Perineal care - BSUH Maternity

Your perineum is the area between your vaginal opening and the rectum. This area stretches a lot during childbirth and sometimes tears. Perineal massage in pregnancy aims to gradually soften and stretch the vagina and area around it in preparation for birth. This page explains why this is important and gives instructions on how you or your partner can carry out this exercise.

What are the benefits of perineal massage?

Research studies have found that perineal massage from 34 weeks of pregnancy can reduce the chance of your vagina tearing and also reduce the need for forceps or ventouse (suction) to help you birth your baby.

It is particularly beneficial for women and people having their first baby, women and people over 30 years old and women and people who have had an episiotomy (vaginal cut) before. It will help you to become familiar with the feeling of pressure or stretching of the perineum that you will feel when your baby is being born.

Therefore our midwives and obstetricians support the practice of perineal massage. Your midwife can discuss perineal massage, its benefits and how to do it. They will also answer any questions you may have.

How do I do perineal massage?

Perineal massage should be done three or four times a week for five minutes, beginning when you are 34 weeks pregnant.
Either you or your partner can do the massage. Use a mirror for the first few times so you can see what you are doing. It is more comfortable to do the massage after a bath as this will soften the surrounding tissues.
Before starting, go to the toilet if you need to, wash your hands and find a comfortable position: sitting, lying down supported by pillows, squatting against a wall or standing with one foot raised and resting on the bath, toilet or a chair.
Use a lubricant such as vitamin E oil, almond oil or any vegetable oil such as olive oil. You may also use a water-soluble jelly such as K-Y Jelly. Do not use baby oil, mineral oil or petroleum jelly (Vaseline). This lubricant will help your fingers move smoothly over the perineum and lower vaginal wall.
If you are doing the massage yourself, it is probably easiest to use your thumbs. Your partner can use both index fingers.
Place the fingers or thumbs about five centimetres (two inches) into the vagina (up to your second knuckle).
Using a sweeping motion, pressing downwards, move in a rhythmic movement from right to left and back again. This movement will stretch the vaginal tissue and muscles surrounding the vagina.
You can also massage the skin of the perineum between the thumb and forefingers.
As you or your partner perform the massage, apply steady pressure downwards towards your bottom until you feel a tingling sensation. This will help you recognise the feeling that you will have when your baby’s head begins to come out of your vagina (crowning).
Use more oil if you need to reduce friction and make the massage more comfortable. Concentrate on relaxing your pelvic floor muscles during the massage.

Perineal massage

Remember:
With time and practice the tissues will relax and stretch. This massage should not be painful and should you find it so please ask your midwife for more advice.

If you do find the massage painful, frightening or distressing, please talk to your midwife or doctor. Some women have had operations or painful or difficult experiences. By letting us know we can plan your care more effectively in labour.

ORB Project at BSUH

At Brighton and Sussex University Hospitals we have launched a new project to reduce major tears that can occasionally occur in childbirth. These tears are termed 3^rd degree and are referred to as OASI (Obstetric Anal Sphincter Injuries). We are joining other NHS Trusts who have successfully implemented similar projects and have seen a significant reduction in these injuries.

Our project is called ‘ORB’, which stands for OASI Reduction at BSUH. We hope this project will help to improve consistency of practice and raise awareness of perineal care amongst childbirth practitioners and lead to a reduction in major tears.

The ORB project incorporates four main principles during delivery of your baby’s head:

Position

It helps if the midwife can see your perineum to assess and apply a warm pack. It is also advised that you adopt the best positions to reduce the likelihood of a major tear, such as being on hands and knees and avoid positions that can increase the risk. Your midwife will guide you with this and help you to feel comfortable and safe. It is recommended to remain mobile and upright during labour.

Guide

Your midwife will support you to have a slow, controlled delivery, talking you through and helping to keep your birth calm and gentle.

Protection

With your consent, a warm pack may be applied to your perineum by your midwife whilst the baby’s head is birthing, and she may place a hand on the baby’s head to help this.

S-L-O-W

With guidance and gentle use of her hands on baby’s head together you and your midwife will aim to achieve a S-L-O-W delivery of your baby’s head, helping to avoid or minimise any damage.

ORB Project at BSUH

Position

Guide

Protection

S-L-O-W

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