Series: Brilliant Activities for Birth Educators- Teaching the Tender Topic of Perineal Massage

By Jen Olsen

This month’s Brilliant Activities for Birth Educators post is written by a new birth professional, Jen Olson, that I had the pleasure of meeting while teaching a birth doula workshop last year and then this past February during a Lamaze seminar. When Jen began her teach back for the seminar and pulled out these perineum/vagina eggs for all the participants, I knew this would make a great activity for her to share on the blog. Now is the time when plastic eggs are available in stores, as Christians get ready to celebrate Easter. After Easter clearance sales mean lots of great teaching aides at super cheap prices. This is a tricky topic to teach and I have never been able to clearly demo how to do this in class. The sensation of practicing on this glove/egg set-up was unbelievably realistic. It is a super clever idea and am all set to use this activity on my new series that starts tonight. Thanks Jen for sharing your creativity! – Sharon Muza, Community Manager, Science & Sensibility.

Introduction

babe-perineal-massage-1.jpgThere are some benefits to performing perineal massages. In first time parents who plan to birth vaginally, it has been shown to decrease the risk of episiotomy and the risk of vaginal tearing requiring stitches. In addition, the sensations of stretching vaginal tissue can help familiarize a person to the sensations often associated with crowning during second stage. This familiarity prior to birth can assist the laboring person in identifying strategies to manage the intense sensations experienced when birthing a baby.

In talking with students, I often find that many of them are not comfortable with discussing the impact that giving birth has on the vagina and perineum, let alone in learning how to perform a perineal massage by themselves or with their partner to reduce the potential for tearing. They did not know that this preparation can help them become comfortable with the sensations they may experience. But I do find that many families do have a fear of tearing or receiving an episiotomy.Objective

Objective

While the main purpose of this activity is to provide families with a somewhat “accurate” replica of a perineum/vagina with which they can practice the awkward new skill of perineal massage, an additional objective is to “break the ice” and have the entire class (and each individual family) successfully face an uncomfortable situation together so that they can feel more comfortable with each other and interact more freely as a cohesive group for the remainder of the course.

When to conduct this activity

There are a few places where this activity would be effective. I would place it in week one when speaking about anatomy and pregnancy. This placement also gives you the advantage of getting an uncomfortable topic out of the way and hopefully relaxing the students enough that they are active participants for the rest of the sessions.


perineal-massage-3-e1458787330508.jpgSupplies

  • Plastic Easter egg that opens lengthwise. (Note: the egg size that I find works best is 2 ¾ inches wide by 4 ½ inches tall andeach egg will make two perineums.) 
  • Vinyl exam gloves (the ones I use say they “fit most sizes”)

In order to make the perineum tight enough, I first tied a small knot in the opening of the glove. This also makes a “realistic” clitoris. Insert one half of the egg into the glove, turning the egg so that the opening of the egg is facing the opening of the glove. Position the small knot you made previously at the top, even with the top of the egg. With a little stretching, pulling and adjusting, manipulate the glove over the egg so that the opening is pretty tight and can simulate the stretching of the vaginal tissue near the bottom (wide part) of the egg. Once you have accomplished this, gather the fingers and excess glove material in the back and tie off in a knot. It does take a bit of practice to get this down.

perineal-massage-2.jpgHow to conduct this activity

I begin the activity by stating that in this class we will get up close and personal to some topics that are not necessarily comfortable to discuss. I acknowledge that there are many topics within pregnancy and birth that are not easy to talk about in our culture. This may be one of them.

I discuss what the research shows about perineal massage, especially in people having their first child. I talk about the benefits, when to begin (36 weeks) and where they can find out more information.

I pass out an egg “vagina” to both pregnant people and their support person and ask families to find a comfortable place to sit. I point out that when performing a perineal massage it is important that the pregnant person feel comfortable and relaxed emotionally and physically. Ask the pregnant person to hold the model with the opening facing away from them, while the partner will hold it with the opening facing them. (This is similar to the perspective they would have if they were doing this themselves or having their partner conduct the massage.) Remind the students that before doing a perineal massage, they should ensure their hands are washed and their nails are cut short. Inform them that they should lubricate their fingers and the bottom of the vaginal opening with a small amount of lubricating oil such as Vitamin E, almond, olive, etc. Demonstrate that they will begin the massage by inserting their thumbs, side by side, into the bottom of the vaginal opening. They will begin pushing down gently until they feel a bit of a stretch or until it becomes uncomfortable whichever occurs first. While explaining this, I am demonstrating on my own egg. Hold that position for a few seconds as the pregnant person adjusts to the feeling and concentrates on relaxing the perineal area. When the pregnant person is able to relax and continues to feel comfortable, continue by moving the thumbs apart and slightly up the opening in a U shape. I continue with the demonstration so they have a clear visual understanding.

perineal-massage-1-e1458791980917.jpgAllow time for the students to practice this skill on the eggs after they have observed me doing it on my egg. After everyone has practiced, we discuss and share how this might feel, things that might help (music, aromatherapy) and how awkward it might be in the beginning.

Conclusion

At the end of this activity, families will be able to decide if perineal massage is a tool they would like to incorporate into their pre-birth preparations. If they decide to try it, they will be confident in how to apply the skill, understand the reasons for doing so and suggestions for making it work for each family.

I have discussed with other childbirth educators other ways to use this model in their classes. An educator could place a cervix inside or perhaps an emerging infant head? (an appropriate sized ball?) that would demonstrate crowning. Do you teach perineal massage in your childbirth classes? If so, do you think you might consider using this hands on tool to help families learn this skill in preparation for birth? If you don’t cover this, might you begin now that you have a great activity to make the topic engaging? Please let us know how you might incorporate this tool into your class?About Jen Olson

About Jen Olson

Jennifer-Henderson-Olson-head-shot-2016.jpgJennifer Henderson-Olson head shot 2016Having raised and homeschooled her seven children for the past two decades, Jen has recently joined the world of birth professionals. Jen’s own pregnancies and labors instilled within her a passion for birth and her diverse birthing experiences make her eager to help families become aware of the choices available to them when it comes to their own birth experience. In April of last year, Jen attended the Birth Doula Skills Workshop at the Simkin Center for Allied Birth Vocations at Bastyr University and in February she attended a Lamaze Childbirth Educator Training through Passion For Birth. Jen is excited about completing her DONA birth doula certification, sitting for the Lamaze exam in April, and continuing to assist families to have empowering birth experiences in South Puget Sound, Washington. You can learn more about Jen and contact her through her website – BlessedDoula.com or her Facebook page.

6 Comments

What research is there on the

March 25, 2016 07:00 AM by Amy V. Haas, BCCE
What research is there on the effectiveness of perineal massage, with regard to preventing tears?

Hi Amy, there is a link in thi

March 25, 2016 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
Hi Amy, there is a link in this post to a blog post S&S ran on the evidence, that was written by Rebecca Dekker. Check it out.

This is excellent! Thank you s

March 25, 2016 07:00 AM by Ashley Lovell
This is excellent! Thank you so much for sharing!

Hi Jess - These eggs came from

March 30, 2016 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
Hi Jess - These eggs came from Walmart (you might try Walmart.com) and also check Oriental Trading (http://www.orientaltrading.com/) might be another source. A google search may yield some other sources. Let me know what you find out. Sharon

http://www.orientaltrading.com

March 30, 2016 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
http://www.orientaltrading.com/the-hunt-is-on-plastic-easter-eggs-a2-13722863.fltr?prodCatId=551711 or http://www.orientaltrading.com/farm-animal-plastic-easter-eggs-a2-37_4681.fltr?prodCatId=551711 http://www.orientaltrading.com/lamb-plastic-easter-eggs-a2-37_1006.fltr?prodCatId=551711 or http://www.orientaltrading.com/gnome-plastic-easter-eggs-a2-37_4684.fltr?prodCatId=551711 The key is that the eggs need to a) open vertically and b) be big enough. I suspect a good google search will yield results. Good luck

Do you have a website link to

March 30, 2016 07:00 AM by Jess
Do you have a website link to where I could buy eggs from please? I can't find them here in NZ

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