Tearing During Childbirth: Approaches That May Help
Perineal tears are common in vaginal birth — by some estimates up to 9 in 10 first-time mothers have a graze, tear, or episiotomy. No approach guarantees you won't tear, but there are several things midwives, the NHS, and the WHO discuss, both before and during birth: conditioning the pelvic floor, perineal massage, good nutrition, a trusted birth team, a warm compress during labor, hands-on perineal support with a controlled delivery, water immersion, breathing technique, and birthing position.
Opting for a vaginal delivery means the vagina and perineum must stretch enough to let the baby's head pass through the vaginal opening. The perineum takes a lot of pressure as the head descends, becoming stretched and sometimes torn — these are called perineal lacerations, often a vaginal tear that requires stitches. Tears where only the skin is involved are 1st- or 2nd-degree; deeper ones are 3rd- and 4th-degree tears.
Even the best doctor can't guarantee you won't experience some degree of tearing. But there are a number of things you can do that may help with how the perineum copes — and they can make a real difference to how you feel about and recover from the birth. Here are ten, grouped into what you can do before birth and what happens during it.
Before childbirth
1. Strengthen the pelvic-floor muscles
You want your body well prepared for labor. The main pelvic-floor muscle, the pubococcygeus, lies around the openings of the urethra, vagina, and rectum. With perineal exercises such as Kegels, you condition and strengthen these muscles.
Simply squeeze the muscles around the vagina — the same "holding in" feeling as when you need the toilet and there isn't one nearby. Hold for about 10 seconds and release, and repeat through the day. These exercises are worth keeping up for life to keep the pelvic floor working well.
2. Specialized physiotherapy
The perineal muscles can be weakened by extra weight, pregnancy, childbirth, and hormonal changes. A women's-health physiotherapist trains these muscles to build strength and flexibility and to condition the pelvic floor, using techniques such as a personalized exercise program and electrical stimulation.
It also matters afterwards: in the early postnatal period, specialized physiotherapy supports a woman's physical and psychological wellbeing if she did experience a tear.
3. Eat well for skin and tissue health
To build good skin and tissue integrity, you need a variety of vitamins and minerals; a healthy diet helps your tissues stay supple and retain their elasticity. A modern "normal" diet is often low in vital nutrients, especially when it's heavy in refined, over-processed foods, so it may be worth discussing a supplement with your provider.
Don't take supplements in pregnancy without your doctor's knowledge — some contain active ingredients with strong biological effects and may interact with prescription medicines.
4. Perform perineal massage
Perineal massage (also called perineum massage) involves working the area between the vagina and the anus to condition it for birth. From around the 35th week, massage the perineum using a plain perineal massage oil to help the tissue become more supple and elastic. Good options include plant oils such as almond oil, olive oil, and coconut oil. The practice is discussed by the WHO and examined in obstetric reviews; results vary, so check with your provider.
During childbirth
5. Have confidence in your midwife or doula
The experience of childbirth depends a lot on the mother-to-be. Many women prepare a birth plan that sets out who will attend, the birthing process they'd like, and what interventions they will allow. Confidence in your support team sets the right stage and mindset for birth.
A doula, for example, provides emotional and physical support through pregnancy and childbirth, showing you relaxation and breathing skills and advising on the birthing process and how to handle possible complications such as a tear.
6. Use a warm compress
During the crowning stage, a midwife or doula may apply a warm compress to the perineum: a clean towel placed in hot water, wrung out, cooled to a comfortable temperature, and held against the perineum to soothe the area. These warm compresses increase blood flow to the tissue.
The World Health Organization lists warm perineal compress among the techniques used during the second stage of labor.
7. Perineal support with a controlled delivery
During birth, your midwife may support the perineum with one hand while guiding the baby's head with the other, keeping the head in the optimal position so there is less pressure on the perineum. During crowning, the midwife or doula deliberately slows the delivery of the head so it emerges gently — a slow, controlled birth — and you may be coached not to push at this stage. These hands-on techniques are part of the care bundles many maternity units use.
8. Consider a water birth
Some labor wards have birthing tubs. Beyond comfort, warm water softens the perineum, which is why some people consider a water birth. The evidence is debated — some studies suggest a difference in the rate of 3rd- and 4th-degree tears, others are inconclusive — so discuss it with your provider.
9. Practice breathing techniques
Knowing how to breathe during labor helps you pace yourself. There are moments when you'll feel the urge to push but it isn't the right time; practising breathing techniques helps you make contractions more productive and gives the perineum time to stretch gently rather than fast.
10. Choose the right birthing position
Your birthing position plays a part. Squatting, for instance, can place more strain on the perineum. There are several delivery positions to consider with your team.
Women were traditionally encouraged to deliver lying on their backs, but this position is now thought to place more pressure on the perineum. Lying on your side or being on all fours puts less pressure on the area and can ease contraction discomfort.
Summing up
Giving birth is a momentous experience, and the reality is you may still face a perineal stretch and some degree of tearing because of the pressure during birth. None of the approaches above is a guarantee, but together they're the things midwives, researchers, and bodies like the WHO most often discuss for caring for the perineum — and many of them are simply good preparation for a calmer birth.
Frequently asked questions
Can you completely avoid a tear during childbirth?
No — there's no guarantee. Tears are common, and even with the best care some degree of tearing can happen. These approaches are about preparation, not certainty.
What helps the perineum stretch for birth?
Perineal massage and pelvic-floor conditioning beforehand, and during birth a warm compress, hands-on perineal support, breathing, and an upright or side-lying position.
When should I start preparing?
Perineal massage is usually started around week 34–35; pelvic-floor exercises can be done throughout pregnancy. Ask your provider what's right for you.
Does a warm compress during labor help?
It's one of the techniques the WHO lists for the second stage of labor. Your midwife can apply one if appropriate.
References
- WebMD. How to Create a Birth Plan. webmd.com
- WHO recommendation on techniques for preventing perineal trauma during labour. who.int
- Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears. NCBI
- The impact of third- or fourth-degree perineal tears on the second pregnancy. NCBI
- Birth, Bath, and Beyond: water immersion during labor and birth. NCBI
- Effect of breathing technique of blowing on damage to the perineum at delivery. NCBI
- Evidence Based Birth. The Evidence on Birthing Positions. evidencebasedbirth.com
If you'd like to make perineal massage easier to do on your own late in pregnancy, the Perimom perineal massager is shaped to reach the area without a partner.
