Podcast Episode #282
Types, Prevention and Healing of Perineal Tears
Worried about perineal tears?
You’re not alone. It’s one of the most common concerns I hear from women preparing for birth.
In this episode, I sit down with Dr Shavi Fernando to talk through what’s normal, what actually matters, and how your body can recover well with the right support.
This is an honest, practical conversation to help you feel more informed and less overwhelmed.
- What perineal tears are and the different types
- What’s normal vs what’s not
- Short-term and long-term complications
- First baby, age, and genetics as risk factors
- Overactive pelvic floor and muscle control
- Baby size vs maternal size
- Perineal length and perineal massage
- Positioning during birth
- The pushing phase and why slowing it down matters
- Warm compress and hands-on techniques
- When episiotomy may be used
- Forceps and assisted delivery
- Healing perineal tears and what recovery looks like
- How pelvic floor physio supports recovery
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In this article you'll find tips to:
- Understand what perineal tears are and what’s normal
- Reduce your risk of severe tearing during birth
- Prepare your pelvic floor for labour and delivery
- Use perineal massage effectively during pregnancy
- Improve pelvic floor relaxation and control
- Choose birth positions that support your body
- Manage the pushing phase to minimise trauma
- Support your perineum during birth (warm compress, hands-on techniques)
- Know when interventions like episiotomy may be helpful
- Feel more informed about forceps and assisted birth
- Care for your perineum in the early postpartum days
- Support healing perineal tears properly
- Start pelvic floor recovery safely and effectively
- Build confidence in your body before and after birth
If you’re pregnant or preparing for birth, chances are you’ve come across the term perineal tears and felt a mix of curiosity and concern.
I get it.
It’s not the most comforting topic, but it can be an important conversation to have. And the goal here isn’t to create fear. It’s to give you clarity, confidence, and reassurance.
Because the truth is, healing perineal tears is not only possible, it’s something the body is incredibly designed to do well with the right support.
In this podcast episode, I sat down with Dr Shavi Fernando, an obstetrician based in Melbourne, to unpack everything you need to know, from what perineal tears are to how we can support recovery.
In this episode, I’m walking you through everything we discussed in a way that’s clear, practical, and empowering.
What Are Perineal Tears?
In basic terms, perineal tears happen when the tissues between the vaginal opening and anus stretches during birth.
And here’s the first thing I always want you to know:
They are very common, especially for first-time births.
There are different types:
- First degree: Skin only
- Second degree: Skin + muscle (most common)
- Third degree: Extends into anal sphincter
- Fourth degree: Extends into rectum
Most women experience first or second degree tears, which generally heal very well with proper care.
Short Term Complications
In the early days after birth, you may experience:
- Pain or soreness
- Swelling
- Stinging (especially when urinating)
- Discomfort when sitting or moving
- Healing stitches
This is all completely normal and expected.
The key here is good wound care, rest, and support.
Long Term Complications
For a smaller percentage of women, more significant tears can lead to:
- Pelvic floor weakness
- Difficulty controlling gas or bowels
- Prolapse symptoms
- Pain with intimacy
But here’s the part that often gets missed:
With proper diagnosis, repair, and pelvic floor rehabilitation, outcomes are usually very good.
You are not “stuck” with these symptoms. There is so much support available.
Risk Factors During Pregnancy
This is where things get interesting, because many women want to know:
“Can I predict if I’ll tear?”
The honest answer is, not perfectly. But there are factors we can be aware of.
1. First Baby
This is the biggest factor. The body hasn’t gone through birth before.
2. Age
As we get older, tissue elasticity can decrease slightly.
3. Genetics
Your family history can play a role in tissue structure and healing.
4. Overactive Pelvic Floor
If your pelvic floor struggles to relax, this can affect how the baby moves through the birth canal.
5. Baby Size vs Maternal Size
It’s not just about a “big baby”. It’s about the ratio between baby size and your body and pelvis.
6. Perineal Size/Length
A shorter perineum may slightly increase the risk of deeper tears.
7. Perineal Massage
This is one of the most practical tools available.
It’s simple, free, and supported by research to help reduce risk of 3rd and 4th degree tears and episiotomies, especially for first-time mums.
What Happens During Birth
Now let’s talk about what actually influences tearing during labour.
Positioning During Birth
Different positions can change how pressure is distributed.
The most important thing?
You feel comfortable and supported.
The Pushing Phase
One of the biggest contributors to tearing is how quickly the baby’s head is delivered.
Slowing this phase down allows the tissue to stretch more gradually. Having trust and the support of your healthcare team helps here.
Warm Compress
A warm compress applied to the perineum:
- Feels soothing
- Helps tissue relax
- Has evidence supporting reduced tearing
Hands-On Technique
This is when your healthcare provider supports the baby’s head as it crowns, helping control the speed of delivery.
This gentle control can make a big difference.
Episiotomies
As Dr Shavi Fernando explained, an episiotomy is not done routinely, but may be used when there is a concern about a more severe tear.
Think of it as a strategic decision, not a default one.
Forceps and Assisted Birth
This is where a lot of fear can come in.
But here’s the nuance we discussed:
It’s often not the tool itself that increases risk, but the situation that made it necessary.
And when used appropriately, it’s about keeping both mum and baby safe.
Healing Perineal Tears: What Recovery Really Looks Like
This is the part I care deeply about.
Because so many women assume:
“If something goes wrong, that’s it.”
And that’s simply not true.
The Body Is Designed to Heal
Even when there is trauma, the body is:
- Highly adaptable
- Capable of repair
- Supported by modern healthcare
Pelvic Floor Physio and Perineal Tears
If there’s one thing I want you to take away, it’s this. I believe:
Pelvic floor physiotherapy is not optional. It’s essential.
We can help you:
- Restore strength and coordination
- Improve healing outcomes
- Reduce pain
- Prevent long-term issues
- Safely return to exercise
And just as importantly:
We help you learn how to relax your pelvic floor, not just strengthen it.
A Final Note From Me
I know this can feel like a lot.
And yes, parts of this conversation are intense.
But I want to leave you with this:
You don’t need a “perfect” birth to have a good outcome.
You need:
- The right support
- The right information
- The right recovery
Because even if you do experience perineal tearing:
Healing perineal tears is absolutely possible, and you are not alone in that journey.
** This podcast has general information only. Always seek the guidance of your doctor or other qualified health professional with any questions or concerns you may have regarding your health or medical condition.
Links
Free Register now: https://www.fitnestmama.com/pregnancyworkshop
Preparing for birth Pelvic health checklist
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Instagram @kathbaquie.physio
1:1 Consultation with Physio Kath
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