How To Avoid Tear During Delivery
Avoiding a perineal tear during vaginal delivery is not always possible, but there are evidence-based strategies that can help reduce the risk and severity of tearing.
Here’s a comprehensive guide for expecting mothers:
✅ How to Reduce the Risk of Tearing During Birth
1. Perineal Massage (from 34 weeks onward)
- Gently stretch and massage the perineum (area between vagina and anus) several times a week.
- Benefits:
- Increases tissue elasticity
- Helps you become familiar with pressure sensations during birth
- How to do it:
- Use clean hands and natural oil (like coconut or vitamin E oil)
- Insert thumbs about 1 inch into the vagina, press downward and to the sides gently
- Hold for a few minutes and massage in a U-shape
2. Warm Compresses During Labor
- Applying a warm, moist cloth to the perineum during the pushing stage can:
- Improve blood flow
- Reduce tension in the tissues
- Lower the risk of serious tears
- Ask your midwife or doctor if they can do this during the second stage of labor.
3. Controlled, Slow Pushing
- Avoid forceful or fast pushing when the baby’s head is crowning (“the ring of fire” stage).
- Let the baby’s head stretch the perineum gradually.
- Follow your provider’s cues to “pant,” “breathe,” or “pause” instead of pushing hard.
4. Birthing Position Matters
- Upright or side-lying positions may reduce tear risk more than lying on your back.
- Try: Hands-and-knees, squatting, kneeling, or side-lying
- Avoid lithotomy (on your back with legs in stirrups), which may increase perineal strain.
5. Stay Hydrated and Nourished
- Healthy, elastic tissue is less likely to tear.
- Stay hydrated, and eat foods rich in vitamin C, E, zinc, and omega-3s in late pregnancy for skin and tissue support.
6. Avoid Episiotomy Unless Necessary
- Routine episiotomies (a surgical cut) are no longer recommended and can cause worse tearing.
- Ask your provider if they use restrictive episiotomy policies.
7. Choose a Skilled, Supportive Birth Team
- Midwives, doulas, or OBs who are experienced in gentle birth techniques can help guide you.
- Look for someone who:
- Supports perineal protection strategies
- Uses warm compresses
- Avoids aggressive coaching or unnecessary interventions
8. Practice Relaxation and Mindfulness
- Tension in your body (especially the pelvic floor) increases risk of tearing.
- Use breathing techniques, guided relaxation, or hypnobirthing to stay calm and relaxed during pushing.
🚫 What to Avoid
| Avoid | Why |
|---|---|
| Aggressive coached pushing | Can increase the risk of tearing |
| Lying flat on your back | Puts pressure on the perineum |
| Rushed second stage | Doesn’t allow tissues to stretch |
| Routine episiotomy (without need) | Often causes more damage than natural tears |
✅ Summary: Best Practices
| Strategy | Benefit |
|---|---|
| Perineal massage | Improves flexibility |
| Warm compresses | Eases tissue stretching |
| Controlled pushing | Minimizes strain |
| Upright or side-lying birth | Reduces pressure on perineum |
| Supportive provider | Encourages gentle, protective delivery |