👍🏼✌🏼Perineal Massage ✌🏼👍🏼

👌🏼🤞🏻Perineal massage 🤙🏼👇🏻

⭐️It’s a BIG popular topic in antenatal preparation courses, birth literature, general birthy chat online, etc etc…….

⭐️It’s a cause of great anxiety for many, because there is the narrative that it may make a HUGE difference to tearing during birth, and let’s face it, that is a big focus for most people about to give birth.

⭐️The thought behind perineal massage is that the regular stretching of the perineal tissues can soften and loosen it to result in less or no tearing during birth.

⭐️There are even oils, ointments to facilitate massage and even devices to ‘prestretch’ the vagina/vulva (EPI-no and Aniball).

⭐️So considering that perineal massage often sounds like the absolute fanny saver extraordinaire, does it really help??

💥Well, not quite.

⭐️Looking a little deeper at the research, overall, as far as we can see, perineal massage can help first time birthers have a lower rate of episiotomy.

That is of course wonderful. But this was only found to be a benefit in the context of birthing in an EXTREMELY high episiotomy rate environment which most people in the UK don’t birth in.

⭐️Does it seem to help with spontaneous tearing?

It doesn’t seem to, significantly. Of course MANY people will say, I did it and it prevented my tearing. There is no way of being sure of this of course, and there is a bigger or equal amount of people who say they did perineal massage and tore anyway.

⭐️Neither does it seem to help people who have birthed vaginally before have any difference in perineal trauma, but those have a HUGELY reduce chance of tearing compared to a first time birther anyway.

⭐️So that’s a bit of a different picture to what people are imagining when they are doing perineal massage, or worrying about NOT doing perineal massage and perhaps when they are finding perineal massage extremely unpleasant.

⭐️Is it harmful to do perineal massage? Probably not, if you are gentle and listen to your body.

⭐️Might it have benefits?

Sure. As above.

⭐️Also, my thoughts are that perineal massage you ACTUALLY want to do may give you some ability to relax into the burny stretch you are very likely to feel during birth.

So as a psychological prep, perhaps it has benefits.

But that can also go the other way…if you feel anxious around perineal massage and maybe it’s painful, it could backfire and lead to more fear and tension.

⭐️Bottom line, crack on if you feel good about it.

⭐️Leave it if you don’t, and don’t feel guilty about it.

⭐️Our vulvas are designed to stretch and tear to an extent, and severe tearing is thankfully rare.

💥There ARE other measures that are MORE protective for perineums than perineal massage seem to be, for example:

⭐️birthing as physiologically as possible

⭐️with good mobility and

⭐️ability to get into instinctive positions (some positions have been shown to be more protective of your perineum, for example all fours and side lying, and some less, such as squatting and lying in stirrups)

⭐️without directed pushing

⭐️with a warm compress

⭐️slowly if possible

⭐️with a supportive caregiver

⭐️waterbirth

⭐️homebirth

💥 Oh, and the research we have on the devices used for perineal pre-stretching, such as the Aniball or the Epi-No has not found any consistent benefits to using them. And personally, I have some concerns about their long term effects on the pelvic floor (I know that some physios share those concerns).

👌🏼Anyway, what I’m trying to say: Perineal massage is overhyped and in my cynical mind I feel it’s easier to bring the attention to our bodies as ‘faulty’, in need of fixing and proactive preparation when REALLY, it’s the system in which we birth that is at fault for making perineal tearing more likely. Meh.

Illustration by The Vulva Gallery