6 Tips To Help Prevent Tears & Episiotomies During Childbirth
By Jess Jenkins, aka The Mama Physio
Let’s be real: the thought of tearing during birth is something that makes most women squirm. And while it’s a common part of vaginal birth, it doesn’t mean there’s nothing you can do to reduce your risk.
In fact, research shows that there are simple, evidence-based strategies that can make a real difference when it comes to protecting your perineum during childbirth. As a pelvic health physio (and a mum myself!), I’m all about helping women feel strong, confident, and empowered in their bodies, especially during pregnancy and birth.
So, if you’re wondering what you can actually do to prepare your pelvic floor and support your body for a smoother delivery, here are my top 6 tips:
1. See a Pelvic Health Physio & Start Pelvic Floor Training
Most women haven’t been taught how to properly activate or relax their pelvic floor, and that’s completely okay. But during pregnancy, we want your pelvic floor to be both strong and flexible.
A pelvic health physiotherapist can help you learn how to engage and release your pelvic floor muscles effectively. We work on building strength, improving coordination, and enhancing mobility, which are all key to preparing your body for birth.
Regular pelvic floor training during pregnancy can:
Reduce urinary incontinence in late pregnancy and postpartum
Lower the risk of third- and fourth-degree tears by up to 50%
Reduce the chance of anal sphincter injury by around 60%
Shorten the second stage of labour (pushing) by approximately 20%
2. Learn How to Do Perineal Massage
Perineal massage from 34 weeks of pregnancy can significantly improve the flexibility of the tissues between the vagina and anus, helping them stretch more easily during birth.
Research shows that combining perineal massage with pelvic floor training, in first time mothers, can:
Reduce the risk of severe tearing (third- and fourth-degree) by 21%
Lower the likelihood of needing an episiotomy by 16%
You can do this yourself or enlist your partner’s help. Aim for 2–3 times per week. It’s a great way to get familiar with the sensation of stretch and reduce anxiety about that part of the birth experience.
3. Stay Active in Early Labour
Movement is your friend in the early stages of labour. Walking, swaying, rocking on a birth ball, or doing gentle stretches can help your baby get into an optimal position, giving your perineum more time to gradually stretch. Upright positions also harness gravity to support labour progression, win-win!
4. Practice Relaxation Techniques
Tension is the enemy of stretch. When your body is tense, your pelvic floor holds tight - making tearing more likely.
As you near the end of pregnancy, shift your focus from strength to release. Deep breathing, meditation, visualisation, and hypnobirthing strategies can help keep your mind calm and your pelvic floor relaxed. Gentle movements like child’s pose, deep squats, and yoga-inspired stretching are also powerful tools for opening the pelvis and lengthening the pelvic floor.
5. Change Up Your Pushing Positions
Lying flat on your back is associated with an increased risk of tearing or episiotomy. This is mostly because this position is anatomically harder to push and puts more pressure on your perineum. It is also associated with use of instruments and epidural.
Instead, try these evidence based recommendations:
Side-lying (especially on your left)
All fours (hands and knees)
Kneeling
6. Use a Warm Compress When Crowning
This simple strategy can make a big difference. A warm compress applied to the perineum as the baby begins to crown can:
Soothe the area
Boost blood flow
Enhance tissue elasticity
Most care providers already do this, but I’d recommend chatting to them beforehand too.
Final Thoughts
Birth is unpredictable. Sometimes, even with all the right prep, tears can still happen, and that’s okay. But the more informed, prepared, and supported you feel, the more positive and empowering your birth experience can be.
If you’re pregnant and want to learn more about preparing your body for birth, come and follow along at @the.mama.physio or visit www.themamaphysio.com.au for more resources, classes, and expert support.
References
Cochrane Reviews 2012, 2013 & 2017