First, I’m not a midwife and this list is not exhaustive. I’m often asked by women what they can do to keep their perineum intact during birth. You see, we women love our perineum and prefer to keep it intact.
Perineum: /peri·ne·um/ (-ne´um) 1. the pelvic floor and associated structures occupying the pelvic outlet, bounded anteriorly by the pubic symphysis, laterally by the ischial tuberosities, and posteriorly by the coccyx
In common language: the part of the body that might tear or be cut (episiotomy) during the birth of a baby.
Here are my top tips.
During pregnancy:
1) Do your kegels
2) Practice perineal massage (especially first time mothers). Some disagree with this instruction. The cochrane database shows some benefit. Mostly, I think perineal massage helps women become accustomed to the sensation of stretching and perhaps, prepares them to release these muscles during pushing.
3) Eat good food
4) Talk with your care provider about his/her thoughts on the perineum. Listen carefully. If you hear something like “everybody tears” or worse, “I usually cut an episiotomy so you don’t tear” then it might be a good time to find another care provider.
During Birth
1) Choose a position like side-lying or hands/knees. Choose ANY position other than semi-reclining. If someone tries to put your legs in stirrups, kick them in the head.
2) Consider providing your own counterpressure as your baby crowns. Place your hands around your baby’s head or anywhere you feel stinging.
3) Say “no thank-you” to holding your breath and pushing until all the veins in your face pop out. Purple is not your color. Push with your urges. Give yourself time to stretch. No need to blast the baby out.
4) When your baby is crowning, give some little nudges in between contractions. You might ease the baby out without the incredible force of your amazing uterus.
5) Listen closely to your body during this time. If you feel stretching or burning, it is a welcome signal. Your perineum is telling you, “Hey, listen up! We’re gonna do this nice and slow.”
You might also consider a waterbirth with a midwife who keeps her hands out of the water (thereby away from your perineum). You may be more relaxed, intuitive in your movements, and inclined to go slowly.
I particularly love this guide to an intact perineum.
Chime in. What did I leave out? What do you disagree with?
Inexplicable Ways 
Thanks for posting this. I definitely want to do this part differently next time. Having 2 tears and being stitched up was no fun. 😦 And the recovery was pretty difficult, too.
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I can say that I agree with #1. Kick hard. 🙂
I experienced tearing with my first three births, and made it my goal this last time to keep it all together. #3 and 4 were what I focused on in the moment. Being at home kept me in control of how I gave birth, and I breathed the baby out, versus purple-pushed her here.
I’m not 100% sold on perineal massage, mostly becuase I wonder about the potential for actually making the skin tear. Does that make sense? I would think that incorporating oils into your diet/supp’ing routine would be of benefit. What I DO think is good about it, is exactly what you said – it’s prepping you for the sensation, as well as just getting you used to your body.
Sally, I almost wrote more about what you’re saying but couldn’t find my original source. I remember hearing a midwife talk about the real purpose of perineal massage was to create a neural pathway so that in the moment of birth, the brain remembered the sensation. She had done a research project on it. In that case, perineal massage only has true value for the first vaginal birth. (Which is why I didn’t do it after my first. :))
I think I’d clarify too that perineal massage is best done prenatally. I believe I’ve read a number of times that doing it during labour can actually backfire, inflaming the tissues. Perhaps, though, it’s just the distraction/annoyance of having it done during labour that leads to a hasty pushing or somesuch? 😉
Yes!! Have you heard care providers call it “ironing out” the perineum? Barf.
I’ve also read that keeping an active sex life throughout pregnancy (especially at the very end!) can help as well. I believe it was Ina May herself who suggested it….
I had a 2nd-degree tear the first time, but that’s what comes of a first-timer pushing for only 15 minutes….I am definitely focusing on going more slowly this time!
We don’t need to discuss my poor perineum here, you already know the outcome. However, I did want to mention something regarding During Birth #1.
I had planned to birth standing, squatting or kneeling. I never considered any other way because I KNEW I would feel better and have an easier time birthing more upright. Then I got in the tub and tried to kneel and squat – no thanks. I wanted my entire body submerged, and I liked laying back in between contractions (but not getting back into a squatted position for them). I ended up wanting to birth in a way that neither my brian nor my perineum agreed with. Maybe it was the size and shape of the tub, or those pesky handles just calling to my feet, but for whatever reason, I broke the first rule, and I paid. Can’t blame it on anyone else though, I did my homework.
You can lead a horse to water . . .