How to Reduce the Risk of Tearing During Birth
By Dr Greg Jenkins, Obstetrician (Sydney)
Tearing during childbirth is one of the most common concerns I hear from patients.
And it’s understandable.
With so much content online, it can feel like there are “secret techniques” to completely avoid tearing. Some of that advice is helpful. Some of it is misleading.
So let me give you a clear, honest answer based on real clinical experience.
Yes, tearing can happen.
But in most cases, it’s minor. And there are very effective ways to reduce the risk of more significant tearing.
How common is tearing during childbirth?
Tearing is relatively common in vaginal births, particularly for first-time mothers.
However, what’s often misunderstood is the severity.
The majority of tears are:
First or second degree (minor)
Involve skin and superficial tissue only
Heal well with routine care
More severe tears (third or fourth degree), which involve deeper muscles, are much less common, especially with careful management during delivery.
In other words, the conversation shouldn’t be driven by fear, it should be guided by understanding.
Why does tearing happen?
Tearing occurs as the baby’s head stretches the vaginal opening and perineum (the area between the vagina and anus).
Several factors influence this process:
First vaginal birth
Baby size and position
Speed of delivery
Strength and frequency of contractions
Instrumental delivery (forceps or vacuum)
Individual tissue elasticity
Some of these factors can’t be controlled. But many aspects of care during labour do make a meaningful difference.
Can you avoid tearing completely?
This is where social media often gets it wrong.
There is no guaranteed way to prevent tearing entirely.
Anyone promising that is oversimplifying a complex, highly individual process.
What we can do, and what I focus on with my patients, is:
Reduce the likelihood of tearing
Minimise the severity if it does occur
Ensure optimal healing and recovery
What actually reduces the risk of tearing?
There are several evidence-based strategies that I incorporate into patient care.
1. A slow, controlled delivery
One of the most important factors is how your baby is guided out during birth.
Rather than rushing this moment, I take a slow and controlled approach as your baby’s head is being born, giving your body time to stretch naturally.
This gentle pacing can make a significant difference in reducing the risk of more severe tearing.
2. Perineal support during birth
During the crowning phase, I often provide hands-on support to the perineum.
This technique helps:
Control the speed of delivery
Support the surrounding tissue
Reduce strain on the perineal muscles
It’s a small intervention that can make a meaningful difference.
3. Warm compresses
Applying warm compresses during the pushing stage can:
Improve blood flow
Increase tissue flexibility
Reduce the likelihood of significant tearing
This is commonly used in well-managed births.
4. Perineal massage (before birth) & EpiNo
From around 34–35 weeks, some patients choose to use EpiNo or perform perineal massage at home.
The goal is to gently stretch and prepare the tissues in advance.
The evidence is mixed and perhaps suggests that EpiNo may be more beneficial than perineal massage. From my experience, I have found EpiNo to be more effective than perineal massage.
5. Positioning during labour
Certain birth positions can reduce pressure on the perineum and allow for a more controlled delivery, but this varies widely between individuals.
This is something I guide in real time, depending on how labour progresses and whether you have an epidural.
What about episiotomies?
An episiotomy is a small, controlled incision made during delivery.
There’s a common misconception that it’s routinely performed. This is no longer the case.
I only suggest an episiotomy when it’s clinically necessary and would only ever perform it with your consent. Episiotomy might be considered in these circumstances:
When the baby needs to be delivered quickly
When there is a high risk of a more severe tear
With a vacuum or forceps assisted birth
In the right situation, it can actually be protective.
If tearing does occur
It’s important to put this into perspective.
In most cases:
Tears are straightforward to repair
Healing is quick and uncomplicated
Long-term issues are uncommon
After delivery, I ensure:
Careful repair of any tear
Clear guidance on recovery and pain management
Ongoing support during the postnatal period
The vast majority of women recover very well.
A note on what you may see online
There is a growing amount of advice online about “how to avoid tearing completely”.
Some of it includes:
Specific breathing techniques
Oils or devices
Very prescriptive birth plans
While some of these approaches can be helpful in a broader sense, they should not replace experienced clinical care during delivery.
The most important factor isn’t a single trick, it’s how your birth is managed in the moment.
The bigger picture
It’s completely normal to feel concerned about tearing.
But I always encourage patients to shift the focus slightly, away from fear, and toward preparation and support.
A well-managed birth, with experienced care, significantly reduces the risk of serious complications.
My approach to birth care
Every patient is different, and every birth is unique.
My role is to:
Guide you through labour safely
Minimise risks wherever possible
Ensure you feel supported, informed and confident
That includes doing everything I can to reduce the likelihood and impact of tearing, while keeping the overall focus on a safe and positive birth experience.
Speak with Dr Greg Jenkins
If you’re preparing for birth and want personalised guidance, I provide obstetric care from Norwest Private Hospital, with delivery options at Norwest Private, Westmead Private, and Westmead Public.
Appointments: 02 8805 7900
