Can vaginal tears during childbirth be prevented?
Answer From Yvonne Butler Tobah, M.D.
Vaginal tears during childbirth, also called perineal lacerations or tears, occur when the baby's head is coming through the vaginal opening and it is either too large for the vagina to stretch around or it is a normal size but the vagina doesn't stretch easily. Tears can range from affecting only the skin around the vagina to involving the anal sphincter (third- and fourth-degree tears).
There's no guarantee you'll be able to prevent vaginal tearing during childbirth, but some research suggests that taking these steps might decrease the risk of severe tears:
- Prepare to push. During the second stage of labor, the pushing stage, aim for more controlled and less expulsive pushing. Pushing the baby out gently and slowly can allow your tissue time to stretch and give way for the baby. Your health care provider will offer guidance.
- Keep your perineum warm. Placing a warm cloth on the perineum during the second stage of labor might help.
- Perineal massage. During the second stage of labor, your health care provider might place two fingers of a lubricated gloved hand just inside your vagina and move them from side to side, exerting mild, downward pressure. Your health care provider might also recommend perineal massage at home at the end of your third trimester, before the start of labor. You can do this yourself or with the help of your partner.
- Deliver in an upright, nonflat position. There are a number of delivery positions that might reduce the risk of a vaginal tear during childbirth. Rather than lying down flat during delivery, deliver in an upright position. Your health care provider will help you find a comfortable and safe delivery position.
If you're concerned about vaginal tears during childbirth, talk to your health care provider. Ask what techniques he or she uses to prevent vaginal tears and for any additional advice to help you prepare for delivery.
Yvonne Butler Tobah, M.D.
April 21, 2020
- Laufer MR, et al. Evaluation and management of female lower genital tract trauma. https://www.uptodate.com/contents/search. Accessed March 26, 2018.
- Basu M, et al. Can the incidence of obstetric anal sphincter injury be reduced? The STOMP experience. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;202:55.
- Aasheim V, et al. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews. http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006672.pub3/full. Accessed March 26, 2018.
- Funai EF, et al. Management of normal labor and delivery. https://www.uptodate.com/contents/search. Accessed March 26, 2018.