Perineal Massage and Birth Preparation in Clapham

The perineum is the area between your vagina and anus. During a vaginal birth it stretches to let your baby’s head out, and it can tear. Perineal massage gently stretches this tissue in the weeks before birth to help it prepare.

According to the NHS, up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy, and massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy.

Evidence summarised by Cambridge University Hospitals NHS Trust shows that perineal massage from 34 weeks reduces the likelihood of needing an episiotomy and of having a tear that needs stitches.

It seems to help most if you’re having your first vaginal birth, are over 30 or have had an episiotomy before. If you’ve given birth vaginally before, it may help reduce perineal pain after birth.

Most guidance recommends starting perineal massage from 34 weeks of pregnancy. NHS guidance suggests:

• Massaging three to four times a week
• Spending three to five minutes each time
• Even once or twice a week may still help

Little and often is the key, and it usually becomes more comfortable with practice.

1. Wash your hands and find a comfortable, supported position, such as propped up with pillows or with one leg raised
2. Use an unscented oil, such as olive or sunflower oil, or a water-based lubricant
3. Insert your thumbs about 3 to 5cm into your vagina and press gently downwards towards your anus until you feel a gentle stretch or tingle
4. Hold the stretch, breathing slowly, then sweep gently from side to side in a U shape
5. Stop if it becomes painful

Many women find it easier for their birth partner to help. Olivia can talk you through the technique in clinic so you feel confident doing it at home.

Don’t start or continue perineal massage, and speak to your midwife first, if you:

• Think your waters may have broken
• Have thrush, genital herpes or another vaginal infection
• Have any vaginal bleeding
• Have been advised by your midwife or doctor to avoid it

Your pelvic floor needs to relax and lengthen to let your baby through. Many women know how to squeeze these muscles but find it harder to let them go.

Olivia can teach you how to relax your pelvic floor and use slow breathing during contractions and pushing. The NHS describes how your midwife may ask you to pant or puff as your baby’s head is born, so it can emerge slowly and gently. Practising this beforehand can help.

There’s no single best position for labour, and what feels right will depend on your body and your birth. Olivia can help you practise positions that keep you mobile and comfortable, and that suit any aches you have.

If you have pelvic girdle pain, she can help you find comfortable positions and work out how far you can comfortably move your legs apart, so you can add this to your birth plan.

Your appointment lasts 60 minutes and takes place in a private, judgement-free room at our Clapham clinic. Olivia will:

• Talk through your pregnancy, any previous births and your birth plan
• With your consent, assess your pelvic floor, including how well it relaxes. It’s always optional and fully explained beforehand
• Teach you perineal massage, breathing and pelvic floor relaxation
• Practise labour and pushing positions with you
• Give you a simple plan to follow until your due date

For a wider check of your posture, tummy and pelvic floor, see our Pregnancy MOT.