One of the biggest concerns many moms-to-be have about childbirth is perineal tearing—and that’s totally understandable! The idea of tearing during delivery can sound intimidating, but the good news is there are several ways to help minimize the risk and keep your perineum as intact as possible.
While not all tears can be prevented, taking proactive steps before and during labor can improve your chances of having less trauma and a smoother recovery. Let’s dive into some evidence-based ways to help protect your perineum during birth.
1. Perineal Massage in the Weeks Leading Up to Birth
Perineal massage is one of the best ways to prepare your perineum for stretching during childbirth. Starting around 34–36 weeks, gently massaging the area can increase elasticity and blood flow, making the tissues more flexible when it’s time for delivery.
How to do it:
- Wash your hands and apply a lubricant like coconut oil, olive oil, or a perineal massage gel.
- Sit in a comfortable position, with knees bent.
- Use your thumbs (or your partner can use fingers) to gently stretch the perineum downward and outward in a U-shape.
- Hold the stretch for 1–2 minutes and repeat for 5–10 minutes a few times a week.
While perineal massage can feel a bit uncomfortable at first, many women find it helpful in preparing their body for birth.
2. Choosing the Right Birthing Positions
Your position during labor impacts how much pressure is placed on your perineum. Certain positions reduce strain and allow for better stretching as your baby is born.
Best positions for preventing tears:
- Side-lying – Lying on your side while pushing slows things down and reduces perineal pressure.
- Hands-and-knees – Helps distribute pressure more evenly and can prevent excessive stretching.
- Squatting (with support) – Opens the pelvis and allows baby to descend smoothly but should be done with guidance.
Positions to avoid:
- Lying on your back (supine position) puts extra pressure on the perineum, increasing the chance of tearing.
- Semi-reclined positions can also limit pelvic mobility, making it harder for the perineum to stretch gradually.
3. Using Warm Compresses During Pushing
One of the simplest and most effective ways to reduce perineal tearing is applying a warm compress to the perineum during the second stage of labor. The warmth increases blood flow, promotes elasticity, and helps the tissues stretch more gently.
Your midwife, nurse, or doctor can place a warm, damp washcloth on the perineum while you’re pushing. Many women find that it provides comfort while also protecting the area from sudden stretching.
4. Slow and Controlled Pushing (The “Laboring Down” Approach)
One of the biggest risk factors for perineal tearing is pushing too hard or too fast. Instead of forcefully pushing, letting your body gradually ease the baby out can help prevent tears.
Tips for controlled pushing:
- Listen to your provider – They will guide you to breathe through contractions rather than pushing with full force right away.
- “Labor down” if you have an epidural – If you don’t feel the urge to push yet, waiting until your baby moves lower on their own can reduce stress on the perineum.
- Panting or “blowing out a candle” breathing – This helps slow things down when baby’s head is crowning, giving tissues more time to stretch.
5. Opting for Hands-On Perineal Support
Your provider may use a technique called “perineal support” or “perineal guarding” during delivery. This means they place gentle pressure on the perineum as the baby’s head emerges, helping to slow down the crowning process and prevent excessive stretching.
Discuss this with your midwife or doctor ahead of time so they know you’re interested in this approach.
6. Staying Hydrated and Nourished for Healthy Skin Elasticity
The health of your skin and tissues plays a role in how well your perineum stretches. Staying hydrated and eating nutrient-rich foods can improve skin elasticity, making it more resilient during labor.
Best nutrients for skin elasticity:
- Vitamin C (oranges, bell peppers, strawberries) – Promotes collagen production.
- Healthy fats (avocados, nuts, olive oil) – Keeps skin soft and flexible.
- Hydration – Drinking enough water keeps your tissues supple and prevents dryness.
7. Consider Perineal Stretching During Birth
Some providers use perineal stretching techniques while the baby is crowning to help ease the baby’s head out more gently. This is similar to perineal massage but is done during labor rather than before.
Let your provider know if you’d like them to use this technique when the time comes!
8. Relaxing and Letting Your Body Do the Work
Tension in the body can actually increase resistance in the perineum, making it more likely to tear. Relaxation techniques like deep breathing, guided meditation, or warm baths during early labor can help your muscles stay loose and flexible.
When your body is calm and working with contractions rather than against them, labor tends to progress more smoothly, and the perineum has a better chance of stretching naturally.
Can These Methods Be Used If You Have an Epidural?
Yes! If you choose an epidural, most of these strategies can still be applied, including:
- Warm compresses to help soften the perineum.
- Side-lying positions to reduce pressure.
- Laboring down to allow for slower, controlled pushing.
- Hands-on perineal support from your provider during crowning.
Even with reduced sensation, your birth team can guide you in breathing and pushing techniques that help protect your perineum.
The Takeaway
While perineal tearing is a natural part of childbirth for many women, there are several ways to reduce the risk and minimize its severity. Preparing your perineum ahead of time, using warm compresses, pushing in a controlled way, and choosing optimal birthing positions can all make a difference.
Most importantly, remember that your body was made for this! Whether you experience a small tear, no tear at all, or need a few stitches, your body is incredible at healing—and soon, you’ll be holding your beautiful baby in your arms
