The word tearing is enough to make any pregnant woman wince, but it's one of the unfortunate risks of labour, whatever the size of your baby. The perineal tissues need to stretch to allow your baby to pass through the birth canal, and if they don't stretch enough, a tear may occur. Alternatively, your midwife or doctor may cut into your perineal tissues to prevent substantial tearing. This is known as an episiotomy, and will need stitching after your child is born.
Perineal massage with suitable oil may help to soften and prepare the perineal tissue for labour. It is thought that it helps the tissues to stretch to accommodate the baby's head, and so may lessen the amount of pain and stinging you feel when your baby's head crowns. It may also help you get accustomed to the feeling of something stretching your perineal tissues so you are more relaxed when you feel the baby crowning as you know what to expect, allowing it to be born more slowly and reducing the risk of tearing.
It is also thought to help encourage blood flow to the area too, so if you do tear, you may heal more quickly. Studies have shown that women who practice perineal massage in the last weeks of pregnancy reduce the need for stiches, and three months after giving birth, fewer women reported pain in the perineal region.
Although called massage, it's a bit more involved than just rubbing oil into your perineal tissues. If you want to give it a go, start six weeks before giving birth to allow your tissues time to stretch. Perineal massage is safe and fine to practice even if you have scar tissue from previous tearing or episiotomies.
Start by washing your hands and sitting in front of a mirror with your back supported if you feel unstable, and use unscented oil such as vegetable or olive oil. Insert your thumbs into your vagina and pull downwards and to the sides gently but firmly until you feel it start to sting. At this point hold your position for about two minutes or until it starts to become numb and the stinging starts to go. Then massage your thumbs over the lower half of your vagina and pull forwards, keeping your thumbs hooked inside, mimicking the stretch you will feel from your baby's head. If you practice this every day you will find it becomes less sensitive and painful. You may wish to ask your partner to help you, especially as you become more heavily pregnant.
Perineal massage should be avoided if you have thrush or any other infection as it can make it worse.
Perineal massage is not everyone's cup of tea however, and some people find it uncomfortable and not worth the fuss. If you have an exceptionally big baby or difficult labour, no amount of stretching will help prevent you tearing. Being relaxed during labour may help, as can the position you give birth in. Delivering your baby standing or kneeling may also help to avoid tearing.
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