Reducing the Risk of Tearing in Birth — What Actually Works
When you think about birth, it’s not uncommon for tearing to be one of the first fears that comes up.
Let’s be honest—it’s one of the things most women really worry about.
But most antenatal education either avoids the topic entirely… or just tells you to “breathe the baby out” and hope for the best.
You deserve better than that.
So let’s talk honestly and practically about what you can do to:
✅ Reduce your chances of tearing
✅ Know what positions and practices help
✅ And recover well if tearing does happen
🧠 First, What Is Tearing?
Tearing refers to small (or occasionally larger) injuries to the perineum—the skin and muscle between the vagina and anus—as the baby’s head is born.
There are four degrees of tearing, but the vast majority (around 90%) are first- or second-degree, which usually heal well with or without stitches.
Third- and fourth-degree tears (which involve muscle or the anal sphincter) are more serious but also far less common—especially with continuity of care, gentle birth practices, and good perineal support.
🌸 How to Reduce the Risk of Tearing
Let’s get into what actually helps protect your perineum:
1. Birth Position Matters
Lying flat on your back can increase pressure on the perineum and reduce pelvic flexibility.
Instead, try:
Side-lying (great for slow crowning)
Kneeling or all fours
Supported squatting
Standing or upright leaning
Positions that allow your sacrum to move freely and your pelvis to open help reduce the chance of tearing.
2. Warm Compresses and Slowing the Push
There’s strong evidence to support the use of warm compresses on the perineum during the second stage of labour, particularly during crowning. These can:
Reduce the risk of third- and fourth-degree tears
Provide comfort and help tissue stretch gradually
Some trusts may use protocols like the OASI Care Bundle, which includes compresses, slowing the push, and hands-on techniques. While these practices individually have value, recent research suggests the overall bundle does not significantly reduce severe perineal trauma, and some providers may increase episiotomy rates under its protocol.
So rather than relying on one bundle or fixed approach, it’s more helpful to focus on personalised care—informed consent, warm compresses, and a slow, instinctive second stage.
3. Perineal Massage (from 34 Weeks)
There’s solid evidence to show that perineal massage:
Reduces the chance of tearing that requires stitches
Makes you more familiar with the stretching sensation of birth
Can help reduce anxiety around crowning
Massage 2–3 times a week using a natural oil or water-based lubricant. If it feels uncomfortable or triggering, go gently or pause. You can always come back to it.
4. Instinctive Pushing > Directed Pushing
Being told to push with all your might when your body isn’t ready can increase your risk of tearing.
When you allow your body to build up to the “fetal ejection reflex,” or when you push only when you feel the urge, you’re more likely to:
Have a gradual crowning
Stretch more gently
Avoid fast or forceful exits (which are linked to more tearing)
5. Stay Warm, Relaxed, and Undisturbed
Oxytocin doesn’t just help your uterus contract—it helps your perineal tissues stay soft and stretchy.
A warm room, dim lights, minimal conversation, and no pressure to perform all help your body do what it’s designed to do.
💛 If You Do Tear
Tearing doesn’t mean your birth wasn’t positive.
If it happens:
Ask for stitches with good pain relief
Use padsicles (pads soaked in witch hazel + aloe vera + water then frozen)
Rest as much as possible in the first 2 weeks
Don’t over-wipe—use a peri bottle with warm water
Stay hydrated and eat fibre to avoid straining
Speak up if you’re in pain, worried about healing, or unsure what’s normal. You deserve follow-up care—even at home.
✨ Final Thoughts
Tearing sounds scary. But knowledge is power.
When you know:
Which positions protect you
How perineal massage and warm compresses help
That your care providers can slow things down and support you with consent…
You go into birth with less fear and more trust in your body.
Birth doesn't have to be perfect to be powerful. And even if you do tear, you’re not broken. You’re healing. And you’re allowed to take your time.
Want to feel more confident about protecting your body in birth?
We cover all of this (and so much more) inside Every Birth Education—with lessons on physiology, perineal care, and exactly how to prep for birth at home.
Join us today or message me for a one-to-one home birth session.
Because birth prep should actually prepare you.