This article is from the General Pregnancy FAQ, by swnymph@FensEnde.com (Sabrina Cuddy) with numerous contributions by others.
From: email@example.com (Sabrina Cuddy)
>: Could someone please e-mail me the method for perineal massage? We are
>: expecting in April and my wife had episiotomies with our first two. Can
>: we please get some advise so she can perhaps avoid being cut this time?
Well, all these requests must mean nobody is sending anything, so I'll
try... I have here an excellent 2-page pamphlet with pictures. If you
really want to learn to do this, I suggest finding something similar
so you can really SEE it! This one is from ICEA (International
Childbirth Education Association) by Elise Fleming. Write for copies
to: ICEA, PO BOX 20048, Minneapolis, MN 55420-0048, USA.
I also hate to be a pessimist, because perineal massage does help, as
do Kegel exercises and squatting during pregnancy, but once you have
had an episiotomy the scar tissue is more likely to tear than either
intact skin or scar tissue from a previous tear.
Anyway, here are the basics from this pamphlet:
Cautions: Avoid the urinary opening to prevent UTI, and if you have
active herpes lesions, wait until they heal to avoid spreading the virus.
General Hints: Use a mirror to find the vagina and perineum at first.
If you feel tense, take a warm bath or use a warm compress 5-10 min on
If you had an episiotomy before, concentrate part of the time on the scar
area to help it stretch.
Remember that upright positions for delivery (sitting, standing, squatting),
or side-lying reduce strain on the perineum. Lying on your back with
feet in stirrups is most likely to get you an episiotomy.
After birth, do Kegel exercises to tone up the muscles which have stretched.
Wash your hands.
Sit or lean back in a comfortable position.
Put a lubricant such as KY jelly, cocoa butter, vitamin E oil, or
vegetable oil on your thumbs and around your perineum. If your body
produces enough natural lubricant, you can use that, too.
Place your thumbs 1-1 1/2 inches (3-4cm) inside your vagina (your
fingers fall against your buttocks). Press downwards (towards your
anus) and to the sides at the same time. Gently but firmly keep
stretching until you feel a slight burning, tingling, or stinging
Hold the pressure steady at that point with your thumbs for about 2
minutes until the area becomes a little numb and you don't feel the
tingling as much.
Keep pressing with your thumbs. Slowly and gently massage back and
forth over the lower half of your vagina, working lubricant into the
tissues. Keep this up for 3-4 minutes.
As you massage, gently pull outwards on the lower part of the vagina
with your thumbs hooked inside. This stretches the skin as the baby's
head will during birth.
Do this every day after the 34th week, and after a week you should
notice an increase in flexibility and stretchiness.
If you can't reach or are uncomfortable doing this, your partner can
do it for you - using thumbs or index fingers, and being sensitive
to your feelings as well as your directions for more or less pressure.
From: firstname.lastname@example.org (Cynthia Hardie)
I couldn't find the instructions my midwife gave me for Perineal
Massage. I did find instructions in the Birth Partner by Penny Simkin.
We did the massage about 5 weeks before my due date. I couldn't really do
this myself so had to depend on my hubby. My friend said that they were
able to use her thumb pushing down and doing a u pattern. These are only
guidelines, once you start you will get a pattern that works for you. We
tried to do this every day.