Perineal Massage
A Possible Alternative to Tearing
*Disclaimer: this post will have graphics that show what these tears look like (so, female anatomy).*
Perineal tears make the entire experience of pregnancy a big “I’m not doing that” for some ladies. “My what does WHAT?!” “A baby’s head is HOW big???” “So you mean to tell me I can tear from my front to my butt?”
—Things we don’t want to accept or say out loud, but this (a perineal tear) is a reality for 50-90% of pregnancies (especially first-time moms). This range is because, with each pregnancy, the stats vary.
Now, not every tear is the same or even the same degree. It’s kind of like a spectrum. Most women will only experience either 1 or 2-degree tears, but a small percentage (VERY small percentage) will experience either 3 or 4-degree tears.
Some women won’t experience any tearing at all, especially after their first child is born, but even if you’ve given birth three times, four times, whatever, tearing the perineum is still a possibility.
The 4 Different Types of Tears
Here’s how we classify those tears1:
1st Degree Tear: “Just the skin”
→ This is the least severe of the 4 classifications and involves the first layer of tissue surrounding the vagina and perineal tissue.
2nd Degree Tear: “Skin and Muscle”
→ This is the most common tear and is slightly bigger than the first-degree tear. This tear extends deeper into the muscle of the vagina and perineum.
3rd Degree Tear: “Skin, Muscle, and Anal Sphincter”
→ This tear extends from the vagina to the anus and involves injury to the skin and muscle of the vagina, perineum, and damage to the anal sphincter muscles (muscles that control bowel movements).
4th Degree Tear: “Skin, Muscle, Anal Sphincter, and Into the Rectum”
→ This is the least common tear (thankfully) and extends from the vagina, through the perineum and anal sphincter muscles, into the rectum. This is obviously the most severe tear that *could* occur.
Some things that can cause these tears, but not limited to:
Position of the baby (face-up deliveries).
It’s your first baby.
You had a severe tear during your first delivery (or other prior deliveries).
If you’ve had an episiotomy (a cut in the perineal area to make it easier for Baby to fit through the vaginal canal).
“Episiotomy is a technique originally designed to reduce the incidence of severe perineal tears” (particularly 3-4 degree tears)2.
Episiotomy: Medio-Lateral or Midline
The use of forceps or a vacuum during delivery.
A large baby (more than 8 pounds).
No need to fear… there are preventative measures we can take to try and avoid this from happening.
Prevention of Tearing
Perineal Massages are a way we can decrease the chance or risk of tearing during vaginal birth. Of course, this is just a preventative measure, and things are not always guaranteed.
(This study here3 is one that always comes up in reference by Midwives, Doulas, OBGYNs, other Hospital Personnel, and Pelvic Floor Specialists + anyone else discussing perineal massaging).
So what is it?
Perineal massages are a manual and gentle approach to stretching your pelvic floor. These massages prepare the muscles and skin between the vagina and rectum for labor and delivery.
These muscles are not as stretchy and need a little push in the right direction, which is what the massages are for. The goal is to reduce the risk of tearing and scarring when you deliver.
If you aren’t comfortable doing this on your own, it’s a good idea to schedule a visit with a pelvic floor physical therapist so they can guide you through with a “How-To”.
How To Manually Massage Your Perineal Area:
You can do this yourself or have your partner do it.
*Wash your hands before you do anything!*
→ Get into a position you are comfortable in. If sitting down, try squatting down with your back to the wall for support. If lying down, prop your legs up with pillows for support and keep the knees bent.
→ Get out your favorite massage oil or lube and apply it all over your fingertips and thumbs, then place one or both thumbs on the back wall of the vagina with your forefingers resting on the buttocks. (Sort of like you’re pulling open the curtains, but your skin instead).
→ Gently, press and move your fingers down towards the anus in a rhythmic motion. Insert your index or middle finger/s into the vagina, resting the palms against the inside leg.
→ If this is your first time massaging the perineum, imagine that your vaginal opening is a clock face. Pull your two fingers down to 6 then stretch outwards to 3 with gentle pressure. Repeat 20 to 30 times then repeat on the opposite side, 6 to 9. You are essentially, manually stretching this area.
If you need extra help there are many tools out there made for this type of massaging that will provide more range than your fingers (or your partner’s fingers) could.
Intimate Rose is a great source to buy from and has “product guide features + helpful videos for getting started with your therapy.”
Other Methods to *Prevent* Tears
→ Learn correct pushing and breathing techniques that you can do prior to and during labor and delivery.
*Labor will call for proper breathing techniques that engage the pelvic floor and core muscles.*
→ Implementation of the use of an EPI-NO device (starting at 36 weeks) - this should create a similar sensation to the feeling of Baby’s head crowning and prepare us for pushing.
→ Applying a warm compress to the perineal area during labor and between each contraction in the pushing stage.
Putting It All Together
So, even though it isn’t a guarantee, perineal massaging can prevent severe tearing (and maybe any tearing altogether).
It’s worth the try and if anything, can give you an idea of what the sensation of Baby’s head stretching your vaginal canal will feel like.
Do this along with proper breathing techniques + pelvic floor and core engagement, and the risk of tearing will substantially decrease.
#WAGMI
Your friend,
- BowTiedHeifer
Disclaimer
I am not a licensed personal trainer or pre/postnatal specialist—these are simply my personal experiences and things I have witnessed to work for many others. This is not legal, medical or financial advice. Please speak to a professional before starting any new programs, applying any new diet plans, or supplement protocols.