From Robin Elise Weiss, LCCE,
Your Guide to Pregnancy & Childbirth.
FREE Newsletter. Sign Up Now!

When we think of avoiding an episiotomy in birth, we rarely think of anything beyond what our doctor or midwife can do for us. There are things that we can do for ourselves.

Prenatal perineal massage has been shown effective in preventing the need for episiotomy and a decrease in the amount of tearing a woman has during her birth. This is particularly effective in women over the age of 20.

This technique is used to help stretch and prepare the skin of the perineum for birth. The perineum is the area of skin between your vagina and rectum.

Not only will this massage help prepare your tissue, but it will allow you to learn the sensations of birth and how to control these muscles. This knowledge will help you be prepared for the birth of your baby. The knowledge of what you are feeling can help you relax this area even more, even during other types of vaginal exams.

Instructions:

• Find a comfortable spot where you can sit and be alone, or with your partner uninterrupted.

• Find your perineum with a mirror, to see what it looks like. You will not always need the mirror.

• You can use warm compresses on the perineum for about 10 minutes, or a warm bath might do the trick if you are tense.

• Wash your hands, or have your partner wash their hands if they will be doing the massage.

• Lubricate your thumbs and the perineum. You can use many different types of lubricant like: KY Jelly®, vitamin E oil, or pure vegetable oil. There are also some oils designed particularly for this use, they may or may not have herbal preparations in them.

• Place your thumbs about an inch inside the vagina, press downward and pull towards the sides. You should feel a light stretching, tingling or light burning, you should not feel immense pain. You will hold this stretch for about two minutes, or until the area becomes slightly numb.

• If you've had a previous episiotomy or tear, be sure to pay special attention to that scar tissue, it will not stretch as readily, and may need some extra work.

• Massage back and forth over the bottom area of the vaginal tissues, while massaging the lubricant in.

• Pull the thumbs out slightly, imagining how it would pull as your baby's head will be born.

• If your partner is doing this massage they may use their thumbs or index fingers, sometimes it's only possible to get one finger in until the area has been stretched. Be sensitive to her body and what she is giving you as feedback on the amount of pressure to use.

CAUTION: Avoid the the urinary opening to prevent urinary tract infections (at the top of the vaginal opening). Do not massage the perineum if you have active herpes lesions, this can cause the lesions to spread.

You can begin to do this massage around the 34th week of your pregnancy. If you are further along and haven't started, there is still benefit from doing it. You can do this massage as often as once a day.

Remember that massage alone will not protect your perineum, it is but one part in the grand scheme. Choosing a position for birth that is more upright (kneeling, squatting, sitting) will allow the perineum to evenly distribute the pressure. If you choose a side lying position this will also prevent enormous amounts of strain on the perineum. Lying flat on your back creates the most stress on the perineum, making a tear or episiotomy almost impossible to avoid.