even be a little swollen, and with too much pressure, you could cause bruising. Keeping a steady pressure, move fingers or thumb from side to side and back and forth along both sides in a U-shaped motion on the lower half of the vagina. Continue this for three to five minutes. This can be repeated daily by gradually increasing the number of fingers used, and pressure applied. After about a week, you will notice an increase in stretchiness in that area.”
Things you can do to help reduce the chances of tearing.
I’d recommend having a conversation with your midwife or OB with your desires. A slow birth of your baby through the vagina allows time for your tissues to stretch. I also use warm compresses to help keep good circulation.
Best Positions for Birth
There are some birth positions that I often encourage a first-time mama to be in because they support an intact perineum. Both hands and knees and the side laying position are gentle birth positions. They keep the main pressure of your baby’s head off the perineum, where there would typically be a tear.
Worst Positions for Birth
Generally, in the hospital, you are in a semi-supine position; this is sitting slightly upright on the bed with the head of the bead raised and pillows behind you. This makes your perineum very tight as well as places all of the pressure of your baby’s head directly on your perineum, which greatly increases the chance of tearing. Although squatting is great for allowing a larger head to pass through it also increases your chance of tearing as well. Also, when a mama is standing, she might be in-store for a quick birth, especially if it’s not your first birth, again increasing your chances of tearing.
Directed Pushing vs Instinctive Pushing
The best thing you can do is have an honest, open conversation with your midwife or doctor. Communication is vital to ensure a slow birth to minimize tearing and avoiding an episiotomy.
Generally, once you hit 10 cm or complete, you will be instructed to grab your knees, bearing down hard for the count of 10, then quickly catching another deep breath and repeating this process until the contraction has ended.
This type of pushing has several detrimental consequences for moms, including increased perineal tears and long-term effects on bladder and pelvic floor health. Not to mention it reduces your baby’s oxygen.
In my experience, when a mama instinctively pushes, it is the most effective and safe way for birthing. I feel like you are the expert, your body tells you what to do, and when to do it. I am just here to support and guide you through your gentle birth experience.
I have mama only push when she gets the “urge”, then very slow and gentle. There are times when a good strong hard push is necessary, especially while birthing the head, it’s helpful to go slow to allow your perineum time to stretch while still having good circulation.
I often use a warm compress as a mom is crowning. It helps to support circulation and ease the tension on the perineum but also gives a good focus point as to where mom should direct her pushing.
Perineal Massage as Baby is Crowning
Massaging the perineum as the baby is crowning can reduce the chance of significant tears. Keep in mind that significant tearing is pretty rare, only around 3%. I like to use a blend of helichrysum diluted with olive oil directly on and around the perineum. This helps support the perineum. It helps keeps the skin nice and supple, and it does not absorb as quickly as coconut oil. Helichrysum helps with bruising, bleeding, and trauma. I don’t mind if it gets on the baby’s head as it will also support your baby’s head while it molds to come through the birth canal.
An episiotomy involves a deep cut into the perineal muscles and skin, ie. creating perineal trauma. Episiotomies are rare in my midwifery practice. I have only done 2 in my career, and both were necessary. In my experience, a tear, although it is much harder to suture, it heals much faster and with less scar tissue.
Healing From a Tear or Episiotomy
A small tear is pretty common, but the body is amazing and usually heals well. Your vaginal wall is a mucous membrane and heals very fast, similar time your mouth. Suturing is the most common method of perineal repair. I always give mom the option to suture or not. In my personal experience as a midwife, I have found that un-sutured perineums heal very quickly and with far less pain than a sutured perineum.
I heard Michel Odent, a French obstetrician specializing in natural childbirth say, “if the two flaps are in the same room, they will heal.” I thought that was so funny, but over the years I’ve also found that to be true.
Here is a blend I use for healing after birth.
Put it in a 6oz spray bottle topped with witch hazel. Great to just spray directly on the area, also on spray-on pads, then put in the freezer to use as a soothing ice pack.
In the end…
There is very little we as care providers can actually do to protect your perineum using interventions. Instead, I want to encourage you to trust your body and your innate ability to birth your baby, and if you do tear despite your preparations, your body is amazing and will heal itself.