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Using Massage to Avoid Episiotomy.

About Perineal Massage.

This technique helps an expectant mother to prepare her birth canal for birth and allows her to get an idea of what giving birth feels like.

• Prenatal perineal massage reduces the need for episiotomy and the chance of serious tearing at birth.
• Perineal massage should not be done if you have a vaginal infection, a herpes sore, or other vaginal condition that may be spread or worsened by the massage.
• If you wish to use it, the massage should be started sometime in the last trimester, at least 3-4 weeks before the due date, 2-4 times per week or more if you are comfortable.
• Not everyone is comfortable with this method, so don't do it if you don't feel comfortable with it.
• Some women find that they like to incorporate the massage into lovemaking but don't like to do it themselves, while others find that they like to do it themselves so that they are in control. The important thing is to do what works for you.

Instructions.

1. Wash your hands and make sure your fingernails are short. Get in a comfortable position with your legs relaxed and slightly bent at the hips and knees. If you wish to use a particular position for birth, try that one.
2. Lubricate your fingers with a vegetable oil, such as wheat germ or olive oil; or use water-soluble lubricant, like K-Y. Vegetable oils are easily absorbed by the tissues, enhancing the suppleness achieved by the massage. Keep the oil in a small squeeze bottle so you don't have to dip your fingers into it and contaminate it.
3. Spread enough oil over your perineum to allow your fingers to glide easily. Your perineum is the area behind and outside your vagina, towards your rectum. You don't need to go near or touch your rectum. In fact, you should never touch your rectum and then touch your vagina because the bacteria that normally live in your digestive tract can cause an infection in your vagina.
4. Using your index fingers or thumbs, insert them into the vagina up to the second knuckle, or as close to that as is comfortable. Press them against the back wall of the vagina and slowly sweep them away from each other up the vaginal wall as you pull outward gently. The movement is a sort of "U" shape. This movement should be repeated for several minutes. This is what you will feel as the baby's head presses down before it starts to emerge from the birth canal.
5. Next, rub the perineum between your thumb and forefinger, one finger inside the vagina and one finger outside. You can use one hand or two. Then place two fingers just inside the vagina, only to the first knuckle, and gently stretch the perineum outward. Massage more with your thumb and forefinger if the tissue feels tight. Remember to consciously relax the muscles. Use slow breathing if the sensation feels a little too intense.
6. As the tissue gradually relaxes and stretches after several sessions, you can progress by putting enough outward pressure on the perineum to cause a burning or stinging sensation. This is the sensation you feel as the baby's head stretches the perineum during crowning. The burning during birth is a signal that your perineum is stretching. This is the time to use pant breathing until the burning eases. Some women suffer a tear at this point in a birth because they don't anticipate the burning sensation and they jump, reflexively tightening their perineal area. Relax into the sensation and know that when you feel it in labor it means your baby will soon be here.

Other descriptions of perineal massage can be found in:

• Simkin, Whalley & Keppler, Pregnancy, Childbirth and the Newborn;
• Davis, Heart and Hands.

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