During childbirth, you want to protect the perineum from tears. This is done by the midwife or obstetrician using something called perineal protection, which aims to slow the birth of the baby so that the woman’s tissues can stretch slowly.

What exactly is the protection? This includes the midwife or obstetrician using their hands! There are several different forms of perineal protection by hand, but no particular hand grip stands out in the research as evidence of reducing the risk of tears.

However, research has shown that the risk of sphincter damage (tears involving the sphincter muscle) is reduced if the baby’s head and shoulders are delivered during two contractions. This means that the head slides out at the end of a contraction or during a pause in contractions, and that the shoulders are then brought forward during the next contraction. At this point, the staff must make an individual assessment of how soon the child needs to be born. The only protection that has high scientific evidence of counteracting tears is heat to the perineum.

Perineal protection also includes communication and choice of birthing position. Most birthing positions allow the midwife to get a good view of the perineum, except if the person is squatting. If it would be difficult for the midwife to keep an eye on the perineum, she should tell you and suggest a better birthing position in consultation with the person giving birth.

The midwife also inspects the colour, elasticity, any swelling and bleeding of the tissue. If there is a risk of tears, measures can be put in place, such as changing position, to relieve the tissues and optimise circulation in the perineum. In order for the tissues to stretch at the right pace, it is better if the head is allowed to slide back during breaks.

Of course, the person giving birth’s wishes are taken into account and will be both informed about the purpose of the perineal protection and involved in the recommendations that are given. Please note that most people get some form of tear after giving birth.