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PT for Birth Preparation pt. 3: Performing a Perineal Massage to Prevent Tearing During Birth

by Manreet Sangha, DPT

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During the third trimester, it's important to work on lengthening and relaxing your pelvic floor. You can definitely continue strengthening your pelvic floor, but we want your main focus during the third trimester to be relaxing it. In addition to your diaphragmatic breathing and stretches, perineal massage can be beneficial to further lengthen and relax those pelvic floor muscles.

Steps to perform a perineal massage for vaginal birth preparation: It's optimal to start this at 34-35 weeks of your pregnancy, 2-3 times per week. Lay in a semi-reclined, butterfly position with a few pillows under your knees and, if you'd like, a towel under your hips. You will need a water-soluble lubricant or a natural oil, such as olive oil or coconut oil, to perform the massage.

  1. With clean hands, apply the water-soluble lubricant or natural oil to your thumb.

  2. Start by bringing your hand around your belly and inserting your thumb into your vaginal opening to your first knuckle.

  3. Press down against the back wall until you feel something similar to muscle, rather than just soft tissue. Start on the lower right side. Apply enough pressure to feel a stretch - this should feel a little tender. Hold for 5-10 seconds and you should feel the muscle soften.

  4. Move down towards the perineum and perform the same thing. Repeat on the other side as well.

  5. You only need to focus on the bottom half, so imagine it like a clock from 3-9 o’clock. Sweep your thumb between 3-9 o’clock and really feel the tissue softening and stretching.

  6. Relax and continue the massage for no longer than 5 minutes.

You can also perform a perineal massage if you have experienced a perineal tear with a past pregnancy, an episiotomy or immediately after giving birth.

Please reach out for further guidance or to schedule an appointment with a physical therapist. For more on PT for birth preparation, check out the other parts of this series:

Part 1: Relaxing Your Pelvic Floor

Part 2: Strengthening Your Pelvic Floor

Part 4: Birthing Position Recommendations

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