Curriculum Topic: Individual Activity
Activity Type: Anatomy, Pregnancy
Supplies: Kegel reminder stickers
Possible handout with instructions
Instructions:
According to Cochrane, “antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.”
Consider distributing information and instructions on perineal massage:
Perineal massage will help you prepare for the stretching and pressure you will feel as the birth canal opens and your baby’s head crowns . Learning to relax as you feel the stretching will help you to release when you feel that burning sensation during the birth .Prenatal massage may help the tissues to stretch during birth so that an episiotomy won’t be needed . The purpose is not to enlarge the opening.
Begin perineal massage about six weeks before your due date . Do it once a day for about five minutes . Do not do the massage if you have active genital herpes or any other genital infection . Always use clean hands with very short fingernails, and avoid touching the opening of the urinary tract .
To learn the process, it may be helpful first to prop a mirror so you can see your vagina and perineum . You can see and feel the perineum move as you do the Kegel exercise . Practice relaxing the muscles with a warm washcloth held on the perineum . (Some women prefer to take a warm bath to help them relax before doing the massage .) A lubricant may help to soften the massaging fingers or thumbs, and to increase the elasticity of the perineum . You may use cocoa butter, K-Y jelly, wheat germ oil, or even vegetable or olive oil from the pantry .
Place either your thumbs or index fingers an inch or two inside your vagina and press downward toward the rectum . As you press, you will feel a slight burning, stretching sensation . At that point, hold the pressure for one or two minutes until the stinging subsides . Slowly move your fingers or thumbs up along the lower sides of the vagina with the same steady pressure . Massage back to center and up the sides, pulling slightly forward, for three or four minutes . This will work the lubricant into the tissues . Practice releasing the perineum to the sensation of the stretch, as you will do at your baby’s birth . In a week you should notice that the tissue stretches much easier as you massage . Do the Kegel exercises to help increase the muscle tone of the pelvic floor .
Directions for doing prenatal perineal massage
1 . Wash your hands thoroughly .
2 . Lean back in a comfortable semi-sitting position, with pillows supporting your back and knees .
3 . Put a lubricant on your fingers and perineum .
4 . Massage, firmly but gently, relaxing your muscles as you feel the pressure or stinging .
5 . Tell your partner how much pressure to apply if he or she does the massage for you .
The Cochrane Review on prenatal perineal massage is available at http://summaries .cochrane .org/CD005123/antenatal-perineal-massage-for-reducing-perineal-trauma
Talking Points:
- Place Kegel stickers around your classroom where students will see them. Provide extra stickers for students to take home as reminders to do the Kegel exercises. You can purchase brightly colored “star” labels to create your own Kegel stickers.
-Information about and instructions for performing prenatal perineal massage on oneself is included above
Reference: Adapted from the Lamaze Toolkit
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