Episode 19: How to Prevent Perineal Tearing
Tearing during birth is one of the most common fears expecting parents have—especially if you’re navigating the Dutch maternity system for the first time.
In this episode of Pregnant in the Netherlands, we talk honestly about:
What the perineum and pelvic floor actually do
Why tearing happens
The difference between natural tears and episiotomy
And most importantly: what you can do to reduce your risk
What Is the Perineum? (And Why It Matters in Birth)
The perineum is the area between the vaginal opening and the anus.
During birth, this tissue stretches to allow your baby to be born.
Supporting it is your pelvic floor—a group of muscles that:
Hold your uterus and organs in place
Help control bladder and bowel function
Stretch and release during birth
👉 Learning how to relax (not just strengthen!) these muscles can make a big difference in your birth experience.
What Is Perineal Tearing?
As your baby’s head crowns, the perineum stretches.
Sometimes, this stretching happens faster than the tissue can adapt, leading to a tear.
There are two types:
Natural Tearing
Happens gradually as the body stretches
Often heals well
Follows the body’s natural tissue lines
Episiotomy (Medical Cut)
A surgical incision made by a care provider
Usually at a 45° angle
Used in specific situations (e.g. baby distress, assisted birth)
👉 Research shows that natural tears often heal better than episiotomies.
Degrees of Tearing Explained
Not all tears are the same:
1st degree: small skin tear, may not need stitches
2nd degree: involves muscle (most common)
3rd degree: extends to anal sphincter
4th degree: extends to rectum (rare but more serious)
💡 Severe tears (3rd & 4th degree) require more recovery and support, often including pelvic floor therapy.
Episiotomy in the Netherlands: What to Know
In the Netherlands, episiotomy is not routine, but it still happens—especially in hospital births.
Lower rates with primary care midwives (low-risk births)
Higher rates in hospital settings with medical interventions
👉 One key factor? The care provider’s philosophy of birth.
Midwife-led care tends to support physiological (natural) birth, while hospital care is more intervention-focused.
What Increases Your Risk of Tearing?
Some common factors include:
Directed pushing or rushing birth
Lying on your back (lithotomy position)
Instrumental birth (vacuum/forceps)
Episiotomy (can increase risk of severe tearing)
High tension in the pelvic floor
How to Reduce Your Risk of Tearing
Let’s shift the focus from fear → preparation.
1. Learn to Relax Your Pelvic Floor
Many women are actually too tense, not too weak.
Practice:
Deep breathing
Letting go during exhale
Awareness of tension in your pelvic area
💡 Relaxation is often more important than strengthening.
2. Practice Perineal Massage (Optional)
From around 37 weeks, perineal massage can help you:
Get used to the stretching sensation
Practice relaxing under pressure
👉 The biggest benefit is often mental preparation, not just physical stretching.
3. Choose Positions That Create Space
Positions that may reduce tearing:
Side-lying
Hands and knees
Squatting
Upright positions
💡 These positions allow the pelvis to open more naturally.
4. Avoid Routine Back-Lying Birth (If Possible)
Being on your back can:
Reduce space in the pelvis
Increase pressure on the perineum
That said—the best position is the one where you feel safe and supported.
5. Use Warm Compresses & Hands-On Support
Midwives may support your perineum with:
Warm compresses
Gentle massage with oil
These techniques can help:
Increase blood flow
Improve elasticity
Slow down crowning
6. Consider Water Birth
Giving birth in water may:
Soften tissues
Reduce tearing risk
Increase comfort and relaxation
💡 Many Dutch hospitals and home birth setups offer birth pools.
7. Follow Your Body’s Urge to Push
Instead of coached pushing, try to:
Listen to your body
Push when you feel the urge
Avoid rushing the process
👉 Slower, controlled pushing allows the perineum to stretch gradually.
8. Create a Safe Birth Environment
Tension increases tearing risk.
Feeling safe helps your body:
Relax
Open
Release
Your support team matters:
Midwife
Doula
Partner
What About Tools Like the Epi-No/Perineal Balloons?
Devices designed to stretch the perineum exist, but:
They’re not necessary
Evidence is mixed
Benefits may be mostly psychological
👉 If you want to use one, that’s okay—but it’s not essential for a good birth outcome.
Important Reminder: Tearing Is Not Failure
This is key.
✔ Tearing is common
✔ It does not mean you did something wrong
✔ It is not the main measure of a “good birth”
The real goal is:
👉 Feeling supported, safe, and empowered
Key Takeaways
Your body is designed to stretch and birth your baby
Relaxation and safety matter more than perfection
Your birth team and environment make a big difference
There are many ways to support your perineum naturally
Support for Your Birth & Postpartum Journey
If you want personalized support preparing for birth in the Netherlands:
