Tearing During Birth: Can It Be Prevented?
If you’re preparing for a vaginal birth, you may have heard about perineal tearing—and you’re not alone in wondering how to avoid it. As a birth doula, this is one of the most common concerns my clients bring up. The good news? There are many ways to support your body and reduce the likelihood or severity of tearing—and most importantly, you can make informed, empowered choices to protect your perineum and your peace of mind.
Let’s explore the science behind tearing and what the evidence really says about prevention.
🤔 First, What Is a Perineal Tear?
The perineum is the area of tissue between the vaginal opening and the anus. During a vaginal birth, as the baby’s head and body move through the birth canal, this tissue stretches—and in some cases, it may tear.
Types of Tears:
First-degree: Shallow, involving only skin—usually heals easily and often does not need stitches.
Second-degree: Involve skin and muscle—most common, may require stitches.
Third-degree: Extend into the anal sphincter.
Fourth-degree: Extend through the rectal lining (least common).
Most tears are first or second degree and heal well, but understandably, most people want to minimize the risk or severity.
📊 How Common Is It?
Around 85–90% of people giving birth vaginally experience some kind of perineal trauma (tear, graze, or episiotomy).
However, severe tears (third- and fourth-degree) occur in 2–5% of vaginal births in the U.S., more commonly among first-time births.
🧠 Is Tearing Preventable?
There’s no guaranteed way to avoid tearing—birth is unpredictable, and every perineum is different—but evidence suggests that certain strategies can significantly reduce the risk or severity of tearing, especially for first-time birthing people.
Prevention is less about perfection and more about supporting your body’s physiology.
Evidence-Based Ways to Reduce the Risk of Tearing
1. Hands-Off or “Hands-On As Needed” Approach During Pushing
Research shows that unnecessary or aggressive perineal support or stretching can increase tearing. A gentle approach—where care providers support the tissue only if needed—has been associated with lower rates of severe tears.
2. Perineal Massage in Late Pregnancy
Starting around 34–35 weeks, you (or your partner) can gently massage the perineal area with oil to increase elasticity and help you become familiar with the stretching sensation.
Shown to reduce the risk of tears in first-time parents
Most effective when done 1–2 times per week
3. Warm Compresses During Pushing
Applying a warm, moist cloth to the perineum during the pushing phase helps relax tissue, increase blood flow, and reduce tearing risk—especially third- and fourth-degree tears.
Can be used by midwives, nurses, doulas, or partners
Gentle, soothing, and well-supported by research
4. Slow, Controlled Pushing (Avoid “Purple Pushing”)
When you push in response to your body (especially without coached breath-holding), your perineum has more time to stretch gradually.
Avoiding forced breath-holding (Valsalva maneuver) reduces strain
“Breathing baby down” gives tissues more time to adapt
5. Upright or Side-Lying Positions for Pushing
Lying flat on your back can reduce space in the pelvis and increase pressure on the perineum. Instead, try:
Hands and knees
Side-lying
Squatting (with support)
Semi-sitting with knees open
These positions can reduce directed pressure on the perineum and help baby descend at an optimal angle.
6. Minimize Episiotomy
Routine episiotomy (a surgical cut to the perineum) is no longer considered best practice, as it increases the risk of deeper tears and longer recovery.
True medical need for episiotomy is rare
Discuss your provider’s views on this before labor
7. Let the Perineum Stretch Naturally
Patience is key. When the baby’s head begins to crown, slowing down and allowing time for the tissue to stretch naturally can make a big difference.
This is often when warm compresses and encouragement help most
Providers or doulas may say, “Breathe your baby out” or “Let baby stretch the tissue gently”
Other Factors That May Influence Tearing
Some things are harder to control but still worth knowing:
First vaginal birth = higher risk of tearing (but also higher elasticity next time!)
Vacuum or forceps-assisted birth = higher risk
Very fast (precipitous) labor = less time for gradual stretching
Large babies (but tearing can still be minimal!)
Previous scar tissue from trauma, surgery, or episiotomy
💖 In Summary: Support, Not Perfection
Tearing isn’t always preventable—but you can reduce the risk and support your body’s natural ability to birth. By choosing care that respects your body, using evidence-backed techniques, and listening to your instincts during labor, you’re already doing everything you can to care for yourself.
And if you do tear? With proper support, healing is very possible, and many people are surprised at how well they recover—especially when they feel informed and supported.
References
Aasheim V, Nilsen AB, Reinar LM, Lukasse M. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev.
Beckmann MM, Garrett AJ. (2006). Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev.
Dahlen HG, et al. (2007). Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labour. Birth, 34(4), 282–290.
Lemos A, et al. (2015). Pushing/bearing down methods for the second stage of labour. BMC Pregnancy and Childbirth.
Gupta JK, Hofmeyr GJ, Shehmar M. (2012). Maternal position in the second stage of labour. Cochrane Database Syst Rev.
Hartmann K, et al. (2005). Outcomes of routine episiotomy: a systematic review. JAMA, 293(17), 2141–2148.
ACOG Practice Bulletin No. 165. (2016). Prevention and Management of Obstetric Lacerations at Vaginal Delivery.
World Health Organization. (2018). Care in Normal Birth: A Practical Guide.
