As you cruise through your pregnancy, you might start to have some niggling fears about giving birth. How does one push a baby through the tiny opening that is your vagina? How will this not result in the splitting of body parts? Ladies, to be very honest, you can expect some kind of tearing down there during a vaginal birth. But, there's a way of minimising, even preventing, this ripping: perineal massage. Here, you'll learn all about it, including when to start perineal massage.
When to start perineal massage so that you can reduce the risk of severe vaginal tearing during birth?
Perineal Massage And When To Start Perineal Massage: A Guide For Expectant Moms
Before we go into exactly how to do a perineal massage on yourself, let's learn some information about your body, first.
You might already know that as your baby grows in your womb, he turns. Towards the end of your pregnancy, your baby should have fully turned, with his head pointing down towards your cervix and the start of your vaginal canal.
As the birth process starts, your baby, pushed forward by your contractions, makes his way down your birth canal and ultimately, through your vaginal opening. It is at this point when his head "crowns" and is birthed, that you are at the biggest risk of tearing.
Know where your perineum is! We also tell you later in the article when to start perineal massage.
What is the perineum?
The strip of soft skin between the anus and the vagina is known as the perineum. Because it comes under immense pressure when the baby is being born, it is very prone to rips and tears. Perineal massage can help prevent the worst types of tears.
There are four types of degrees of tears, ranging from very minor to severe.
1. First-degree perineal tears
These are the least severe of vaginal tears during childbirth and only affect the skin of the perineum.Usually, you'd only feel a bit of pain or stinging when you pee. If the tear affects the tissue underneath, then you get get a few stitches after the baby is born. First degree perineal tears will heal in a week or two.
2. Second-degree perineal tears
This type of tear affects both the skin and muscle of the perineum. It could extend deep into the vagina. A second-degree perineal tear needs stitches and takes a few weeks to heal.
3. Third-degree perineal tears
These tears "extend into the muscle that surrounds the anus (anal sphincter)," according to WebMD. Due to their rather severe nature, a third-degree perineal tear may need to be repaired in an operating theatre rather than the delivery room.
Typically, they take longer to heal than the other types of tears.
4. Fourth-degree perineal tears
The most severe of all perineal tears, these rip through the anal sphincter and extend to the mucous membrane that lines the rectum. Such tears will need to be repaired in an operating theatre too, and might need more specialised and rigorous after-care.
Sometimes, obstetricians will perform what is known as an episiotomy. This is a clinical incision of the perineum to allow for the baby's head to pass through more easily. This cut is stitched up after the baby is born.
When to start perineal massage? If you find it uncomfortable to massage your perineum on your own, get your partner to help.
How Perineal Massage Can Help Prevent Vaginal Tears And Episiotomies
Moms, ideally we don't want any kind of tearing of our lady parts during birth, whether these are natural rips or surgical cuts.
And this is where perineal massage can help.
What is perineal massage?
Very simply, it involves massaging the perineum by yourself, or with your partner's help.
What does it achieve?
By massaging the perineum, you're improving its flexibility in preparation for birth. Ideally, this will help the perineum stretch during the birth process, reducing or preventing the more severe tears.
The benefits of perineal massage in reducing perineal trauma have also been proven by research.
In one study involving over 2,000 women, researchers found that perineal massage reduced incidences of vaginal tears needing stitches in first-time mothers. Perineal massage also helped reduce the need for an episiotomy. But there was an even better benefit: mothers who practiced perineal massage had less pain in the region three months after giving birth.
How To Do Perineal Massage
By now, we've established the benefits of massaging your perineum if you're pregnant. Here's a step-by-step guide on how to do it.
- Wash your hands, and if your partner is involved, he should have clean hands too.
- Trim your/ your partner's nails
- Have on hand an organic massage oil like almond or coconut
- Get a clean towel and a mirror
- Take a warm bath or soften and relax the perineum with a warm, wet towel
- Settle yourself in a comfortable position on a clean towel. Use a pillow under your back and position the mirror if needed.
- Breathe in and out and relax yourself. This will help relax your anal area too.
- Take a small amount of oil into your palms, rub it between your palms for a bit so it warms up, then apply it on your perineum.
- Insert one or both thumbs about an inch deep into your vagina. Gently yet firmly press down towards the perineum (the direction of your anus).
- Let your perineum stretch for at least a minute. Initially, you may feel a slight burning or stretching sensation, but this will ease as your perineum becomes more flexible.
- After you've stretched the perineum for a few minutes in this manner, gently sweep your thumb/s up along the sides of your vagina applying slight pressure.
- Do this up and down and for as long as you are comfortable with it.
- If your partner is the one doing the massage, then they should use their index finger/s rather than their thumb/s.
When To Start Perineal Massage?
If you're wondering when to start perineal massage, Assistant Professor Rebecca Dekker (PhD, RN, APRN) says you can start at about 34-35 weeks of pregnancy. You should ideally perform it once a day, for at least 10 minutes.
Moms-to-be, we hope this guide on perineal massage is useful, and helps you prepare better for childbirth.
Also read: Pushing during labour increases chance of vaginal tearing by 700%!
References: Cochrane Database Syst Rev, Mayo Clinic, Science & Sensibility