Did you know that 81.3% of women in Australia will experience a perineal tear or episiotomy during their first vaginal birth? Most of these are first- or second-degree tears (involving skin and sometimes muscle), or episiotomies (a small surgical cut made by a care provider).
Thankfully, only about 3% of women will have a third- or fourth-degree tear, which involves the anal sphincter.

But here’s the good news: there are several evidence-based strategies you can use to reduce your risk of tearing during childbirth.
 
As a pelvic health physio, here are my top 7 tips:
 
1. See a Pelvic Health Physio
Many women have no idea how to activate their pelvic floor — and that’s completely normal. But during pregnancy, we want your pelvic floor to be strong and flexible. Getting assessed by a pelvic health physio can help you learn how to properly engage and release these muscles, and work on building strength while also improving mobility. It’s one of the best ways to prepare your body for birth.
 
2. Learn Perineal Massage
From 34 weeks onwards, perineal massage performed 2-3 times per week can improve the flexibility and stretchiness of the tissues between the vagina and anus. It also helps you become more familiar with the sensations of stretching, so when that moment comes, your body and brain don’t panic.
 
I always recommend Pure Mama’s Perineal Massage Oil - it’s beautifully formulated with nourishing, natural ingredients, and specifically designed for this purpose. And if you're not sure whether you're doing it right (or you're a bit nervous!), a pelvic health physio can guide you through the technique.
 
3. Stay Active in Early Labour
Keeping upright and mobile during the first stage of labour - walking, moving your hips, gentle stretching - can help your baby descend into the birth canal in an optimal position, giving your perineum more time to stretch gradually.
 
4. Practice Relaxation Techniques
Tension is the enemy of stretch! Deep breathing, visualisation, and hypnobirthing strategies can help keep your pelvic floor relaxed throughout labour. A calm mind = a relaxed body, and a relaxed pelvic floor is more likely to stretch instead of tear.
 
5. Change Up Your Pushing Positions
Evidence shows that lying on your back increases your risk of tearing. Instead, try pushing while lying on your left side, in an all-fours position, or kneeling. These positions reduce pressure on the perineum and allow for more control as baby crowns.
 
6. Use a Warm Compress During Crowning
A warm compress applied to the perineum as the baby’s head begins to emerge (known as crowning) can help soothe the area, increase blood flow, and improve elasticity. Ask your care provider to help with this, it's such a simple yet powerful tool.
 
7. Perineal Massage During Labour
Some care providers are trained to offer perineal massage or gentle support during the second stage of labour. This hands-on support can help slow down the speed of delivery and guide the baby's head out more gradually, reducing the chance of a fast stretch and tear.
 
My final thoughts
Birth is unpredictable, and sometimes even with all the preparation in the world, tears still happen. But the more informed, prepared, and supported you feel, the more empowered your experience will be.
 
If you’re pregnant and want to learn more about preparing your body for birth, you can follow along at @the.mama.physio on Instagram or visit www.themamaphysio.com.au
 
*References: Cochrane Reviews 2012, 2013 & 2017
 
 
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