For many expectant moms, protecting the perineum during childbirth is a top priority. Perineal tearing—when the area between the vagina and anus stretches and tears during delivery—is common, but there are plenty of strategies to minimize the risk. Whether you plan to use an epidural or go unmedicated, many of these techniques can be adapted to suit your birth plan.
Here’s a friendly guide to understanding how you can prepare for childbirth and protect your perineum during delivery.
1. Perineal Massage: Prep Before Labor
One of the best ways to prepare your perineum is by practicing perineal massage in the weeks leading up to delivery. Starting around 34–36 weeks of pregnancy, you (or your partner) can use clean hands and a lubricant like coconut or vitamin E oil to gently stretch and massage the perineal area.
This technique improves the flexibility of the tissues, helping them stretch more easily during childbirth. Research shows that perineal massage can significantly reduce the risk of severe tears, especially for first-time moms. The good news? Perineal massage works whether or not you plan to use an epidural.
2. Choose Positions That Support Your Perineum
Labor positions can make a big difference in how pressure is distributed on your perineum. Upright positions—like standing, squatting, or using a birthing stool—let gravity help your baby descend, while side-lying positions are particularly gentle on the perineum.
With an epidural: While mobility may be limited, you can still try positions like semi-sitting, side-lying, or supported squatting with the help of your medical team or partner.
Without an epidural: You’ll have more freedom to move around, allowing you to find the positions that feel best for you and your baby.
3. Warm Compresses During Pushing
One of the most effective ways to protect the perineum during delivery is using a warm compress. Applying a warm, clean cloth to the perineal area during the pushing stage increases blood flow, helps the tissues stretch, and reduces the risk of tearing. The warmth also provides soothing relief as the baby crowns.
With or without an epidural, warm compresses are a great option. Your healthcare provider or birth partner can apply the compress for you, ensuring comfort and support.
4. Focus on Controlled Pushing
Controlled pushing gives your perineum time to stretch gradually, reducing the likelihood of a tear. Instead of pushing forcefully, listen to your provider’s guidance—they may encourage short, gentle pushes or ask you to pause and let the perineum adjust.
With an epidural: While you may not feel the urge to push as strongly, your provider will guide you through the process, ensuring the baby descends slowly and safely.
Without an epidural: You may feel a natural urge to push, which can help you work in sync with your body. Take slow, deep breaths to stay in control.
5. Perineal Support from Your Provider
During delivery, your midwife or doctor may use techniques to protect your perineum, such as gently guiding the baby’s head or applying counter-pressure to the area. These hands-on measures help ease the baby out slowly, minimizing strain on the tissues.
Discuss these options with your provider before labor so they know your preferences.
6. Slow Down During Crowning
When the baby’s head begins to emerge (also known as crowning), it’s important to slow down and let the perineum stretch naturally. Your provider may encourage you to pause pushing briefly, which can help reduce the risk of tearing.
This step is just as important with an epidural as it is without one. While you may not feel the intense stretching sensation if you have an epidural, following your provider’s cues is key to allowing the tissues to adapt.
7. Hydrotherapy During Labor
Laboring in water, such as a warm bath or birthing pool, can help soften the perineum and make stretching easier. The warm water promotes relaxation and reduces tension, which can minimize tearing.
Note: Hydrotherapy is typically only an option if you’re not using an epidural, as mobility and monitoring are required for water labor.
8. Healthy Tissue, Healthy Birth
Taking care of your perineum during pregnancy can make a difference. Staying hydrated, eating a nutrient-rich diet, and keeping the skin moisturized can help maintain the elasticity of your perineal tissues. These steps support a smoother, safer delivery regardless of your pain relief plan.
Can These Tips Be Used With an Epidural?
Absolutely! Most of these techniques—like warm compresses, controlled pushing, and perineal support—work just as well with an epidural. While an epidural may limit certain movements or sensations, your healthcare team can adapt these measures to help protect your perineum during labor.
For example:
- You can use side-lying or semi-sitting positions with an epidural.
- Your provider can guide your pushing efforts and apply warm compresses or manual support to the perineum.
By communicating with your medical team and birth partner, you can still incorporate many perineum-protecting strategies into your birth plan.
The Takeaway
While some perineal tearing is common during childbirth, there are many ways to reduce the risk of severe tears and support your body’s natural process. Whether you’re planning an epidural or going unmedicated, techniques like perineal massage, warm compresses, controlled pushing, and thoughtful positioning can help protect your perineum and promote a smoother delivery.
Every birth experience is unique, and there’s no one-size-fits-all approach. Trust your body, communicate with your healthcare team, and focus on what feels right for you and your baby.
