I. Background
The perineum is the triangular layer of skin between the vagina and the anus in females and between the scrotum and anus in males. Beneath the perineum in females are the muscles and fibrous tissues that stretch in order to accommodate the baby during childbirth.

Historically, physicians believed that episiotomies would help decrease the risk of vaginal lacerations and perineal tears during childbirth. An Episiotomy is an incision made into the perineum at the end of the second stage of labor to help facilitate the birth of the baby.

II. Research
However, research during the 1970s and 1980s revealed that not only have episiotomies failed to prevent lacerations and perineal tears, they actually tend to increase the incidence and severity of lacerations associated with childbirth. Since then, researchers have been studying other variables that might decrease the incidence and severity of vaginal lacerations and perineal tears. Three variables have been identified including maternal position, style of pushing and perineal massage.

From 1979 - 1985, researchers in the northwest part of the United States studied 368 women whose deliveries had been attended to by a home-based midwifery practice. (Davidson, Jacoby & Brown, JOGNN, Vol.29, No.5, Sept-Oct. 2000). The women were primarily white with 61 first-time moms (primiparas) and 307 women who had already birthed at least one other child (multiparas).

Even though findings indicated that first time moms had more vaginal lacerations than multiparous women, the severity of lacerations were less serious in women who practiced perineal massage. Multiparous women who had received episiotomies for previous deliveries were also found to derive benefits from performing perineal massage this time around.

Although there are still questions concerning the optimum frequency, timing and technique of perineal massage, researchers encourage pregnant women to practice perineal massage to help prevent and/or decrease the severity of vaginal lacerations and perineal tears associated with childbirth.

II. Technique
Start daily perineal massage around 34 weeks of pregnancy. This type of massage helps women prepare for the stretching sensation during the birth of a baby as well as reducing the need for episiotomy and risk of perineal tearing.

Getting started:

1. Wash your hands. Find a comfortable, warm, private place to practice. Position a mirror in front of your perineum to see what you are doing. (Partners can also be taught to perform perineal massage.
2. Lubricate your fingers and perineum with a vegetable oil, cocoa butter, KY jelly or Vitamin E oil.
3. Place the thumbs inside the vagina about 1-1 1/2 inches and press down and to the sides to gently stretch the skin. This might cause a slight tingling or burning sensation. (Avoid moving upwards toward the urethra).
4. Hold a steady pressure for about 2 minutes until the perineum starts to feel numb. 
5. Gently massage the oil into the lower half of the vagina for another couple of minutes while pulling down and outward with the thumbs. This motion simulates the way the perineal skin will be stretched during childbirth.

Contraindications: Avoid perineal massage if you have any active vaginal infections including herpes.

*Discuss perineal massage with your Obstetrical Health Care Provider
prior to practicing this technique.

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