Research has shown that massaging your perineum from 34 weeks, reduces the chance that you might damage this area during birth (with a tear or bruising). This is particularly beneficial if you are having your first baby.
The perineum is the area of tissue between your vagina and anus. It connects with the muscles of your pelvic floor. Your pelvic floor is a hammock of muscles which support your pelvic organs, such as your bladder and bowels.
Stretching or tearing of the perineum during childbirth can affect the support that your pelvic floor gives you. This can mean that you are more likely to have a prolapse (dropping down) of your uterus. A weak pelvic floor can also affect the control you have over your bladder and bowels. Damage to your perineum might also lead to discomfort and pain during sexual intercourse.
Approximately 85% of women will have some degree of perineal tear during vaginal birth.
What is perineal massage?
Perineal massage is a way of preparing your perineum to stretch more easily during childbirth. During birth, the perineal tissue needs to relax and open to allow your baby to pass through your vagina.
Advantages of perineal massage:
When should I start and how do I do it?
You can start at any time from 34 weeks of your pregnancy and it can be done by you or your partner, if you are comfortable with this.
When should I do it?
A good time is during or after a bath or shower because blood vessels in the area are dilated. This makes the perineum softer and more comfortable to touch. You are also already more relaxed!
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We suggest using a small amount of unscented, organic oil for example, olive, sunflower or grape seed oil, to lubricate the area and make the massage more comfortable. My expert midwife have created the perfect product with ‘peri-prep your bits‘ so go check them out!
Don’t use synthetic oils such as baby oil or vaseline.
Make sure your hands are clean before you start.
Comfortable positions include:
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Technique:
Do not do perineal massage if you have, vaginal herpes, thrush or any other vaginal infection
If you feel pain at any point, stop and try again another time. If you continue to find this painful speak with your GP, midwife or even better- see a Women’s Health Physiotherapist.
There are many risk factors to pelvic pain during pregnancy and one of the most common is hypermobility.
If you have hypermobility it means that your joints are more flexible than other peoples (sometimes referred to as being ‘double jointed’).
During pregnancy a hormone called relaxin is produced, with important effects in the female reproductive system, to allow your body to adapt to maintain the pregnancy. Later in pregnancy it helps the body prepare for childbirth and relaxes the ligaments in the pelvis and softens and widens the cervix.
So if you add relaxin to an already ‘over mobile’ joint the result can be pain, most often pelvic pain, as this is where your body is taking all of the additional pressure.
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To find out if you are hypermobile you can test yourself with the Beighton Score (out of 9).
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You do not have to score 9/9 to be deemed as hypermobile, it is a sliding scale so the higher the score the more hypermobile, it is suggested, you are.
Knowing if you are hypermobile can be hugely helpful during or pre-pregnancy. Anyone that is thought to be hypermobile should be vigilant, keeping their body strong to cope with the additional strains that pregnancy puts on them. It is best to avoid impact and very strenuous exercise but instead do activities which engage your core muscles (especially your pelvic floor as this helps to support your pelvis).
Pregnancy pilates and swimming are both usually safe exercises to continue throughout your pregnancy.
If you have any concerns, or are experiencing pelvic pain, please do not continue and ignore the pain, cut back from what you are doing to see if this helps and try to get to a specialist Physiotherapist as soon as possible.
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The same principle applies to your pelvic floor which, in case you aren’t aware, is also a muscle.
So when you are doing your pelvic floor exercises it is very important to contract the muscle as hard as you can, to build its strength and endurance, but it is equally, if not more, important to fully relax the muscle in between each contraction (like the bicep curls in the first half of the video).
The pelvic floor muscles have such an enormous responsibility in birth. They are like the gatekeepers for the pelvis. When they have normal tone, things go really smoothly. But when they have too much tone or uneven tone side to side, that’s when they can cause problems.
Ideally, we want pelvic floor muscles that have a functional strength. We want the muscle to be able to contract and relax. It needs to be strong and flexible so it can lengthen when pressure is applied. That is what needs to happen for birth – the baby’s head applies pressure, and the muscles lengthen and open up.
When doing your pelvic floor exercises, always ensure you allow the muscles to fully relax between repetitions. Think about your pelvic floor as an elevator, when you contract you want to take it to the 10th floor, but before you do the next contraction you need to take the elevator all the way back to the ground floor.
If you feel like you are not lowering all the way to the bottom floor, take a deep breath in and out and relax as much as possible between each repetition of pelvic floor exercises.
If you struggle to feel what you pelvic floor is doing i.e. if it is contracted or relaxed try doing them in lots of different positions until you start to become more aware of them.
Seeing a Women’s Health Physio can really help as they can check your strength, check the technique of your exercises to make sure you are executing them correctly and guide you on how long you should hold for and how many repetitions you should be doing! If you are in Cornwall feel free to check out Laura, Ottilie Founder and Women’s Health Physio, at her Fit Bumps and Mums clinic in Newquay.
Lots of the women I speak to are very concerned about pelvic floor weakness, very few people know or understand about pelvic floor tightness or “hypertonicity”, whilst for the majority of the ladies I treat, especially those in pain, this is the problem.
Lets think about the pelvic floor simply, it is just like every other muscle in the body. It can be weak or strong, it can be flexible or tight, or it can be any combination. Ideally we want a strong but flexible pelvic floor- just like we would want that of any other muscle.
So, hopefully, when you exercise other parts of your body whether it be with weights or going for a run, you do stretches before and after…yes? But have you ever thought about stretching your pelvic floor? No? Most people haven’t, as we have been taught to just squeeze, squeeze and squeeze some more.
So these exercises aren’t just for those having problems, this should be routine, perhaps not every day but maybe once a week or whatever you have time for, try to put this gentle series into day.
When doing these exercises, I always recommend taking time out of the day, just 10 minutes, to fully concentrate on yourself. You do not want “mummy, mummy, mummy” whilst trying to do these, nor do you want to feel conscious that your husband is wondering what the hell you are doing. So wait until the children are in bed or being looked after, and take yourself to a calm area of the house. This needs your full attention. YOU need your full attention.
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Lie flat on your back, with the soles of your feet together and knees falling apart. Bring your feet comfortably close to your bottom. Hold an easy stretch for 30 seconds. Breathe deeply into your belly.
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Start with your feet on the floor and knees bent. Bring your right foot to the front of your left knee. Then lift your left knee towards your chest. Hold an easy stretch for 30 seconds. Breathe mindfully. Repeat the stretch the opposite way, with right foot to left knee etc.
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Start lying on your back with both legs straight and relax. Bend one knee to your chest. Hold an easy stretch for 30 seconds and breathe deeply into your belly. Repeat the stretch with the other leg.
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Start with your weight on your hands and feet. Relax your bottom down between your heels. Your elbows gently push your knees apart. Hold an easy stretch for 20 seconds. Breathe mindfully into your belly. This stretch is only good for people with good knees!
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Start lying on your back. Grasp the inside of each foot with your arms inside your knees. Allow your knees to widen apart. Hold for 30 seconds and breathe mindfully into your belly.
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Start on your hands and knees. Relax your bottom down towards your heels – your knees are wider apart, feet closer together. Hold an easy stretch for 30 seconds and breathe deeply into your belly. Your head can rest on the floor.
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**You do not need to do all of these poses, I would recommend trying them all initially and seeing which ones you feel most comfortable and relaxed in, and sticking with those. As you might be able to tell from the picture, I am not so keen on the happy baby stretch- to me it just feels awkward but everybody is different and some people love it!
These exercises work well combined with some relaxation which might just be listening to some music you enjoy but something I recommend to many of my clients is an app called “head space”. I struggle with lots of fluffy stuff but this app is brilliant, it takes just 10 minutes and is very “normal”, not airy fairy, just simple- I find it hard to explain so just trust me and try it! Many of us, myself included, are so busy juggling kids/work/home life that we become very tense. Think again of your pelvic floor like the muscles in your shoulders…do you they get tight and need a warm bath and a stretch out from time to time? Well your pelvic floor is another area that can suffer from these “trigger points” of tight muscle which in turn can lead to pain.
Simply by giving yourself some “head space” and reducing you stress you can help relax your pelvic floor.
If you have specific concerns about your pelvic floor, suffer with incontinence and/or pain it is always advisable to see a Women’s Health Physiotherapist.
If you are in Cornwall Laura, Ottilie Founder, is highly trained and will always handle your situation sensitively and confidentially. If you want to have a chat to see if Physiotherapy can help you, please do not hesitate to get in contact.
We are looking at creating a portfolio of practitioners so please do get in touch if you can recommend a Physio that you have been to!
A cross between a mint aero and a bounty these bars are delicious!!!
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MINT LAYER INGREDIENTS
1 Avocado
1/4 cup honey
6 tbsp coconut oil, melted
1 1/2 cup shredded unsweetened coconut
3/8 tsp mint extract
dash of salt
CHOCOLATE LAYER INGREDIENTS
1/4 cup coconut oil
2 tbsp honey
1/4 cup cocoa powder
1/4 tsp vanilla extract
dash of salt
(Or if you are slightly lazier like me, melt dark chocolate and add some coconut oil!)
MINT LAYER INSTRUCTIONS
1. Line a 9×9 inch baking dish with foil.
2. Place all ingredients in high powered blender.
3. Blend until smooth.
4. Smooth mixture into prepared dish and stick in the freezer.
CHOCOLATE LAYER INSTRUCTIONS
1. In small saucepan, melt coconut oil and honey over low heat.
2. Remove from heat and stir in remaining ingredients.
3. Pour over chilled bottom layer and return to the freezer for about 15 minutes, or until the chocolate layer is hardened.
4. Remove from foil and cut into bars. Store covered in the freezer.
