I recently did a Facebook Live discussion on ‘Protecting Your Perineum for a Positive Birth’ on the Gentlebirth mums Facebook group which you can join and watch back if you’d like. I’m including some of the main points we touched on in this article too. So first of all, what is a perineal tear and how common (or uncommon) are they? Well, a perineal tear is a tear of the tissues between the vagina and anus (back passage) that occurs during birth. We classify tears into four main types – 1st degree, 2nd degree, 3rd degree and 4th degree.

1st and 2nd degree tears are relatively common, often don’t require any stitching and usually heal quickly and very well. 3rd and 4th degree tears are larger, extending as far as or into the anal sphincter (the muscle that holds your bowel closed) and always need stitching. Because of this, they heal more slowly and cause more discomfort for longer after the birth.


This is a question that nearly always comes up in my Gentlebirth and Pregnancy Pilates classes, and if you’re reading this, it’s probably a concern for you too. So here are my top tips for things to do during your pregnancy that will reduce your risk!

  1. Choose your place of birth carefully. There are several interventions that increase your risk of larger tears. We know that the rate of these interventions is different, depending on your model of care. There are three main models of care available to women: Obstetric-led care, Midwife-led care and Homebirth. We know that intervention rates are higher in obstetric-led care models. They are lower in midwife-led care and lowest in a homebirth situation. For example episiotomy, which is an independent risk factor for large perineal tears, is less likely for women who give birth at home or in a midwifery-led unit.

  2. Write Birth Preferences. Birth preferences are another way of ensuring interventions are evidence based rather than routine care.

  3. Exercise. There’s plenty of research showing women who exercise during their pregnancy have a lower risk of large tears. I normally recommend that mums do at least the minimum recommended by the World Health Organisation. That is 150 minutes per week or roughly half an hour most days. There aren’t any recommendations for the amount or type of exercise. A mixture of toning/flexibility like pilates or yoga or weight training and cardiovascular exercise like cycling, walking, running or jogging, swimming or aerobics (depending on what you have been doing pre-pregnancy of course) could be good options.

  4. Practice your Perineal Massage. There is great evidence to show the benefits of perineal massage for first time mums. It reduces the risk of episiotomy (thereby reducing the risk of larger tears). For women who have had a baby before, it reduces the chance of having perineal pain at 3 months post partum. I usually recommend starting your perineal massage at around 36 weeks and doing it about 2-3 days a week. More info on perineal massage here!

  5. Lastly, do you have Gestational diabetes? There seems to be an increased risk of larger tears for women who have gestational diabetes and have difficulty controlling blood sugars. However, you can change this too! Exercise will be even more important as it helps your body to regulate blood sugars more effectively. Mindfulness meditation has also been shown to help with blood sugar control. So definitely worth adding a short 10 minute practice to your daily routine!

    Womens health

So, as you can see, there’s loads you can do even before you go into labour to increase your chances of birthing your baby with an intact perineum. It’s never too late to get started, unless of course, you’ve already had your baby! In my next post I’ll be discussing things you can do in labour to reduce your risk of perineal tears.