Prevent Tearing in Birth: What Actually Helps Most

Let’s Talk About Tearing (Without the Fear)

If you’re pregnant, there’s a good chance you’ve Googled “how to avoid tearing during birth” at least once—probably late at night, while spiraling just a little. It’s okay, we’ve all been there.

And I get it. The idea of tearing sounds scary. But here’s the honest, grounded truth: tearing is common, it’s often minor, and in many cases, it heals really well.

But also? There are absolutely things within your control that can reduce your risk—especially your risk of more significant tearing.

This is where I want to shift the conversation. Because preventing tearing isn’t just about perineal massage (though we’ll get there). It’s about:

• Who is supporting your birth

• How you push

• The positions you give birth in

• And how you prepare your body ahead of time

If you’re planning your birth prep and want to protect your pelvic floor, this is exactly where to focus.

What Actually Causes Tearing?

Before we jump into prevention, we need to understand what we’re working with.

Perineal tearing happens when the tissue between the vaginal opening and anus (your perineum) stretches beyond its capacity during birth.

Some factors you can’t control:

• Baby size and position

• First vaginal birth

• Tissue elasticity

But here’s the key:
Many of the biggest contributors to tearing are actually provider-driven and environment-driven.

Your Biggest Risk Factor: Your Provider

I’m going to say something that might feel bold, but it’s backed by research and clinical experience:

Your OB or provider is one of the biggest predictors of whether you tear—and how badly.

Why? Because they influence:

• Whether an episiotomy is performed

• Whether forceps or vacuum are used

• How fast your baby is delivered

• Whether your pushing is guided or rushed

Episiotomy: Ask the Right Questions

An episiotomy is a surgical cut made to the perineum. Years ago, it was routine. Now we know better.

Research shows that routine episiotomies do NOT prevent tearing—and can actually increase the risk of more severe (3rd and 4th degree) tears.

According to American College of Obstetricians and Gynecologists, episiotomy should be used restrictively, not routinely.

👉 You need to ask your provider:

• Do you perform episiotomies?

• In what situations?

• How often in your practice?

If they can’t clearly explain their reasoning—or if it sounds routine—that’s worth paying attention to.

Instrumental Delivery: Forceps & Vacuum

Forceps and vacuum-assisted deliveries can be necessary and lifesaving. But they also significantly increase the risk of severe tearing.

A large review published in Cochrane found higher rates of third- and fourth-degree tears with forceps compared to spontaneous vaginal birth.

👉 Ask:

• When would you use forceps or vacuum?

• What alternatives do you try first?

You’re not trying to avoid intervention at all costs—you’re making sure it’s used appropriately, not routinely.

Why This Matters for Pelvic Floor Therapy

From a pelvic floor physical therapy perspective, higher-degree tears can impact:

• Bowel control

• Pelvic organ support

• Long-term pelvic floor function

This is why provider choice is not just a “birth preference”—it’s a pelvic health decision.

How You Push Matters More Than You Think

Now let’s talk about something you do have a lot of control over.

Closed vs. Open Glottis Pushing

You’ve probably heard the classic:

“Take a deep breath, hold it, and push for 10 seconds!”

That’s called closed glottis pushing.

But research increasingly supports open glottis pushing—where you exhale while bearing down.

Why it matters:

• Reduces excessive pressure on the pelvic floor

• Allows more gradual tissue stretching

• Decreases risk of sudden, forceful delivery

A study published in the National Institutes of Health database shows that open glottis pushing may lead to improved oxygenation and more controlled descent.

👉 Translation for moms:
Think slow, controlled, breath-supported pushing—not purple-faced, all-out straining.

“Coached” vs. “Instinctive” Pushing

When you’re allowed to follow your body’s urge to push instead of being coached through it:

• Pushing tends to be more effective

• There’s less strain on tissues

• The baby descends more gradually

This matters because fast, forceful births increase tearing risk.

Birth Position Can Make or Break Your Perineum

Let’s talk positioning—because this is a big one.

The Problem With On-Your-Back Birth

Lying flat on your back (supine position):

• Narrows the pelvic outlet

• Works against gravity

• Increases pressure on the perineum

And yet…it’s still the most commonly used position in hospital births.

Positions That Help Reduce Tearing

Research supports more upright and forward-leaning positions:

• Side-lying

• Hands and knees

• Squatting

• Supported forward lean

These positions:

• Open the pelvic outlet

• Allow better sacral movement

• Reduce direct strain on the perineum

A systematic review in World Health Organization supports upright positions for improved birth outcomes and reduced interventions.

Slowing Down the Final Moments

One of the most protective things for your perineum?

A slow, controlled crowning phase.

This is where your provider matters again. Ideally, they’re:

• Supporting gradual stretching

• Encouraging you to pause or breathe

• Not rushing the baby out

Because tearing often happens when things move too fast, not too slow.

Perineal Massage: Is It Worth It?

Now let’s talk about the thing everyone hears about.

What the Research Says

Perineal massage in the final weeks of pregnancy has been shown to:

• Reduce risk of episiotomy

• Lower incidence of severe tearing (especially in first-time moms)

Research found that regular perineal massage after 34 weeks can be beneficial.

How It Works

Perineal massage helps:

• Improve tissue awareness

• Increase stretch tolerance

• Reduce fear and guarding

Because here’s the thing—your pelvic floor isn’t just physical. It’s neurological and responsive to tension.

How to Do It (Simply)

• Start around 34–35 weeks

• Use clean hands and a natural oil

• Apply gentle downward and outward pressure

• Aim for 5–10 minutes, a few times per week

Consistency matters more than perfection.

Where Pelvic Floor Physical Therapy Comes In

This is where everything ties together.

Working with a provider trained in pelvic floor therapy—especially for birth prep—can help you:

• Practice effective pushing strategies

• Learn optimal birth positions

• Improve pelvic floor coordination

• Reduce fear and tension

At enCORE Therapy, we work with moms across Kansas City and Overland Park to prepare their bodies for birth in a way that actually translates in the delivery room.

Because knowledge is great—but practice is what changes outcomes.

Putting It All Together

If you’re walking away with one big takeaway, let it be this:

Preventing tearing isn’t about one magic trick.

It’s about a combination of:

• Choosing a provider who uses interventions appropriately

• Using pushing strategies that protect your pelvic floor

• Laboring and delivering in positions that support your anatomy

• Preparing your tissues ahead of time

Your Next Step

If you’re currently pregnant and thinking:

“Okay… but how do I actually do all of this?”

That’s exactly where guided birth prep comes in.

Whether it’s learning how to push, practicing positions, or understanding your options—you don’t have to figure this out on your own.

And your pelvic floor will thank you for it later.

Final Thought

Your body is designed to do this—but it’s also deeply influenced by the environment you give it.

The more supported, informed, and prepared you are, the better your outcomes tend to be.

And that includes protecting your perineum—not with fear, but with strategy.