Evidence Library · Tearing

What reduces tearing

Some things genuinely work, and one of them you can do yourself.

Perineal massage during pregnancy, from about 35 weeks. Across 4 trials and 2,497 women it reduced trauma requiring stitches (relative risk 0.91, about 15 women needing to do it for one to benefit) and reduced episiotomy (relative risk 0.84, about 21 women per benefit). The benefit was in women without a previous vaginal birth. It did not reduce severe tears.

Warm compresses during the birth. Across 4 trials and 1,799 women, fewer third and fourth-degree tears (relative risk 0.46).

Perineal massage during the second stage. Across 5 trials and 2,477 women, fewer third and fourth-degree tears (relative risk 0.49), and more women with an intact perineum.

Hands-on versus hands-off. No clear difference in intact perineum or severe tears, but more episiotomies in the hands-on group.

Ask for the two that work"I would like warm compresses and perineal support during the pushing stage." Both are free, both have Cochrane evidence, and neither happens unless someone thinks to do it.

Where this comes from:

215. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;(4):CD005123.

216. Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;(6):CD006672.

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