A couple of years ago, I felt ambivalent towards perineal massage. Mostly I thought that it was awkward for the very pregnant woman to do, and there was little research to support the reported anecdotal outcomes.

Skip forward to today and new research shows done correctly and consistently in late pregnancy perineal massage can help reduce injury to your perineum after birth in the following ways:

• A reduction in severe perineal tears by 64%
• Reduced anal incontinence by 70%
• Reduction in episiotomy rates by 21%
• Reduced postnatal perineal pain

In my eternal quest for more knowledge to help improve outcomes for my patients, I have trained in perineal massage and can now teach pregnant women and their partners correct perineal massage technique for them to continue at home.

But first, let’s go back to the basics, where is the perineum?

Your perineum is the skin and muscle between the vagina and anus. It needs to stretch over your baby’s head and body during vaginal birth.

Many first-time mums will experience some tearing with vaginal birth. Most tears are minor and often don’t need stitches. These are called first degree tears.

Second and third degree tears involve tearing of muscle layers in the perineum and require repair after birth by an Obstetrician. Fourth degree tears are thankfully very rare. This is where the tearing extends through into the bowel itself. It is these tears we want to proactively reduce with perineal massage.

What is perineal massage?

Perineal massage aims to stretch and manipulate the perineum to help prepare the perineum for birth and labour.

Perineal Massage can be self-taught and a quick google search will give you lots of sites to show you the steps.

To some, perineal massage may sound daunting and understandably you may not feel confident to do this from written or verbal instruction alone.  You are not alone if you are wondering if you are doing the technique 100% correctly!

If you want reassurance that your efforts are the most effective, in your physiotherapy appointment, I teach you the practical skills of perineal massage with direct guidance and feedback to enhance your technique which are suited to your individual needs.

The consultation is also a great space to teach your partner the technique. This is ideal as it can be difficult to massage your perineum by yourself in the later stages of pregnancy. Both your partner and yourself can get direct feedback and correction in technique if needed.

Current recommendations suggest starting perineal massage at 34 weeks following clearance from your Obstetrician or care provider.

Perineal massage is also recommended if your obstetrician or care provider has noted an overactive pelvic floor or pelvic pain. If this is the case for you, a consultation can be made earlier than 34 weeks for a perineal massage assessment and treatment.

If you are going to start perineal massage, there are some indications where it should be avoided.

Perineal massage should not be performed if:

• You have placenta praevia (a low-lying placenta) or any other condition where there may be bleeding from the vagina during the second half of pregnancy.
• You are suffering from vaginal herpes, thrush or any other vaginal infection, perineal massage could spread or worsen the condition.
• You are not 34 weeks or more pregnant.

Written by physiotherapist, Belinda Matthews.

Belinda  has been working in Women’s health physiotherapy for 20+ years and has a special interest in the management of incontinence, prolapse, preparation for and recovery after pelvic surgery, pelvic joint pain during pregnancy, abdominal /pelvic floor muscle weakness and pre and postnatal pilates.

For more information on perineal massage or to book in with Belinda, please call Ballarat Women’s Clinic on (03) 5332 9940