Reducing the risk of sustaining a deeper, third or fourth degree tear
First and second degree perineal tears are most common type and are unlikely to cause long-term problems.
For third and fourth degree tears, there is often no clear reason why this happens, and it is not possible to predict. However, it is more likely if:
- This is your first vaginal birth
- Your baby is over 4kg (9lb)
- You have a long second stage of labour (the stage during which you push your baby out)
- Your baby’s shoulder gets stuck behind the pubic bone (shoulder dystocia)
- You have an operative vaginal birth (forceps or vacuum assisted)
The information on this page will help to reduce the potential risk of a tear.
Perineal massage while pregnant
From 35 weeks onwards, you or your partner can use daily perineal massage until your baby is born which may reduce your risk of tearing.
Perineal massage tips
- Warm bath
Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
- Short nails
The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
- Comfortable position
You need to be relaxed during the massage so its important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees.
Use a lubricant like vitamin E oil, almond oil or olive oil.
Hold your thumbs in the position shown for about 1 minute (diagram below). Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breath deeply.
- Gentle massage
Gently massage the lower half of your vagina using a U shaped movement for 2-3 minutes. Repeat this 2-3 times.
- Repeat daily or when possible
It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area.
Perineal protection at the time of birth
You can ask your healthcare professional to support your perineum as your baby is being born, which may reduce the risk of a third or fourth degree tear. This is called manual perineal protection.
Manual perineal protection can be provided in any birth position, apart from in the water, or on a birthing stool. It is only used for a short period, during the birth of your baby.
Your healthcare professional should also work with you to ensure have a slow and controlled birth.
If you are concerned about tears or have any questions, speak to your healthcare professional. They will be able to discuss any increased risk factors related to your birth, and what they and you can do to try to prevent them.