Just as you prepare your muscles for delivery by toning them through exercise, you should also prepare your perineum for the stretching required to accommodate the baby’s head. Perineal preparation is especially important if you want to avoid an episiotomy. Many caregivers feel that prenatal preparation of the perineum increases the chances of delivering with an intact perineum.
Prenatal preparation includes several steps. The most important is to determine your caregiver’s philosophy about episiotomies. Is he willing to support you in your desire to deliver without one? Secondly, excellent nutrition will contribute to healthy tissues that stretch and heal rapidly. Some caregivers feel that taking a supplement of vitamin E will also enhance your tissues’ ability to stretch. Practicing relaxation, pushing, and Kegels will help you gain additional control over the perineal area, which is so important during labor.
Perineal massage will prepare you for the sensations of stretching that you will feel during your baby’s birth. It also increases the elasticity of the perineal tissues and thus reduces your need for an episiotomy. You should begin practicing perineal massage around the thirty-fourth week. You can either do the massage yourself or have your partner perform the massage for you. The person doing the massage should have clean hands and short fingernails. For lubrication, use your body’s secretions or some K-Y jelly, vitamin E oil, or vegetable oil. If you have a scar from a previous episiotomy, spend additional time massaging vitamin E oil into the scar tissue. Some women find that taking a warm bath prior to the massage is helpful. You may want to use a mirror the first few times for optimum vision.
To perform the massage yourself, insert your thumbs into your vagina about 1 inch and press them toward your rectum. Stretch your perineal tissues outward toward your thighs using your thumbs. Keep the knuckles of your thumbs together to prevent overstretching. You should feel a stinging or burning sensation. Continue to hold this pressure for an additional 2 minutes, until the perineum becomes somewhat numb and the tingling is less distinct. Then gently slide the tips of the thumbs back and forth as you continue to stretch the tissues outward. continue this action for another couple of minutes. See the image below for more clarification. If your partner does the massage, he should insert his index fingers into your vagina and keep his thumbs on the outside. The knuckles of his index fingers should remain together.
Note: do not practice perineal massage if you have active herpes lesions or another infection. Also, avoid the urethral area to prevent a bladder infection.