Perineal massage

The perineum involves the skin and muscles between the vagina and the anus. After your baby's head 'crowns' the perineum naturally relaxes, stretches and expands to allow the head to be born. It is amazing how amazingly these tissues can distend and then return to shape after the birth. This massage, done during the last month of pregnancy, helps to prepare these tissues for the stretching needed for birth. Research indicates that perineal massage can help to reduce tears, episiotomies and instrumental births.

You can do the massage yourself with the aid of a mirror. Or your partner could be the masseur. This will help to develop the co-operation, use of feedback and touch that you will need in labour. Pick a time of day when you are relaxed and free from interruptions. The massager should clip the fingernails and wash hands well. Most people report a noticeable change in the consistency and stretchability of the perineum a week or two after starting this massage.

You will need

• a small amount of warm unscented massage oil
• a clock to time the massage
• plenty of pillows

Your position

Doing the massage yourself:

Stand with one foot raised and resting on the bath, or a chair or knee upright with one leg up. It will be easiest to massage with your thumb.

With a partner massaging:

Relax comfortably in a well propped up semi - reclining position with your back, neck, head and each thigh well supported by pillows. With legs apart place a pillow under each knee. Your partner can use the index and middle finger of one hand or both index fingers.

Perineal massage technique

When you are relaxed and ready, dip two fingers in the oil and slowly and gently insert them no more than 1-2 inches into the entrance of the vagina (a maximum of up to the second knuckle). First, feel if the perineal muscles are relaxed then breathe deeply, relax and consciously 'let go' of these muscles. If it is hard to tell whether you are relaxing, first tighten with a pelvic floor exercise then let go and relax . When working with a partner, feedback is helpful here.

The massage itself involves a slow, rhythmic, gentle pulling down and out of the perineum. Be sure that you are using plenty of oil to avoid uncomfortable friction on the skin. Stay in the lower third of the vaginal opening and pull the skin gently down towards the back passage and out (as the baby's head will do).

With a sweeping motion move from '3 o'clock to 9 o'clock' and back again. You should feel a slight tingling or burning sensation, but not pain. Try using more oil, going slower or more gently if there is discomfort or stop and try again tomorrow. You must be relaxed for this to work. You can also massage the skin of the perineum between your thumb and forefingers.

Timing

You can start any time from 6 weeks before your due date and do the massage 3-4 times a week and then daily in the last two weeks up to the birth.

Continue for 2 minutes for the first week and then up to 4 - 5 minutes until the birth. Discontinue if the waters break or leak, or if labour starts.

Benefits of this massage

These include stretching and increasing the elasticity of the perineum and vaginal opening as well as teaching you to actively relax your perineum while there is a sensation of pressure on it, as there will be when the baby's head begins to crown during birth.