If you’re moving into your last trimester of pregnancy, chances are you’ve heard something about perineal massage—the practice of gently stretching the skin between the vagina and the anus in order to “condition” the tissues for birth. The theory is that having a more stretchable perineum lessens your chances of tearing during delivery, and that it may even help you avoid an episiotomy. Perineal massage during late pregnancy has long been supported by anecdotal evidence, but clinical research has been less conclusive; however, a recent review of randomized, controlled studies of complementary and alternative medicine practices used during pregnancy showed that perineal massage may truly be helpful, says Frank Anderson, MD, MPH, an assistant professor of Obstetrics and Gynecology at the University of Michigan Medical School. Dr. Anderson, who co-authored the review, notes that while more research is needed, the three studies of perineal massage examined in the review showed that it does seem to result in a greater likelihood that the perineum will be intact at the time of delivery.
The studies also showed that perineal massage is most effective in women having their first baby. If you’ve had an episiotomy or tearing in a previous delivery, perineal massage may not work as well for you. “In multiparous women who have had previous episiotomies, the perineum contains scar tissue that is weaker than normal tissue, so the perineum will be more likely to tear at subsequent deliveries and will be less likely to respond to massage,” says Dr. Anderson. Perineal massage also seems more helpful to first-time moms over the age of 30, says Dr. Anderson, noting that this could be due to older tissues being stiffer than younger tissues. Proponents of perineal massage point out that it may have other benefits besides helping the perineum stretch. Practiced regularly, perineal massage may also help you cope with the stinging sensation you’ll feel as your baby’s head crowns. In addition, perineal massage may have the effect of focusing the mother’s determination, says Peg Plumbo, CNM, a certified nurse-midwife and instructor at the University of Minnesota School of Nursing.
“The type of woman who wants to do perineal massage is the same one who is motivated to find a care provider who blends with her birth philosophy and who will work with her for the extra time it takes to deliver baby gently and slowly,” notes Plumbo. Is perineal massage safe? As with any complementary or alternative therapy you try during pregnancy, it’s best to check with your healthcare provider before beginning perineal massage. According to Dr. Anderson, perineal massage could be harmful if done improperly, and it’s important to use adequate lubrication and avoid excessive force. Plumbo adds that she would caution a woman against perineal massage if she has a history of preterm labor, premature rupture of membranes, a vaginal infection, if the massage induces contractions, or even if the procedure simply makes her sore or uncomfortable. Finally, if you do try perineal massage, keep in mind that birth is unpredictable by nature. Tears do often happen, and episiotomies sometimes become necessary, even during highly prepared-for births.
I tried perineal massage during my first pregnancy. I was happy to be doing something proactive as I waited—endlessly, it seemed—for the birth of my son. His delivery was easy, and afterwards, I would have recommended perineal massage to anyone. At around the same time as I was expecting my little boy, Amy Kameda-Smith* was expecting a girl. She didn’t try perineal massage. “For exercise, I stuck to water aerobics—and night time aerobics!” laughs Kameda-Smith, an Atlanta-area mom of one. She, too, had a happy birth experience and wouldn’t change a thing. In the end, both approaches were fine. “Perineal integrity has more to do with race, parity, age, and overall state of health than it does to perineal massage,” says Plumbo. *Name and location changed by request. When to start: Begin perineal massage around 34 to 35 weeks into your pregnancy. Be sure to check with your healthcare provider first, in case there is something in your medical history that would make perineal massage inadvisable for you.
What to do: After your bath, find a private place and sit back on a towel in a comfortable position. Apply the oil or lubricant to your hands and around the perineum. Put your thumbs (or have your partner put both index fingers) about one to one-and-one-half inches (three to four centimeters) into your vagina. Next, press firmly but gently downward towards your rectum. A little tingling is okay, discomfort or burning is not. These tissues are sensitive, especially during pregnancy. Being too vigorous could lead to swelling or bruising. Hold this stretch until the area begins to feel a little numb (around two minutes). Then, maintaining steady pressure, gently move the fingers or thumbs back and forth upward along the sides of the vagina. Continue for around three to four minutes, being careful to avoid the urethra (urinary opening). Perineal massage can be repeated daily, and in about a week, you’ll probably notice increased “stretchiness” in your perineal area.
Some surgeons suggest using a scar cream after surgery. With so many out there, another big challenge is choosing the right one for you and your baby. The options range from $20 silicone based scar cream all the way up to $300. So which one is right for you? Only you can decide that, but we hope we can help make your decision a little easier. Essential oils are quickly becoming a favorite amongst cleft moms, since they are an all natural approach to healing. Essential oils treat the scar on a cellular level and promote repair of the tissue to its original condition.You have to be extremely careful where you buy your essential oils, as you only want to use the best on your baby, and most “essential oils” on the market have been manufactured and are considered “perfume grade.” That means that they may contain additives that are not safe to be applied topically to the skin or to be ingested. doTERRA and Young Living have proven to be some of the best around, as they offer 100% pure essential oils, which are completely safe to apply topically and ingest.)
doTERRA’s Immortelle is a proprietary blend that supports skin on a cellular level. Unlike silicone based products, Immortelle is easily absorbed into the skin and can treat the scar all the way through, thus greatly reducing any scar tissue buildup. The ingredients of Immortelle are Frankincense, Hawaiian Sandalwood, Lavender, Myrrh, Helichrysum and Rose. Cost: $92.67 retail $69.50 wholesale* (*To inquire about wholesale cost please contact Cleftopedia) You can also make your own blend by adding 6 drops of each Helichrysum, Frankincense, and Lavender to 5ml roller bottle. Empty 6 capsules of vitamin E and top the rest off with a carrier oil, such as Fractionated Coconut oil. Both of the babies in the before and after photos here have been using this blend with oils purchased from doTERRA. Average cost for all three oils to make this blend is $200. This may seem pricey at first, but since you only use a few drops in the blend the bottles will actually last a very long time!
(Again, there are many places to buy essential oils and not every brand is meant for topical use, so always do your research and make sure they are safe for topical use and ingestion before you buy! We mention doTERRA often here because we have personal experience with this brand of oils and can vouch for their purity and effectiveness. Remember, a higher cost does not necessarily mean better quality and purity, but if you find an oil offered at a significantly cheaper price than everywhere else, this could indicate an issue with purity. To read more about purity as well as more about essential oils in general, we’ve found Aroma Web to be a great neutral source of information.) There are quite a few of options out there when it comes to a silicone based scar cream. Below you will find the three most popular scar creams that have been used amongst other cleft moms in the past. Scarfade is a topical silicone treatment designed to help make scars less prominent. When scars form, the body naturally creates new tissue to close the gap created by injuries to the skin’s dermis.
As the scar forms over several weeks and months, Scarfade scar treatment cream is used to make the tough new layer of skin softer. It adjusts the pigment to make the scarring less noticeable. There are several variations of Scarfade available. Which one to choose depends to some degree on the type and location of the scar. None are effective treatments for acne scars. All Scarfade products are medically proven to work through direct skin contact. They are easily tolerated by children and should be used for three to four months or until the scar is no longer noticeable. “Our cleft team in Chattanooga, TN recommends the use of ScarFade starting at 2.5 week post lip repair. My sons lip scar started pulling up about 3 weeks post repair. At first, I was putting the ScarFade on and massaging it in for about 30-60 seconds. His lip continued to pull and pull, and our surgeon started talking about a revision. He asked how I was applying the ScarFade and insisted I was doing it all wrong and gave me new directions.
We have been using it “his way” (he says how its intended to be used) for 15 days and there is already a huge difference in my sons lip scar pull! So, this is what we do now. Twice a day- usually after breakfast and before bed- I get Sawyer in my lap and rub his scar in a circular motion. Once, the blood starts really flowing to it and gets red I apply a pea size amount of the ScarFade silicone gel to his scar and spread it out just enough to cover the whole scar. We leave it on thick and let his skin absorb it- it takes about 5 minutes. Once its dry and fully absorbed I let him down to play again. The silicone gel works from the inside out and that’s why massaging it in the skin really just wastes it. Its helped my son so much by letting it just absorb. I highly recommend ScarFade Silicone gel. When used properly you can see a difference very quickly.” “We’ve been using Scar Fade since around 2-3 weeks post lip repair. I bought the 1/2 ounce size from Amazon.
A little expensive for such a tiny tube, but you don’t use much, so it lasts awhile. I put a teeny tiny dab on my finger and then massage it into his lip in small circles. I do the massage during diaper change, then sing a song or make a silly noise. If I had to choose a product all over again, I would still choose Scar Fade. Very pleased with it!” – Jamie Neally NewGel+E ointment is a medical grade, fast drying, hypoallergenic silicone gel with vitamin E that helps soften, flatten, smooth and fade scars. It is formulated to be used in the management of all types of scars, including hypertrophic, keloid and scars resulting from surgical procedures, trauma/accidents and burns. “Oliver was born with a bilateral cleft lip that was repaired when he was 3 months old in November 2013. He is now 1 year old and 9 months post lip repair. We have been using Newgel+E on our sons repair for 90% of the time. We used Kelocote at first because we bought it prior to lip repair, but didn’t like how runny it was.
I like how the Newgel is a thicker silicone texture. we put it on about 2 times day. But I would be a liar if I said I haven’t forgotten to put it on some days, with having four kids! We apply an even coat and then rub it in. We don’t do very long scar massages, just basically rubbing in the gel. Ollie’s scar is more red than it is thick. His scar is actually pretty soft which i am happy about I have seen dramatic changes in Oliver’s scar since surgery. The left side of his repair is pretty much invisible, the right side however is still a little bit raised and red. According to our surgeon, as long as the scar is red, the Newgel will continue to work.” – Kristen Garza Mederma® Advanced Scar Gel can help to improve the overall appearance, color, and texture of scars. It works for many types of scars, including acne scars, surgery scars, and scars from burns, cuts, and other injuries. And since you only have to apply Mederma® Advanced Scar Gel once a day, it’s easy to use.
Kelo-cote’s patented silicone scar gel dries within minutes forming a flexible, breathable, waterproof sheet over the affected area. This invisible silicone sheet binds with the stratum corneum (the outer layer of dead skin cells) to protect the underlying tissue against chemical, physical and microbial invasion of the scar and provide the optimal healing environment for aesthetic scar outcome. “Daisy was born with an incomplete cleft lip on the right hand side. Following repair, our cleft team gave us a tube of Kelo-cote UV scar gel. Her surgeon recommended we apply it morning and night or 30 minutes before sun exposure. He also recommended that we massage her lip with aqueous cream morning and night. Daisy absolutely hated being massaged, so I wasn’t particularly diligent with that, but we did apply the Kelo-cote twice a day. Now the wound is almost 8 months old we tend to only apply once a day or when we are going to be in the sunshine. Daisy has had an excellent result.