I'm currently almost 40 weeks pregnant, and after doing some research and talking with my care provider, I decided that I wanted to give perineal massage a try, in the hopes of possibly avoiding or minimizing tearing during vaginal birth. My partner agreed to help me (though I should note that it's definitely something a person could do on their own!).
We've been using the method described here, with a variation as suggested by my midwife. The method at the link is as follows (paraphrased and edited to include some of my own thoughts/experiences and my midwife's advice, and to put the instructions for partners performing the massage in the main body rather than at the end):
- The person performing the massage should thoroughly wash their hands, and trim nails if needed. (I asked my partner to use soap and water and a nail brush to scrub his hands and under his fingernails, and I did the same before trying it myself.)
- Find a comfortable place and sit in a relaxed position, seated with knees bent. (I found sitting on our bed propped up with pillows was most comfortable.)
- Lubricate the digits that will be doing the massage (either the pregnant person's thumbs, or a partner's forefingers) with a safe lubricant. Suggestions: Natural oils (olive, almond, canola - we used jojoba) or a water-based lubricant; avoid baby oil, mineral oil, and petroleum jelly.
- Place fingers or thumbs about 1-1.5 inches inside the vagina. Press gently down toward the anus and out toward the thighs until you feel a slight burning/stretching sensation.
- Hold for 1-2 minutes.
- Slowly massage the lower half of the vagina in a U-shaped motion. During the massage, concentrate on relaxing the area; try taking slow, deep breaths. (This is the part my midwife suggested changing up. She said that in her experience/opinion, the goal here isn't so much to stretch or prepare the perineum, as it will stretch naturally on its own during birth a lot of the time. Her view is that the primary benefit of perineal massage is to allow you to experience the feeling of the perineum stretching in a safe, comfortable, and controlled environment, so that when/if you experience it during childbirth it's not a totally foreign and potentially alarming feeling but one you've experienced before and have some way(s) of handling without either tensing up or trying to, in her words, "power through it." She recommended skipping the U-shaped movement part and focusing on relaxing/breathing through the gentle pressure down and to the sides.)
- Do this once a day starting at around six weeks prior to your due date, for ten minutes per day.
My thoughts (apart from the ones above): This is definitely not a feeling I've experienced before, and I'm glad that I'm experiencing it first when I'm calm and relaxed (and can make it stop at any point). I also like having my partner's support in this. I found when I tried to do this myself that it was harder than it seemed to be for him; I think this may be because his index fingers are more flexible than my thumbs -- I had a tough time finding the right spot when I was doing it. (That said, I'm sure with practice I could have figured it out.)
The sensation is really intense. It reminds me of the way a stubbed toe feels at the midpoint of that experience, right in between the "OW OW OW OH GOD OWWWW" and the point at which it stops being outright painful. Manageable discomfort, I guess, is the best way I can describe it.
I found that relaxing and breathing through it really did make a difference in how I handled it. Taking nice slow, deep breaths and focusing on relaxing my whole body and my pelvic floor particularly made the two minutes seem much, much shorter.
We also did not do this for a full six weeks, or every day. (We were doing it at bedtime and many nights our conversation was along the lines of "Do you want me to do the massage thing again tonight?" "zzzzzzzzzzzzzzz." "Okay, maybe tomorrow.") I still think it will be helpful, because after just a few sessions I felt I had figured out some good ways to make the sensation easier to handle (and learned to recognize and manage my first impulse, which is to tense up in response).
Anyway, if you're considering trying perineal massage as a way of preparing for childbirth, it's something I would definitely recommend (provided you're comfortable touching or having someone else touch that area of your body on a semi-regular basis, which might not be okay for some) as I think it has the potential to be helpful and isn't a huge investment in terms of time or money.