Prenatal perineal massage is a technique which slowly and gently stretches the skin and tissues around the vagina and perineum. The perineum is the area between your vagina and rectum. Perineal massage helps reduce both the risk of tearing during birth and the need for an episiotomy (or “stitches”).

Perineal massage helps prepare you for the feelings of pressure and stretching that come as your baby’s head is born. Knowing what some of the sensations will be like can help you to relax and give birth instead of tensing up and fighting the sensations such as stinging, tingling or burning that you may feel as your baby’s head is born. Perineal massage can also encourage you to relax when you have a vaginal exam.

It is also helpful to learn relaxation techniques, information about your anatomy and what will happen during labor and birth. Childbirth preparation classes can help you become more aware of your body and how you can help yourself during birth.

CAUTIONS:

1. Avoid the urinary opening (see diagram) to prevent urinary tract infections.
2. Do NOT do perineal massage if you have active herpes lesions, as you could spread the herpes infection to other areas.

General Hints:

• The first few times It’s helpful to use a mirror to find the vagina and perineum and see what they look like.
• If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.
• If you have had an episiotomy with a previous birth, concentrate part of your massage on that area, Scar tissue isn’t as stretchy as the rest of your skin and needs extra attention.
• The position in which you give birth can affect the likelihood of perineal tearing and the need for an episiotomy. Upright positions (sitting, squatting1 kneeling) or side-lying positions reduce the strain on the perineum. Lying on your back with feet up in stirrups makes an episiotomy almost inevitable.

After childbirth, tone up the stretched muscles in the vagina by continuing the pelvic floor (Kegel) exercises that you learned in childbirth preparation classes.

Directions:

	1. Wash your hands.
	2. Find a private, comfortable place and sit or lean back in a comfortable position.
	3. Put a lubricant such as KY Jelly, cocoa also butter, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum. You can also use your body’s own natural lubrication.
	4. Place your thumbs about 1-1 1/2″ (3-4 cm) inside your vagina Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation.
5. Hold the pressure steady at that point with your thumbs for about 2 minutes until the area becomes a little numb and you don’t feel the tingling as much.
	6. Keep pressing with your thumbs. Slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Keep this up for 3-4 minutes. Remember to avoid the urinary opening.
7. As you massage, pull gently outwards (forwards) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin as the baby’s head will stretch it during birth.
8. Do this massage once a day starting around the 34th week of pregnancy. After about a week you should notice an increase in flexibility and stretchiness. PARTNER MASSAGE: General Hints for mothers: You may use either your index fingers or your thumbs. Sometimes only one finger or thumb will fit into the vagina until the skin has become stretched. Listen to your partner. It is her body. Be sensitive to what she wants you to do. Massage firmly but gently. She will tell you how much pressure to apply Directions: Wash your hands. Put some lubricant on your fingers and on your partner’s perineum. Place your fingers gently inside her vagina about 1-1½” (34 cm). Press down until she tells you it is beginning to sting and burn. Hold the pressure there for about 2 minutes until she tells you it is getting numb. Gently and slowly sweep your fingers from the center to the sides and back to the center again, pulling forward slightly as you massage. Give extra attention to any episiotomy scar. Remember to avoid the urinary opening. Massage for about 3-4 minutes once a day.   This information has been prepared by Elise Fleming, MA, CCE, with illustrations by Leigh Landskroner. Published by ICEA. For more information on childbirth preparation and other topics related to family-centered maternity care, write to ICEA, PO Box 20048, Minneapolis, MN  55420-0048, USA