Birth places incredible demands on the tissues of your pelvic floor — and for many women, some degree of perineal tearing is a normal part of that process. In fact, 80–90% of first-time vaginal births involve some tearing. While perineal tears are common and often heal well, there are ways to support your body before and during labor that can reduce the risk of more severe tears.

Below are four evidence-informed ways to support your perineum and pelvic floor as you prepare for birth.

What is Perineal Tearing?

Your pelvic floor has three openings: the urethra, the vaginal opening, and the anal sphincter. The tissue between the vaginal opening and anus is called the perineum, and this tissue stretches significantly as your baby moves through the birth canal. Sometimes, that stretching results in tearing.

Perineal tears are categorized by severity:

• First-degree: Superficial tissue; may need minimal or no stitches
• Second-degree: Involves deeper pelvic floor muscles; usually requires stitches
• Third-degree: Extends into the anal sphincter; often require stitches and pelvic floor rehabilitation
• Fourth-degree: Extends into the rectum; requires more intensive care and long-term rehab

When I refer to severe perineal tearing, I’m talking about third- and fourth-degree tears, as these typically require more short- and long-term support.

It’s important to know that even when tearing occurs, most women heal very well, especially when they’re supported with appropriate postpartum care and pelvic floor rehabilitation when needed.

4 Ways to Support Your Perineum and Reduce the Risk of Severe Tearing

1. Connect with Your Pelvic Floor

Awareness is key. During pushing, your pelvic floor needs to relax and lengthen – it’s not about squeezing harder or “pushing with your pelvic floor.”

Your uterus and abdominal muscles do the work of pushing. When the pelvic floor remains tense, it can increase resistance and raise the risk of tearing.

For many women, relaxing the pelvic floor on command doesn’t come naturally, especially if you’ve spent years being told to “do your kegels.” This is a learned skill. Practicing pelvic floor relaxation and breath coordination before labor makes it much easier to release tension when it matters most.

2. Avoid Pushing Flat on Your Back

The classic lithotomy position (lying flat on your back with feet in stirrups)  limits sacral movement and reduces the space available at the pelvic outlet, which can increase the likelihood of tearing.

Many women find the below positions more supportive because they allow more pelvic movement and space:

• All fours: Allows the sacrum to move freely and uses gravity to your advantage

• Side-lying: Comfortable, effective, and often a great option with an epidural

• Semi-reclined: Elevating the head of the bed can help if back-lying is needed

Remember: the best pushing position is one where you feel comfortable, supported, and able to relax your pelvic floor. If that means a semi-reclined position on your back, that’s absolutely okay. Birth is not one-size-fits-all.

3. Apply a Warm Compress

Applying a warm compress to the perineum between pushes has been shown to:

• Promote muscle relaxation
• Increase tissue elasticity
• Reduce the risk of severe tearing

This is a simple but powerful tool that I used during the hospital-based birth of my second born. My midwife applied a warm compress at my perineum between pushes and because I didn’t have an epidural this time around, I could actually feel the warmth helping to relax my muscles!

If this is something you’re interested in, talk with your provider and support person ahead of time so it can be easily implemented during labor!

4. Avoid “Purple Pushing”

“Purple pushing” is a way of describing the common method of pushing known in the medical world as “closed glottis” – aka holding your breath and bearing down forcefully. While purple pushing is effective most of the time, it creates unnecessary tension and strain on your pelvic floor.

Instead, many women benefit from open-glottis pushing, which is gentler on the pelvic floor because you are instead exhaling as you bear down while pushing rather than holding your breath.

To practice open-glottis pushing, follow the below steps:

1. Take a deep inhale through your nose focusing on expanding your ribcage 360 degrees. This will naturally inflate your belly, chest and abdominal cavity.
2. Keep your belly “big and hard.”
3. Exhale while bearing down (imagine you are pushing out a tampon) keeping your belly big and hard.
4. If you are practicing at home, use a handheld mirror and look at your pelvic floor. Your vaginal opening should remain open even as you bear down.

Some providers still default to coached breath-holding because it is much easier to learn in the heated moment of labor. Plus, not all medical providers are well-versed in open glottis pushing or just have not seen it done effectively.

But trust me, it CAN be done effectively. I used open-glottis pushing with both of my births (first with an epidural, second without) and avoided any form of tearing. Thousands of women who have gone through my Movement Through Labor and Delivery program have also been able to successfully utilize open-glottis pushing during their births.

Letting your care team know ahead of time that you prefer open-glottis pushing can help you feel more supported and aligned during labor. Practicing this breathing technique beforehand makes it easier to access when you’re in the intensity of birth.

Preparing Your Body for Birth

Preparation doesn’t mean controlling birth. It means giving your body options and building confidence in how it moves, breathes, and responds under pressure.

Learning how to relax your pelvic floor, explore supportive pushing positions, and use simple tools like warm compresses can go a long way in supporting your perineum and overall birth experience.

That’s why I created the Movement Through Labor and Delivery program.

Movement Through Labor and Delivery Program

Movement Through Labor and Delivery was co-created alongside a hospital-based Certified Nurse Midwife, because collaborative, team-based care is essential in birth. The goal is not to replace your provider, it’s to help you feel informed, prepared, and supported as you work with your care team.

Inside this comprehensive childbirth education and pelvic floor prep program, you’ll learn how to:

• Prepare your pelvic floor and full body for childbirth with targeted movement flows designed for weeks 36–41
• Understand what’s happening in your body as you move through each stage of labor
• Breathe and move with intention to support your pelvic floor and reduce tension
• Know your options for pushing, positions, pain management, and labor settings
• Advocate for yourself and have empowering conversations with your provider and support person
• Actively involve your partner or support person, with simple, hands-on techniques they can use during labor to help you stay relaxed, supported, and grounded
• Set yourself up for optimal healing in the fourth trimester
• Use printable PDF cheat sheets you can bring with you to the birth setting
• Connect with other moms and moms-to-be in the app community for encouragement and shared experience

The program includes 12 educational modules, weekly labor prep movement flows, lifetime access to the materials, and an easy-to-use mobile app so you can reference everything on your phone or desktop.

Walk into labor feeling prepared, supported, and confident — backed by evidence-informed education, practical movement, and collaborative care.