Mama In the Making

Preconception Planning • Home Birth Resources • Postpartum Support

What You Can Do To Reduce the Risk of Perineal Tears During Childbirth

Is there anything that sounds more painful than tearing down there during childbirth? As if the intensity of labor wasn’t enough to think about and prepare for, us mamas have to worry about the possibility of healing from a vaginal tear after it’s all said and done. Yikes!

Although tearing can be common for first-time moms, there are some things you can do during pregnancy to prepare your body beforehand — and things you can do during labor too — that may help lessen your chances of tearing. Let’s talk about them.

During Pregnancy

Practice relaxing your pelvic floor. My husband and I took a Bradley childbirth class leading up to our son’s birth. Our instructor talked about how when she was pregnant she had to consciously remind herself to relax her pelvic floor throughout the day. She said she often would be going about her day and realize she was tensing her pelvic floor. I thought about this and realized that I too tensed up my pelvic floor throughout the day for no reason.

Why does a relaxed pelvic floor matter? Because tension in your pelvic floor can hinder the progression of labor, and it can also make contractions more painful.

One exercise you can do to work on relaxing your pelvic floor:

  • Squat and release. Not only do squats strengthen your core for labor, you can also practice releasing your pelvic floor at the bottom of each squat, which is a position you may find yourself pushing in during labor. Here’s what to do: in a standing position, breathe in slow and deep through your nose, pull in your pelvic floor and hold (aka Kegel), squat down and once at the bottom, slowly release your breathe through your mouth and release your pelvic floor.

Sit on a birth/exercise ball often. Sitting on an exercise/birth ball gently massages your perineum, improves posture, and is great for doing hip circles and engagement exercises to encourage baby into an optimal position for birth. A birth ball may also come in handy during labor. I recommend a non-toxic and BPA-free Trideer exercise ball.

Do perineal massages leading up to birth. A perineal massage is exactly what it sounds like. It involves gently stretching/massaging the skin of the perineum to increase flexibility and lessen the chance of a tear. I found that this was best to do after a hot shower using coconut oil. You can do this a few times per week around the 35 week mark.

Here’s an interesting stat about perineal massages from the Mama Natural Week-by-Week Guide to Pregnancy and Childbirth: “A 2013 Cochrane review of four separate clinical trials found that once or twice weekly massage — performed 35 weeks onward — reduces the risk of a tear requiring sutures by around 10 percent in first time moms.” I don’t know about you, but when I read this I was willing to give it a try. While I did end up having two superficial tears (very small, heal on their own, and don’t require stitches), I felt the perineal massage helped prepare my skin down there and prevented a bigger tear.

During Labor

Listen to your body. Mama, YOU know your body better than anyone else. And it’s you alone who is going to birth your baby. If someone in the birthing space tells you to push when you feel your body is not ready to push, do not force it. Forced pushing can cause trauma to the perineum. Listen to your body. Exercise your autonomy in the birthing space and don’t be afraid to say “No” during labor. This is your body, your baby, your birth experience.

Ask your midwife (or person delivering your baby) to apply a warm compress to your perineum during pushing. A study from the National Library of Medicine found that, “Warm compresses applied during the second stage of labor increase the incidence of intact perineum and lower the risk of episiotomy and severe perineal trauma.” This is something my midwife did for me during labor and I believe it helped prevent larger tears.

Be aware of pushing positions that can increase the risk of tearing. From “Certain positions are more likely to lead to larger perineal tears. In particular, these positions are ones where the sacrum (part of the low back) is pressed against another surface, such as a bed or chair (Jansson et al., 2020).”

It’s important to note that while positions where the sacrum is immobile can increase the chances of tearing, it’s not a guarantee you will experience a tear if you end up pushing on your back. But I still think it’s good to know what positions create optimal space for baby to emerge and allow the sacrum to move freely. Some of these positioning include side lying, on hands and knees, and squatting.

Consider a water birth. Warm water helps relax muscles during labor and offers some pain relief. Simply put, you’re less likely to tear when your muscles are relaxed. However, it’s worth mentioning that if you choose to go this route, you can actually get a little too relaxed in the birth pool and this could stall labor.

What techniques did you use or are you considering implementing to reduce the risk of tearing? I’d love to hear!


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About jill

Hey there! I’m Jill. I’m a 28-year-old Tennessee native, wife and first-time mom. Before I became pregnant with my first baby I immersed myself in all things preconception, pregnancy, home birth and postpartum and was fascinated by what I learned! In sharing my journey to motherhood I hope to provide current and future moms with helpful tips to make the path a little easier as we figure it out together. I’m so glad you’re here and hope we can learn something from each other!

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