Many expecting mamas understandably have anxiety around the sensations that may be felt during labour and birth. While no two women’s experiences are the same, what is common is that, without an epidural, some discomfort can be felt around the vagina and perineum during the pushing phase. This is so delightfully referred to in birth circles as the “ring of fire”, and takes place in the second stage of labour as the baby’s head is crowning and the perineal tissue is stretching.
There is an easy and handy self-massage exercise that I like to give as home care to my prenatal massage clients that can help prepare the tissue of the perineum for the big stretch of birthing. Many of us may not be aware of scar tissue that has formed in the vaginal/perineal area that may have been the result of a previous birth, surgery, injury, infection, or inflammation. The perineal muscles themselves may be hyper or hypotoned as well, especially if there is a presence of pelvic floor dysfunction.
It is important to mention the potential impact of trauma. Some expecting women are also survivors of sexual abuse and/or sexual violence, so I always use caution when giving this homework to clients. Those who have experienced sexual abuse/sexual violence have the potential to be triggered with this home care. If that is the situation for you, I offer you my empathy and compassion and I encourage you to talk to your RMT, counselor, midwife, or other health care providers before attempting this exercise. For some it can feel empowering, but for others it may add to the already heightened emotions of the survivor’s pregnancy experience.
Firstly, credit is due to the amazing Paula Jaspar, RMT for teaching me this technique. If we take a look at the diagram above, we can imagine the vagina in the shape of a clock with the urethra in the twelve o’clock position, and the bottom of the vaginal opening at the six o’clock position. The area that is safe to work with is between three and nine o’clock. We avoid the area between nine and three o’clock because we don’t want to put any pressure upwards on the urethra as it can be uncomfortable and we want to avoid any risk of causing a urinary tract infection by moving bacteria towards the opening of the urethra.
This exercise is appropriate for women experiencing a healthy pregnancy, between 30 and 38 gestational weeks, and whose membranes have not yet ruptured. If your water has broken, please don’t do this exercise as we don’t want to risk introducing any bacteria into your vaginal canal.
Choose one of three positions: lying on your side, reclining on your back with pillows propping you up, or floating on your back in your own bathtub. If you choose to be in your own bathtub, just use plain water, do not add any bath products or epsom salts. You may opt to have a partner help you with the exercise, but do have a conversation first to decide if you do or do not want this to lead to intercourse. Some partners may become aroused with this exercise, but you may not be open to going there, so it’s best to discuss your needs before you get started.
Be sure to only use a personal lubricant designed for genital use (KY for example), and please avoid using any oil or food grade product as we don’t want to encourage the growth of any harmful bacteria. Begin by washing your hands thoroughly, then get comfortable and begin your exercise.
Starting with the pad of one finger, insert it into the vaginal opening in the three o’clock position. Gently apply pressure to bring the tissue to a stretch. You want to feel some sensation (pressure, stretching, burning, stinging), but it should be very mild (we’re talking a one or two out of ten on a pain scale). Hold at that barrier for a count of three, then release. Move your fingertip a little closer to six o’clock and repeat, gently applying pressure to the new area for a count of three and releasing. Work your way along until you have reached the nine o’clock position. Once you have finished there, begin again at three o’clock, this time doing a small, circular massage motion with a slight stretch at the end. You may need to focus on deeply breathing and relaxing the perineal muscles as you do this if they are tight. You will also want to feel for any areas in the tissue that feel like a hardened lump or knot. If you do find something as you go along, I encourage you to make an appointment with your doctor to have it checked out just to be sure that everything is a-ok. I recommend women aim to do this two or three times a week and it should take about ten to fifteen minutes.
After a couple of weeks, once you are feeling accustomed to the exercise, you can try using two fingers to increase the intensity of the stretch and massage.
I suggest stopping this exercise a couple of weeks before your due date as the goal is to relax and prepare the perineal tissue. Give the area some time to rest before the demands of labour and birth.
I also wish to emphasize that at no point should any RMT be performing this technique on you. Direct, internal massage therapy in the vaginal area is not within our scope of practice. This is meant to be given as a home care exercise for you to do yourself. If an RMT suggests they can, or does perform it for you, please report them to the CMTBC.