Midwife Matters

Massing the perineum (skin and tissues around the vaginal opening) daily during the last six weeks of pregnancy may help you avoid the need for an episiotomy or prevent tearing by stretching the vaginal and perineal tissues. Strengthening and learning to relax the pelvic floor muscles by doing Kegel exercises is also helpful.

1. The massage should be done daily for five to 10 minutes beginning at 34 weeks (six weeks before your due date). You can do the massage yourself, but many women have found it easier for their partner to do it.
2. Make sure your bladder is empty and that your hips are propped up comfortably. When starting the massage, you might find that a warm bath softens your perineum. Use a mirror the first few times to become more familiar with the area you are massaging.
3. Massage a natural oil (wheat germ, olive, or plain salad oil) into the tissues of the perineum and just inside the vagina. Pay special attention to any scar tissue from past deliveries.
4. Put your thumbs (or have your partner put both index fingers) about 2 inches into the vagina and press downward toward the rectum. While maintaining steady pressure, the fingers should be moved upward along the side of the vagina in a rhythmic “U” or “sling” type of movement. Be sure to avoid rubbing the urinary opening, which is at the top of the vagina.
5. As you massage each day, your tissues should relax and stretch. Gently stretch the vaginal opening as wide as possible each time until you feel a tingling or burning sensation. This will help you recognize the feeling that you will have when the top of your baby’s head begins to show during delivery.
6. Hold this stretch, without pain, for 45 to 60 seconds and then release. Massage with more oil, stretch again to the maximum hold, then release.
7. In the beginning, your perineum will feel tight, but with time and practice, the tissues will relax and stretch. If you do the massage faithfully, you/your partner will be able to insert more fingers into the vagina as our perineum becomes more elastic.
8. Do a Kegel exercise (tighten the pelvic floor muscles) and feel how strong the muscle is. Feel how difficult the stretching is when you are tensing the muscles of the pelvic floor. Consciously release them as you do the massage. Remember to do Kegel exercises before and after your baby is born to improve muscle strength and tone.
9. This massage should not be painful. If you have any problems, talk with your care provider.