Irish midwife reveals why the perineal massage is so important

"Greater understanding of perineal trauma is really vital."

Clinical data shows that 9 in 10 first-time mothers who have a vaginal birth will experience some sort of perineal damage, such as a tear, graze, or episiotomy, which can contribute to a slower physical and psychological recovery. Yet, half of the women surveyed did not know that they might sustain perineal trauma when giving birth. This startling lack of awareness might help to explain why only a quarter of the Irish women surveyed carried out perineal massage regularly during their pregnancy - a technique that has been shown to reduce the incidence and severity of perineal damage. Speaking on the importance of perineal massage in pregnancy My Expert Midwife, Lesley Gilchrist said;

"Severe perineal trauma may not only have a psychological impact. It can also lead to long term issues, such as urinary and/or faecal incontinence, pelvic organ prolapse, vesicovaginal fistulas, lower levels of sexual satisfaction or pain during intercourse. Greater understanding of perineal trauma and preventative measures, including perineal massage, is really vital."

To help pregnant women in Ireland, Lesley has shared her expert advice on how to carry out perineal massage to help educate and empower women to have a more positive birth experience. First things first, what is the perineum?

"The perineum is the patch of skin and muscle between your vagina and anus and it is this part that is most likely to tear – or be cut (episiotomy) - during childbirth. While the majority of minor tears will heal without any long-term problems, 3rd and 4th degree tears, which are more severe and involve the muscle fibres of the anal sphincter, often need to be repaired in an operating theatre."

Is there anything we can do to prevent tearing during childbirth?

"Avoid active pushing or the ‘Valsalva’ manoeuvre, where you hold your breath and push during the pushing stage of labour. Push when you get the urge and avoid holding your breath. Hypnobirthing techniques are good to help you learn how to breathe your baby down, especially as their head crowns. Give birth in any position other than on your back when possible. Upright positions are advisable but, if you are on the bed, lying on your left or right side are good positions, too. Practice a simple technique called perineal massage which has been which has been clinically proven to help make the perineum more elastic."

What does giving a perineal massage entail?

First, find a perineal massage oil. You can use one specially blended and designed for perineal massage – such as Peri Prep Your Bits - or an oil such as almond oil. Wash your hands. Sit comfortably, bring your knees together and towards your chest and then open your knees like a book, or you may find it easier to put one foot on the toilet/bath/stool in a similar way to how you would insert a tampon. Put a small amount of the massage oil on your perineum to make the massage more comfortable. Using your thumbs, insert them into your vagina and then place your forefingers on the skin of your perineum. You now need to stretch this skin gently by pressing downwards towards your anus and to the sides until you feel a slight burning, stretching sensation Hold the stretch for 1 to 2 minutes. Then massage the area between your thumb and fingers upwards and outwards and back again in a “U” shape.

To help mums-to-be prepare for childbirth, My Expert Midwife has launched the #PowerToThePerineum campaign to ignite conversations about perineal trauma, address the associated taboos and raise awareness of the steps that women can take to protect their perineum during labour. The team at My Expert Midwife has also released a step-by-step video demonstrating how to do a perineal massage, which can be viewed here.