Massaging the
perineum in the weeks before
childbirth can reduce the risk of
episiotomy during
childbirth. The actual technique is difficult to describe, so I will quote three different sources, plus the results of a study into its effectiveness.
This first description is borrowed from Women's Health, UK
(www.womens-health.co.uk) who, in turn, borrowed it from
the British Journal of Obstetrics & Gynaecology.
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The massage oil to use is sweet almond oil.
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The massage should be done three to four times a week for 4 minutes, beginning 6 weeks before your baby is due.
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Lubricate your fingers well with the almond oil. You need enough to allow your fingers to move smoothly over the perineum and lower vaginal wall.
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If you are doing the massage yourself, it is probably easiest to use your thumb. Your partner can use both index fingers.
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place the fingers or thumb about 2 inches (5cm) into the vagina (up to the 2nd knuckle).
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use a sweeping motion with downward pressure, move in a rhythmic movement from 3 o'clock to 9 o'clock and back again. This movement will stretch the vaginal tissue and the muscles surrounding the vagina.
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you can also massage the skin of the perineum between the thumb and forefinger.
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As you or your partner perform the massage, apply steady pressure downwards toward the back passage, until you feel a tingling sensation. This will help you to recognize the sensation that you will experience when your baby's head begins to crown.
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Use more oil if required to reduce friction.
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Concentrate on relaxing your pelvic floor muscles as you massage.
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In the beginning you will feel tight, but with time and practise the tissues will relax and stretch. The massage should not be painful.
The next description of from the Q&A section of ParentsPlace.com
(http://www.parentsplace.com/pregnancy/labor/qa/0,3105,13778,00.html) and is written by Peg Plumbo,
CNM.
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First of all, wash your hands. Then find a private place and sit or
lean back in a comfortable position. Put a lubricant such as
KY jelly, cocoa butter, olive oil, vitamin E oil or
pure vegetable oil on
your thumbs and around the perineum.
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Place your thumbs about 1 to 1 1/2 inches (three to four
centimeters) inside your vagina. Press downward and to the sides
at the same time. Gently and firmly keep stretching until you feel a
slight burning, tingling or stinging sensation. With your thumbs,
hold the pressure steady for about two minutes or until the area
becomes a little numb and you don't feel the tingling as much.
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As you 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 three to four
minutes. Remember to avoid the urinary opening.
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As you massage, pull gently outward (and forward) on the lower
part of the vagina with your thumbs hooked inside. This helps
stretch the skin much in the same way that the baby's head will
stretch it during birth.
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Do this massage once or twice per day, starting around the 34th
week of pregnancy. After about a week, you should notice an
increase in flexibility and stretchiness.
And finally, with thanks to Child Birth.org (http://www.childbirth.org/articles/massage.html)
an excerpt from The Birth Book by William and Martha Sears
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Scrub your hands and trim your thumb nails. Sit in a warm comfortable area, spreading your legs apart in a semi-sitting birthing position. To become familiar with your perineal area use a mirror for the first few massages (a floor-to-ceiling mirror works best). Use massage oil, such as
pure vegetable oil, or a water-soluble lubricant, such as K-Y Jelly (not a petroleum-based oil) on your fingers and thumbs and around your perineum.
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Insert your thumbs as deeply as you can inside your vagina and spread your legs. Press the perineal area down toward the rectum and toward the sides. Gently continue to stretch this opening until you feel a slight burn or tingling.
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Hold this stretch until the tingling subsides and gently massage the lower part of the vaginal canal back and forth.
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While massaging, hook your thumbs onto the sides of the vaginal canal and gently pull these tissues forward, as your baby's head will do during delivery.
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Finally, massage the tissues between the thumb and forefinger back and forth for about a minute.
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Being too vigorous could cause bruising or swelling in these sensitive tissues. During the massage avoid pressure on the urethra as this could induce irritation or infection.
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As you become adept with this procedure, add Kegel exercises to your routine to help you get the feel for your pelvic muscles. Do this ritual daily beginning around week 34 of pregnancy.
Does Perineal Massage make a difference? Let's look at study.
Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial.
British Journal of Obstetrics & Gynaecology. 104(7):787-91, 1997 Jul.
Shipman MK. Boniface DR. Tefft ME. McCloghry F.
Department of Obstetrics and Gynaecology, Watford General Hospital,
Hertfordshire, UK.
OBJECTIVE: To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery.
DESIGN: A randomized, single-blind prospective study.
SETTING: Department of Obstetrics and Gynaecology, Watford General Hospital.
PARTICIPANTS: Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995.
RESULTS: Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P = 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P = 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P = 0.024 and P = 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30.
CONCLUSION: Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.