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Childbirth is an incredible experience, but it can also come with physical challenges — one of
the most common being perineal tears. These occur in the area between the vaginal opening and the anus (the perineum) during vaginal birth.

While minor tearing is common, particularly for first time vaginal births, some can be more
serious and affect your recovery. The good news? There are steps you can take to reduce your
risk — working with a pelvic health Physiotherapist (also known as a Women’s Health Physio)
can be one of the most effective.

What Are Perineal Tears?

Perineal tears are divided into 4 stages:

First-degree tear: Involves only the skin of the perineum.
Second-degree tear: Involves the skin and underlying muscle.
Third-degree tear: Extends to the anal sphincter muscle.
Fourth-degree tear: Extends through the anal sphincter and into the rectal lining.

Most women experience some degree of tearing during their first vaginal birth, but not all require stitches or lead to long-term problems — especially with the right care and preparation.

What Increases the Risk of Tearing?

While every birth is different, some common factors that may increase the risk include:

First-time vaginal birth
Larger baby (over 4kg)
Baby in a posterior (back-to-back) position
Fast or very prolonged labour
Use of forceps or vacuum
Lying flat during pushing
A perineum shorter than 2.5cm
Episiotomy

How to Reduce the Risk of Perineal Tearing

You may not be able to control every factor during birth, but there’s a lot you can do to support your body ahead of time.

1. Perineal Massage
From around 34 weeks of pregnancy, regular perineal massage can help improve tissue elasticity. It involves gently stretching the perineal area for a few minutes a day using fingers or thumbs. Evidence shows that perineal massage can reduce the risk of more severe tears and the need for stitches, especially in first-time births.

2. Pelvic Floor Preparation with a Physiotherapist

Seeing a pelvic health Physiotherapist is one of the most effective ways to prepare your perineum for birth. They can:

Teach proper perineal massage techniques
Help you understand how to relax (not just strengthen) your pelvic floor during labour
Guide you through breathing and pushing techniques
Identify and treat any tightness or dysfunction in the pelvic floor or surrounding muscles
Address any pain or ongoing symptoms related to the pelvis and/or vulvar area

�� Tip: Overactive pelvic floor muscles can actually increase your
risk of tearing. Physiotherapy can help you learn to let go at the
right time.

3. Optimal Birth Positions
Certain birthing positions may reduce strain on the perineum, such as:

Side-lying
Hands and knees
Squatting (with support)
Upright positions using a birthing stool or ball

Avoiding lying flat on your back if safe to do so may help minimise tearing.

4. Warm Compresses During Labour
Midwives and birth providers may use warm compresses on the perineum during the pushing
stage to help relax the tissue, improve blood flow, and reduce the risk of tearing.

5. Controlled, Gentle Pushing
Rather than forceful, prolonged pushing, many birth professionals now recommend “breathing your baby out” — a slower, more instinctive pushing technique that allows the perineum to gradually stretch.

Why See a Pelvic Health Physiotherapist Before Birth?
A pelvic health Physiotherapist specializes in preparing your body for labour and supporting
postpartum recovery. They can help you:

Prepare your pelvic floor for birth
Practice and perfect perineal massage
Address pelvic pain, tension, or past trauma
Develop strategies to minimise tearing and support healing

Bonus: Your Physio will also be a valuable resource postpartum —
helping with recovery from tears, managing scar tissue, pain,
leakage or prolapse, and regaining strength and mobility safely.

Perineal tearing is common — but it doesn’t have to catch you off guard. With education, body
awareness, and the right support, you can reduce your risk and feel more confident going into
labour.

Whether it’s learning how to breathe and push effectively, improving pelvic floor mobility, or
practicing perineal massage, a pelvic health Physiotherapist can guide you every step of the way.

�� Ready to Prepare for Birth?
Working with a pelvic health Physiotherapist can make a huge difference in your birth experience and recovery.

Kelly Rigby – Senior Physiotherapist

Women’s Wellness Project

1 Hornet Place, Burleigh Heads Queensland 4220, Australia

0406941605

team@womenswellnessproject.com

https://womenswellnessproject.com/