Perineal Tearing

A common fear for women throughout their pregnancy is perineal tearing or the risk of tearing in general during the pushing stage of labour, and how to minimize the risk of this occurring.


  • The perineum is the area between the vagina and the anus.  The skin that is between there, is the part of your body that gets really stretched during the pushing stage as the baby is coming down the birthing canal.
  • As the baby gets to the opening of the vagina there is stretching. That stretching sensation is sometimes called “The Ring of Fire”.
  • Perineal tearing or lacerations occur as the perineum stretches to allow for the baby’s head to enter through the birthing canal. This is also where you may experience perineal tearing during birth.


  • First Degree – Lacerations to the perineum, just to that bit of skin
  • Second Degree – Tearing of the perineum and the pelvic floor muscle
  • Third Degree – Anal tearing, internal and external
  • Fourth Degree – Anal tearing and muscles in that area


Perineal Massage during pregnancy can help expecting mothers prepare themselves mentally and physically for labour.  This is where you will stretch the perineal skin out in a sweeping up movement as you concentrate on your breath.  It works well for just birth preparation to manage and connect into your breath to really soften through your perineum, to relax your pelvic floor. This can only be done from 35weeks on, once or twice per week and for 2-7minutes at a time.

Positions during labour are important as some can really minimize potential perineal tearing whereas others can result in higher rates of tearing.  The best positions to reduce tearing are on all fours, leaning forward in a supported standing or kneeling position or lying on your side.

Warm compresses, so try to labour in the bath so when you’ve got that warmth on the perineum, we know that warmth brings better blood supply to provide more stretch into tissues.  A water birth or water labour are great options to go with.  Otherwise, a warm compress onto the woman’s perineum, to increase the blood flow and allow for the skin to stretch a little bit more.

Avoiding an episiotomy if you can. However, if an instrument-assisted delivery is needed, for example with forceps, almost all obstetricians will do an episiotomy there. So, you will get perineal damage that way.

Epidural plans are great for pain management, particularly if you’re very tired, and you’ve managed as far as you can with your pain relief methods so far. However, having an epidural can limit your movement and birthing positions and you will be less likely to feel your contractions to know when to push. Generally, with an epidural you will be lying on your back which means your baby needs to move almost uphill instead of downwards with gravity. This can be a problem because it can increase the risk of tearing and perineal damage.

If perineal tearing is something that is worrying you throughout your pregnancy, taking a proactive approach can really put your mind at ease. You can also use visualization and meditations to relax your body and mind. So, with your affirmations, your music, and your relaxation, try to really visualize the baby coming down into the pelvis during the pushing stage and being calm and in control, working with your body waiting for that urge to push and then breathing the baby out.

Birth can be unpredictable but with the right support and professionals around you, you will get through this incredible experience of bringing life into this world.

For more information, take a look at our Nest Active Birth courses online 

To learn more tips on childbirth preparation, visit our YouTube channel – Nest Birth & Motherhood