Evidence-Based Ways to Prevent Perineal Tearing During Birth

Written By Kelsey Beach

Your Birth, Your Body, Your Power

Expecting a baby is thrilling—and sometimes nerve-racking. One concern many women share is perineal tearing during birth. As a pelvic floor physical therapist in Kansas City and Overland Park, I'm here to reassure you: you aren’t at the mercy of fate. There are research-backed strategies—evidence-based tools that empower you to protect your body while honoring the wisdom of birth.

Whether you’ll be working with pelvic floor physical therapy or not, these approaches are for everyone—and they’re not just optional extras. This is education you cannot miss.

1. Slow, Mindful Pushing: Let Your Body Lead

When contraction hits, it’s tempting to push hard. But guess what? Pushing with your body’s rhythm—not against it—reduces tearing.

The Evidence:

  • A 2015 review found pushing with an open glottis and slow expulsion significantly decreases the risk of severe tears compared to forced, closed-glottis pushing.

  • Guiding your partner, doula, or care provider to offer supportive hand-holding and verbal cues “you’re doing great” can help you slow down and stay connected to your body.

Real talk for moms: Think of this like breathing through a wave instead of fighting it—less muscle cramping, more steady control.



2. Warm Compresses during Crowning: Gentle Heat, Big Impact

That intense stretch? It’s called crowning—and it’s where tears most often happen. A simple, beautiful hack: warm compresses.

Evidence Speaks:

  • A 2017 Cochrane review showed that warm compresses during the pushing phase reduce the chance of 3rd- and 4th-degree tears.

  • They work by increasing blood flow and elasticity, making skin more forgiving.

Moms’ takeaway: Ask early in labor for warm, gently pressed towels—they feel like a loving hug to that tissue when it matters most.

3. Perineal Massage Before Birth: Practice = Prevention

Just like stretching before exercise, doing it on your perineum helps get that tissue ready for labor.

Science-Backed Insight:

  • A large trial published in The Lancet (2018) showed antenatal perineal massage starting at week 35 lowers your odds of tearing—especially if this is your first baby.

  • Just 5 minutes a day can make a difference—you can use gentle downward strokes with a little natural oil.

Real-life note: Tell yourself, “This is self-care.” Grab some time with your partner or solo, do the massage, and think about how you're preparing your body to cradle your baby.

4. Hands-On Support: The Right Pressure, the Right Timing

Sometimes your provider or birth partner can gently guide — not push— your perineal tissue.

Research Says:

  • A 2019 study found hands-on support during crowning, combined with warm compresses, significantly reduced tear rates.

  • The trick is slow, steady pressure (think “press downward but with kindness”), not brute force.

Why it matters: It turns you from passive to supported, like having a trusted friend helping you stretch into your superpower.

5. Position Your Body with Intention

Not all birthing positions are created equal when it comes to tearing risk. Gravity helps—but so does space.

Evidence-Based Recommendations:

The mom-to-mom message: If your body can, trust it. Positions that feel more natural to you might also help your baby descend more gently.

Bringing It All Together: A Quick Reference Table



Why This Matters—Even Beyond Birth

As someone working in pelvic floor physical therapy Kansas City and pelvic floor therapy Overland Park at Encore Therapy, I’ve seen firsthand that preventing tears is more than about avoiding tears. It’s about preserving pelvic floor integrity, speeding postpartum recovery, and reducing risk of complications like incontinence or pelvic discomfort.

By giving birth with strategies rooted in research, you’re not only protecting your perineum—you’re setting the stage for a stronger, more supported postpartum journey.

Kelsey Beach
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