Perineal massage (TMI alert)

[Howtomassage]

I need some help with perineal massage. I am 35 weeks pregnant and tried it for the first time this evening....and I just can't do it! I'm now getting really stressed and upset and worried that I am going to tear horribly when I give birth

I trimmed thumb nails, put sunflower oil on them, sat on the floor in front of a mirror. But I just can't get my thumbs inside me! One will just about fit in...but as soon as it passes all the fold of skin and breaks the seal of the vagina, the vaginal passage is tiny, with ridges on the side and slopes completely away from the anal area...so I'm massaging into my tummy if that makes sense? And it hurts like hell

Am I meant to be massaging the ridges inside the vagina or just touching the outside of the vagina and rubbing the bit between the vagina and anus?

DH says that my bits are no different from other women he's encountered in the distant past but I just don't get it. It looks so simple on the pictures...does anyone have any advice please?

Hi, I'm 27 weeks and thinking of starting with perineal massage soon. Not sure what to advise really, but have a look at this thread and this link.

Could you ask your DH to try, you might be more relaxed? Or ask your midwife for advice/demonstration?

My NCT teacher told me to think about my mouth first. Putting a finger into each corner of the mouth and then attempting to stretch it can be painful. Therefore just gently hold the sides open before doing it more rythmically if you see what I mean.

Try fingers instead of thumbs maybe, or 1 finger held in there until your body gets used to the stretch.

Don't stress about it though - it's not vital you do it.

Wem - my understanding is that you shouldn't start perineal massage as early as 27 weeks. I am also 27 weeks along and was advised by midwife and doctor not to start for at least another 6 weeks. Apparently there is no benefit to starting earlier than that anyway.

It sounds like you're tensing up.

(TMI alert!)

The ridges inside your vagina are where the membranes/skin are all crunched up because you're tense and holding the muscles tight.

Imagine getting a top and squeezing it in between your hands so that the top, which would normally fit around your chest, is now tightly compressed. It'd be wrinkled up, with the material in ridges, right? Well, that's you.

So those ridges mean stretching room for your vagina so that it can be big enough to fit a baby's head through. But right now, they also mean you're tensing up so you can't get more than 1 thumb in there.

I think with this massage you mostly want to be concentrating on stretching the outer bit at the back towards your bottom. If you're massaging your tummy from the inside, it sounds like you're working on the opposite bit of the vagina to what is needed.

Thanks for the advice ladies! I've tried again tonight in a different position. Whilst it was easier on my back (although I could only just reach down) I still don't get it.

japhrimel - TMI but I'm always ridged inside no matter how relaxed I am...hmm..thought that was normal

Also still confused about the whole insertion for 1 inch thing that I read on the links you all provided - I have about an inch of deep saggy skin before I break into tight part that hurts (the seal if you will) which is when everything slopes off towards my tummy so not sure if I need to actually break the seal or just massage the saggy tissue? When I do break the seal I feel ridges and hard pelvic bone so nothing there to massage....oh well. Thanks for all the advice though!!!!

I could never manage to do this and got myself in a right tizz about it. Convinced I was going to tear and it would all be my own fault. Relax, take the advice on here but if you can't manage it don't worry. FWIW I managed to avoid stitches with both DS, but honestly I think thats down do damn good luck than anything else.

You could try lying on your side kind of in the fetal position (as far as your bump will allow your legs to bend towards your stomach!) and start off with inserting either one thumb or just index finger from behind rather than taking your hand down the front. Definately take it slow and gently though, and rather than massaging initially I think it helps to just stretch the area downwards and while doing this to take long slow breaths and relax the muscles and rubbing the perineal area from the outside is also supposed to help...I am 36 weeks and started this last week, my midwife gave me a handout that had instructions on it about inserting 2 thumbs while squatting but that was not working for me at all so I tried some other positions and lying on side worked best for me. I don't think its worth getting stressed though and worrying about sticking to the 'rules' about how to do it, just do what feels right to you but as others have said, its not vital that you do it but apparently it does avoid the risk of tearing so really whatever you can do is probably better than nothing at all if you really want to stick at it.

Howtomassage, really really worth your DH doing this for you -- the angles just work better!

Your description of feeling your pubic bone makes me think you're doing it too much around the front - appologies if I've got that completely wrong!
The advice I found off the internet was: go in about 1-2 inches and do sweeping massage movements and static stretches around the back - i.e. don't bother trying to massage around the front where your pubic bone is, but rather try to stretch the back backwards towards your anus.

I did all the massage stuff, including buying an epi-no.

FWIW my obstetrician told me tearing was more to do with the speed of delivery of the head. so the more slowly you do this, the better the outcome will/should be. supposedly.

Delivering DD1's head took about an hour, we just went bit by bit. My dr also applied hot compresses and kept (sorry if tmi) running her index finger along the perineum in a u shape (well it's what it looked like she was doing in the mirror iyswim) just to tease it further back.

result - intact perineum.

admittedly, I had a giant epidural so could push very calmly and did exactly what I was told. so not sure if this makes a difference?

good luck!

The ridges are the normal state of that part of the vagina, nothing to do with being tense. But they are the wrong place to massage - they are too far in. In order to massage the perineum from inside and outside, you only need to be just inside the vagina. The perineum is very small: if you were to insert your thumb into your vagina, just up to the first knuckle and with the pad of the thumb facing backwards, then your thumb would be coverning most of your perineum from the inside.

Having said that, I don't think perineal massage matters much. I could never reach to do it once I was far on enough to start. I tore with my first 2dc, but not with my 11lb dc3. What made the difference was, IMO, being upright, relaxed, and not actively pushing.

I think you'll find that there's more evidence supprting upright position and relaxed, un-pressured labouring for minimising tears than there is supporting perineal massage.