You’re a pregnant mama and you want to learn more about perineal massage. Now, let’s begin with the basics on what is the perineum. It’s the area between the rectum and the vaginal opening. In the middle of the perineum is the perineal body, it’s at the perineal body where a lot of the pelvic floor muscles attach.

There is mixed research out on the protective effects of perineal massage on pelvic floor muscle tearing during a vaginal delivery. But, I still teach this technique to my patients and I also perform perineal massage myself when pregnant and here’s WHY!

Just like you would progressively stretch and prepare your muscles prior to a big performance you want to do the same for your pelvic floor prior to a vaginal delivery. The goal is not the change the actual length of the muscle but the change the nervous system’s response to the stretch of the muscle.

Think about it this way, if I ask you to do a split today could you? Probably not, but if we trained your muscles to slowly stretch further and further each day, you’d feel less and less resistance to stretching and eventually would be able to successfully do a split. We are attempting to gain the same effect with the muscles of the pelvic floor via perineal massage.

The pelvic floor muscles stretch up to 2x its resting length during a vaginal delivery to accommodate for the baby to exit the vaginal canal. We need to prepare the muscles to respond appropriately to that stretch so that it doesn’t reflexively clench and tighten up during a vaginal delivery.

So, how do we perform perineal massage? Get comfortable in a reclined seated position with some pillows behind you to prop you up behind your back. Place some pillow underneath your knees so that you are as relaxed as possible. Grab your lube and let’s get to work!

Before we begin let’s familiarize ourselves with some pelvic anatomy. In the image below you can see an overlay of a clock over the vulvar region, 12 o’clock is the location of the clitoris, 6 o’clock is the location of the perineal body. This is important to note because we will be staying away from the clitoris.

Sustained Pressure: 

1. Begin with placing some lubrication on your finger you can use which ever finger is most comfortable to you, insert a single finger one knuckle deep into the vaginal canal.

2. Starting at 9 o’clock apply some gentle pressure until you feel a stretch. This should not feel intolerable or like tearing or severe burning.

3. Hold this position and perform 3-5 deep diaphragmatic breaths trying to relax and lengthen through the pelvic floor using your breath work.

4. Repeat this at 6 o’clock and 3 o’clock.

Sweeping Pressure:

1. Begin with placing some lubrication on your finger you can use which ever finger is most comfortable to you, insert a single finger one knuckle deep into the vaginal canal.

2. Starting at 9 o’clock apply some gentle pressure until you feel a stretch. This should not feel intolerable or like tearing or severe burning.

3. Maintain that pressure as you sweep your finger back and forth from 9 o’clock to 3 o’clock.

4. Repeat this for 2-5 minutes.

See my Youtube Video on how to perform perineal massage.

Follow me on Instagram for more tips on childbirth.

View my handout on perineal massage. Download the perineal massage handout.

Images used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)