As women we go through many vaginal changes during pregnancy as well as after birth; and it's down to use to pay extra attention down there to ensure maximum comfort throughout.
We catch up with women's health physio Clare Bourne to get the full low down on how to perform perineum massage, pre and post childbirth as well as top tips for vagina recovery.
Did you know perineal massages have been clinically proven to lower the risk of tearing, and also reduce the risk of the most severe types of tears by nearly 20%? (according to the NHS). So here at NESSA we believe this massage is worth it.
Clare says “There are a lot of techniques you can do to prepare the muscle for childbirth.
“90% of first time mums will have an element of tearing, it sounds terrifying, but it can be anything from a small skin or labia tear, to a more severe tear which can involve the anus.”
“Perineal massage is a technique you can use from 35 weeks of pregnancy to help gradually stretch the perineum, and prepare the pelvic floor muscles, the skin, and the connective tissue.”
“Women worry about what oil to use on their vaginal tissues during pregnancy so to have a totally natural oil like VVO - Nessa's vagina oil to recommend is brilliant.”
Do How You Perform A Perineal Massage?
We looked at a few different techniques, and we have uploaded some great perineal massage videos with Clare so you can actually see how to perform the best massage.
Note: If you are pregnant - At 35 weeks, you are normally a little uncomfortable, and it can be hard to reach down there, so lie down somewhere comfortable, get a mirror, and get someone to help if you can 😊
- Make sure you have perineal massage oil handy
- Ensure your hands, or partners hands are nice and clean.
- Make sure you are comfortable and lie on your back, bringing you knees together towards your chest, and then open your knees like a book.
- Apply 3-4 drops of oil to your fingertips.
- Using your thumbs, insert them into your vagina and then place your forefingers on the skin of your perineum. You now need to stretch this skin gently by massaging and moving your fingers from the middle of your vagina outwards, it shouldn't hurt so if you feel a burning sensation you've stretched too far.
- Imagine your finger is sweeping like a clock hand from 3 to 9 o’clock. You are aiming to soothe the area just below your vagina and between your anus - your perineum.
- Massage upwards as you gently stretch the skin and repeat for around three to five minutes and do this at least three times per week.
Over time you should aim to build up the intensity and duration of the stretches.
Recovering from a Vaginal Birth
As Clare mentioned, most women will have some degree of tearing, and hopefully made less by your great massaging from 35 weeks, but let’s look at recovery.
According to the NHS, sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.
An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy might be done if:
- the baby is in distress and needs to be born quickly, or
- there is a need for forceps or vacuum (ventouse), or
- there is a risk of a tear to the anus
- you have been trying to give birth for several hours and are now tired after pushing
Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side. The cut is stitched together using dissolvable stitches after the birth.
Around 1 in 7 deliveries in England involves an episiotomy.
Clare's Tips for The First 6 weeks
During the first 6 weeks you want to keep the vulva clean with water, either in the shower or bath, but it doesn’t need cleaning with lots of soaps and scented products.
Pouring warm water over the outer area of your vagina as you pee may also help ease the discomfort.
The vagina is very good at healing and cleaning itself, sometimes when we try to interfere and over clean we can cause more problems.
Regular pad changes help but stick away from scented pads for the same reason.
Placing an ice pack or ice cubes wrapped in a towel on the cut. Avoid placing ice directly on your skin as this could cause damage
Painkillers such as paracetamol and ibuprofen can help relieve pain and is safe to use if you're breastfeeding.
Exposing the stitches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help.
It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks. If the pain lasts longer than this, speak to a doctor, health visitor, or another health professional.
Pelvic floor exercises are key and safe in this initial time, it might feel difficult to contract due to swelling but exercises can actually help reduce this swelling and reduce pain.
Clare’s Tips Post 6 weeks
“We often think we have done all the hard work, let's just leave the vagina alone and hope for the best”“We are often told to work on our pelvic floor exercises after birth, squeeze and relax but actually this doesn’t work for all of us.”
“Some women will have symptoms of ongoing incontinence despite trying really hard with their pelvic floor exercises. This can be due to the pelvic floor being slightly restricted by scar tissue that forms after a tear.”
“As mentioned 90% of first time mums will have an element of tearing during birth, it sounds terrifying, but it can be anything from a small skin or labia tear, to a more severe tear which can involve the anus.”
“Women can often feel more movement of the muscles and also see their symptoms improve when they combine this with ongoing strengthening.”
“Postnatal massage is not widely talked about, but helping to stretch scar tissue that has formed after vaginal tears from birth can really help pelvic floor function and strength. Having an oil like Nessa's Vagina Victory Oil to use during this time on delicate tissue is just what women need.”
Watch Clare’s demo on how to perform postnatal massages: