Relaxation and Perineum Massage for Birth

The perineum, plays a significant role in the birthing process, and as the body undergoes the transformative journey of childbirth, perineal relaxation techniques and perineum massage have emerged as valuable practices. Aimed at preparing the perineum for childbirth, reducing the risk of trauma and enhancing the birthing experience for women, perineal relaxation involves learning to release tension and tightness in the perineal muscles, promoting flexibility and elasticity.

Techniques in a HypnoBirthing education course, such as breathing, visualisations, relaxation and fear release hypnosis, are designed to release tension in the mind and body, and support hormonal physiology to keep your body nice and relaxed for birthing. We also educate on birth physiology and how to best support and optimise your body’s natural design, including your perineum.

A study published in the "Journal of Obstetric, Gynecologic, & Neonatal Nursing" in 2020 suggested that pregnant women who participated in perineal relaxation exercises experienced reduced perineal trauma during childbirth and reported greater satisfaction with their birthing experience.

Perineum massage involves the manual stretching and massaging of the perineal tissues. This self practice is typically initiated around the 34th week of pregnancy, when a final surge of relaxin and other hormones occur to further soften and lengthen tissues preparing for birth. Gently stretching the perineal tissues, gradually increasing the pressure to soften tissue and enhance flexibility, also supports a proprioceptive benefit in being able to recognise and feel at ease with the sensation of your baby as it moves along the birth path in the final descent.

A randomized controlled trial published in "Birth: Issues in Perinatal Care" in 2018 demonstrated that regular perineum massage significantly reduced the incidence of episiotomies and perineal trauma during childbirth. The study also indicated that women who engaged in perineum massage reported less pain and discomfort postpartum.

Research into perineal relaxation and perineum massage has highlighted several potential benefits. These include:

1. Reduced Trauma: Engaging in perineal relaxation exercises and massage can lead to increased tissue elasticity, potentially decreasing the likelihood of severe tears or episiotomies during childbirth.

2. Improved Comfort: Women who practice perineal techniques often report feeling more in control and less anxious during labor. This contributes to an overall more positive birthing experience.

3. Postpartum Recovery: Enhanced tissue flexibility may lead to faster healing and reduced pain after childbirth.

4. Increased Body Awareness: Perineal relaxation exercises can help women develop a deeper understanding of their bodies, particularly the pelvic region, aiding in labor progression.

How often do I practice perineal massage?
A good time to start is around week 34 of your pregnancy. The aim is to massage your perineum, for around 5 minutes, three to four times a week. It is totally ok for it to feel a little uncomfortable at first, but this will get better after a few massage sessions. It is important to focus on being relaxed, to breathe and if doing a HypnoBirthing course use some of your visualisations as you massage.

Method:

1. Perineal massage can be done by yourself, but is also a great way to connect with your partner. Make sure you are comfortable. This could be with your back supported and resting against some pillows and sit with your knees open like a book. You might want to have a hand mirror handy, so you can see your perineum. Or your partner can do the massage for you.
2. Ensure your hands, or partner’s hands are nice and clean. Dip your fingers or your partners fingers into the massage oil as deep as the 2nd knuckle (see below for the oils we recommend)
3. Place a thumb or finger about 2 inches or 5cm into your vagina, and use it to gently stretch the wall out to the side. Call this 3 o’clock. You may wish to use a pressing action with the tissues being pressed between your thumb and side of first finger.
4. Still pressing and stretching outward, sweep down to 6 o’clock and around to 9 o’clock. It shouldn’t hurt so if you feel a strong burning sensation you’ve stretched too far. You are aiming to soothe the area just below your vagina and between your anus – your perineum.
5. There is also the technique whereby you will gently insert thumbs or 1-2 fingers, 3-5 cm into the vagina, and firmly sweep in a downward and side to side motion.
6. Over time, it’s good to build up the intensity and duration of the stretches and aim for a total of 4 or 5 minutes. Remember to breath and practice relaxation or visualisation techniques to optimise benefits.

What oils should I use?

It is best to use natural and preferably unscented oil for perineum massage. Here are some oils that we recommended to our birthers:

Apricot kernel oil: is rich in antioxidants and also contains anti-inflammatory properties, helping to soothe and comfort the delicate area. Apricot kernel oil is also deeply moisturizing.

Jojoba oil: is extremely moisturising and is renowned for it’s ability to enhance the skins stretching ability. It may also help speed up wound healing.

Calendula oil: is great for it’s anti-inflammatory properties that can help soothe the delicate perineal area, whilst promoting skin healing and repair.

Vitamin E oil: extremely moisturising and softening yet strengthening for the skin barrier. And research suggests that it may assist in skin repair, healing and scar tissue.

We strongly advise that you avoid any synthetic oils or mineral oils.

**NOTE:
It is advised that you should not perform perineal massage in any of the following situations:
• prior to 34 weeks of pregnancy.
• if you have placenta praevia (a low–lying placenta) or any other condition where there is bleeding from the vagina during the second half of pregnancy.
• if you are suffering from vaginal herpes, thrush or any other vaginal infection, as massage could spread the infection and worsen the condition.

The information and resources we share are for informational purposes only and are not intended to replace the advice of your doctor or health care professional. Please seek the guidance and support of your midwife or GP.

HypnoBirthing International

References:

1. Dahlen, H. G., & Schmied, V. (2020). The miracle of life: The art of relaxation, massage, and touch in pregnancy and birth. *Journal of Obstetric, Gynecologic, & Neonatal Nursing*, 49(1), 9-17.

2. Aasheim, V., Nilsen, A. B. V., Reinar, L. M., Lukasse, M., & Fosse, E. (2018). Perineal techniques during the second stage of labour for reducing perineal trauma. *Cochrane Database of Systematic Reviews*, (12).

3. Beckmann, M. M., & Stock, O. M. (2013). Antenatal perineal massage for reducing perineal trauma. *Cochrane Database of Systematic Reviews*, (4).

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403252/

5. https://clinicaltrials.gov/ct2/show/NCT04157777

6. https://www.uofmhealth.org/health-library/stp1452#stp1452-sec

7. http://brochures.mater.org.au/brochures/mater-mothers-hospital/perineal-massage