Perineal massage benefits

More than 85% of women that have natural births will suffer from some form of perineal tear. It is estimated that between 0.6 to 11% of deliveries produce third and fourth degree tears that can lead to permanent life altering changes. The risks involved in this are based on three main factors; maternal, fetal and intrapartum risk factors. 

Maternal risk factors include ethnicity, complications arising from a vaginal birth after a caesarean section has been conducted and births in women younger than 20 years old. Additionally, a perineal length less than 25mm also increases the odds of tearing occurring.
Fetal risks include a larger fetus >4kg along with birth defects and misalignment of the fetus.
During the intrapartum stage of delivery, instruments used including forceps can initiate tearing, prolonged second stage of labor lasting more than an hour can increase the probability of tearing, delivery in a deep squatting position and the use of an episiotomy to reduce the risk of a bad tear.  

Interestingly, recent research conducted in 2017 has suggested that the use of a standard episiotomy is not required in births that do not require instruments. As such the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANCOG) do not favor them. 

Perineal Massage
Perineal massage benefits range from increasing the flexibility of your  perinium before the big day to having you feel more relaxed prior to delivery. Perineal massage is done either with the aid of a unique perineal massage tool, or, by the woman’s fingers in a ‘U’ shape motion at the base of the vagina. Perineal massage oils and gels can be used to reduce irritation and treat swelling during the massage process. These are specially formulated to minimize irritation, hydrate the skin and also bend scents into the oil to help with relaxation. Many oils and gels are not designed for this sensitive area and therefore it makes sense to buy only specially formulated perineal massage oil and gels. In general, You should be aware that such oils and gels use non-toxic additives to reduce spoiling of the product that other lubricants may not formulated to accommodate this need.   
This stretching process needs to focus on the area that will likely start the tare and propagate it back. 

How should you start?
To achieve the best results you need to start at week 34 of the pregnancy and conduct the massage for 10 minutes 3 times a week.
Most women start by trying the massage laying down after washing their hands in a secure and relaxing environment. It’s important, as you do not want to be disturbed and need to be relaxed to achieve the most benefit of the process. At 34 weeks your body will be a different shape and require support and vaginal accessibility may be a challenge in certain positions. If laying down does not work some find sitting on the toilet a practical way to make space and get the support for the baby. The great thing about using a perineal massage device is that you do not need the accessibility required for manual massaging.
Whatever you decide to do, consult first with your midwife or healthcare professional.