Can vaginal tears during childbirth be prevented?

Vaginal tears can happen when a baby's head comes through the opening of the vagina during childbirth. They're also called perineal lacerations or perineal tears. These tears usually are repaired with stitches after birth to help healing.

Vaginal tears may occur if the baby's head is too big for the vagina to stretch around. Or sometimes a tear might happen if the vagina doesn't stretch easily. Minor tears are most common. They only affect the skin around the vaginal opening. Severe tears may extend to the tissue and muscle around the anus. The practice of making a surgical cut near the vaginal opening at the time of delivery — called an episiotomy — is no longer done routinely.

It's hard to completely prevent vaginal tears during childbirth. But some research suggests that the following steps could lower the risk of serious tears:

• Keep the perineum warm. The area between the opening of the vagina and the anus is called the perineum. Placing a warm, damp cloth on this area during the pushing stage of labor may help the tissue stretch more easily.
• Use perineal massage. During the pushing stage of labor, a member of your healthcare team may place two fingers of a lubricated gloved hand just inside your vagina and move them from side to side. This is called perineal massage. It puts mild, downward pressure on that area and can help to stretch it. Doing perineal massage at home at the end of your third trimester also may help the tissue stretch more easily during labor.
• Control your pushing. Aim for controlled, consistent pushing. If you can, try not to push down hard all at once while the baby's head is coming through the vaginal opening. Pushing gently and slowly can give the tissue time to stretch.

• If you're concerned about vaginal tears during childbirth, talk to your healthcare professional. Ask what the care team does to prevent vaginal tears. Talk about what you can do to help prepare for delivery and lower your risk of tears.