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 
