Perineal massage has been shown (Source) to reduce the likelihood of perineal trauma such as tearing or requiring an episiotomy during birth.
What is my perineum and why should I care?
Your perineum is a group of muscles that form the Pelvic Floor. These muscles act as a trampoline requiring both strength and flexibility to hold up your organs and, if you're pregnant, your growing baby.
The weight of your organs and baby can put a lot of stress on the pelvic floor. This weight can cause it to be pulled taught, becoming strained, weak, and tight.
Enter: Childbirth. Your baby now needs to be pushed through these taut muscles and into the world! By manually loosening these muscles, you can make the pushing process easier, and reduce the likelihood of perineal trauma during your birth. This will also aid your postpartum recovery!
Why is an RMT talking to me about an area she can't legally work on?
While the perineum is not an area I can personally help clients release, I can educate clients on how to release it at home. It is a sensitive area that legally an RMT cannot work on. Your pelvic floor is fundamentally a muscle group. I work with massage therapy clients to reduce tension in muscles on a daily basis. I have taken courses that have educated me on prenatal massage and the pelvic floor. In the prenatal classes that I teach, I talk about the pelvic floor muscles and perineal massage in regards to birth. I educate my doula clients about perineal massage and it's benefits. For something I can't legally work on, I have a extensive amount of experience educating people about it. I have also conferred with local pelvic floor physiotherapist Anita Lambert, who has provided suggestions to ensure my information is accurate and safe. It is a completely personal decision whether or not you choose to heed my advice.
Continue Reading for my step-by-step guide to Home Perineal Massage:
I would like to recommend that all women check with their care provider prior to beginning this exercise to make sure it is safe and appropriate for them. It is best to begin this exercise as early as 35 weeks into your pregnancy. Because of this it may be easiest to get your partner, a pelvic floor physiotherapist, or someone you trust to assist you in reaching your perineal area. If you are comfortable with going through this exercise with your partner they may be able to more effectively release tense muscles that you have trouble reaching.
You will want:
-Oil (a natural oil is best to avoid any irritation, I recommend coconut oil because it's cheap, effective, and seems to irritate very few people. Olive oil or any other kind will do). You can also use any type of personal lubricant if you prefer, but typical lubricants like astroglide or KY Jelly can sometimes cause tissue irritation. Usually something vegan, water-based, and without parrabens is ideal. Sliquid, which can be found locally at forbidden pleasures is also a good personal lubricant option.
-A place you find relaxing
-To be alone (see below)
3. Make Sure You're Undisturbed
Not only will this exercise involve you sitting spread legged in front of a mirror, it's a very mental exercise that will go further if you are able to fully focus on what you are doing.
4. Get to know Yourself
If you have never gotten intimate with yourself before, take it slow. Get to know what you feel like, and know that you are in control and in a safe space. How can you know if anything has changed or released unless you know where you've started?
Many women feel uncomfortable with their bodies. Many women have even expressed to me that they hate what their vaginas look like, or ask if various things are 'normal'. If you feel negatively towards your sexual anatomy, I strongly suggest checking out a website such as here, here, and here. The mirror may help you to become more comfortable by getting a better view of what you're feeling.
Once you feel at ease with the various parts of your anatomy, continue the exercise.
Please read each of the following sections a,b,c, and d before proceeding.
a) Your pelvic floor is most easily accessed about 1-2 inches deep into the vagina. Put a bit of oil onto your fingers for lubrication. You can begin by inserting one thumb (which may be easier to reach with than a finger) and moving it around slowly in a circular motion. As you move through the circle, notice which directions your finger moves easily, and which do not. Also notice if anything feels uncomfortable, which may indicate tension or not enough lubrication. This will give you an idea of where your pelvic floor is tight.
b) The pelvic floor often tenses on its own if we feel stressed or anxious. Many women who have not had children or worked on relaxing their pelvic floor before may find this exercise painful or very uncomfortable. If there is any pain upon insertion, (or if it feels tense in all directions) try taking three deep, slow breaths. This may help to centre you- we only breathe slowly when we are relaxed, and doing so when we're stressed can trick the brain into a relaxed state. If you are still in pain, I recommend going to see a pelvic floor physiotherapist. Your pelvic floor may be too tense to release on your own, or you may need assistance in improving your body awareness in this area. They can help you to learn how to work with your pelvic floor and release it effectively.
c) Once you identify an area of restriction/discomfort, hold it (some people may find this easier to do with two fingers inserted, depending on your body). You should hold, practice deep slow breathing, and really focus on what you're feeling beneath your finger (how tense it is, if it seems to be releasing, etc). Note that you should feel some discomfort, but the area shouldn't be so painful that you want to cry out or kick your partner. If it is, you may need to try another position, less pressure, or more lubricant. It may take anywhere from a couple breaths up to a minute, but you should feel the muscle release. You will know it has released either by feeling reduced tension under your finger, or less discomfort in the area you are holding. These breathing techniques also may come in handy during labour!
Holding and Releasing isn't the only way to reduce tension, gliding techniques against the muscles (like a massage stroke) can be beneficial as well. Picture the circle as a clock, with 12 o'clock being the urethra and 6 o'clock toward the anus. A horseshoe motion between 11 o'clock and 1 o'clock is one glide that helps. Many people find they feel restricted around 4, 6, and 8 o'clock. Holding and breathing in those areas may be beneficial. Note that you should stay away from 12 o'clock as the urethra can be quite painful.
d) Continue this practice until you have released 2-3 areas within the pelvic floor. The more you practice, the less time it should take to release areas of discomfort (and the less areas of discomfort there should be!).
6. Guidance and Postpartum
If at any point during this exercise you feel unsure, I would recommend seeing a pelvic floor physiotherapist. Anita Lambert at Holistic Health Physiotherapy , Leah Stajcer and Jenn Donovan at Pulse Physiotherapy, and Kim Payne at Lead The Way Physiotherapy are all wonderful local resources.
Regardless of how your birth goes, your pelvic floor could use some attention postpartum. While decreasing muscle tension was important prenatally, strengthening postpartum is important in order to regain a normal tone in these muscles. Incontinence issues can be a side effect of strained pelvic floor muscles which can occur during birth. Pelvic floor physiotherapy can give you exercises to get your perineum on track to recovery.
If you have any questions or require any additional information, please send me an email or contact one of the ladies above. We would love to hear from you!