The mistake 70% of birthing people make that leads to perineal tears 😖 Start preparing during pregnancy!
- Doula Jules
- Mar 31, 2025
- 2 min read
Did you know that about 60 to 80 percent of birthing people experience a perineal tear during birth? That means nearly one in three goes through this! But don’t worry – there are many ways to reduce the risk, and that’s exactly what we’ll talk about today.
We’ll answer three key questions:
What is a perineal tear?
Is a natural tear better or worse than an episiotomy?
What is the mistake 70% of people with perineal tears make and what can you do to prevent or minimize tearing?
Let’s dive in!
What is a perineal tear?
The perineum is the area of tissue between your vagina and anus. During birth, this tissue stretches to make way for your baby. Sometimes, it doesn’t stretch enough, and a tear occurs.
There are four degrees of perineal tears:
First-degree:Â A small tear in the skin that usually heals on its own.
Second-degree:Â The muscles are affected and may need stitches.
Third-degree:Â The tear extends to the anal sphincter.
Fourth-degree:Â The most severe, involving the rectal lining as well.
Most perineal tears are first or second degree and heal well. Recovery typically takes about four to six weeks.
Is a natural perineal tear better or worse than an episiotomy?
An episiotomy is a surgical incision made during birth to enlarge the vaginal opening. It was once a routine procedure to prevent tearing, but research now suggests that natural tears often heal better because they involve less tissue trauma.
That’s why routine episiotomies are no longer recommended unless medically necessary.
What can you do to prevent or minimize tearing?
Even though perineal tearing can’t always be prevented, there are proven methods to reduce the risk. Some factors make tearing more likely, and the good news is that you can influence some of them:
1. Choose the right birthing position
The mistake 70% of birthing people with perineal tears make is lying on their back or birthing in a half-upright position on their tailbone. Positions like side-lying or hands-and-knees put less pressure on the perineum. Lying on your back increases the risk of tearing. Talk to your midwife or birth team before labor to ensure they know you want to birth in a more upright position!
2. Controlled pushing
It’s important to only push during contractions and avoid forceful pushing. The best way to push is by listening to your own body and trusting your instincts. But if you have an epidural, your midwife can guide you to breathe through the pushing phase for a slower and gentler delivery.  A fast birth increases the risk of tearing because the tissue has less time to stretch.
3. Warm compresses during labor
Placing warm towels on the perineum during birth increases blood flow and helps the tissue stretch more easily. Your midwife can again help you with this during labor.
4. Perineal massage during pregnancy
One of the most effective ways to increase flexibility and elasticity in the perineum is perineal massage. This technique is so important that I’ve made a whole video showing you exactly how to do it! (in German) Follow the link below and watch step by step how to carry out perineal massage by yourself or with a partner.
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