Risk Factors & Prevention
Risk Factors for a 3rd or 4th degree tear sourced through The Queensland Clinical Guide
- Having their first baby or first vaginal birth
- Who are of Asian ethnicity
- Giving birth to a baby greater than 4 kg
- Who have their birth assisted with forceps or a vacuum
- Who have a midline episiotomy
- Where the baby's shoulders become stuck during birth
Some 3rd or 4th degree tears can potentially be prevented by:
- Applying a warm compress to the perineum as your baby's head begins to crown. This aids in the natural stretching of the perineal muscles.
- Encouraging movement and various birthing positions that allow you to have more control during the second stage of labor (e.g., hands and knees position, squatting).
- Assisting you in achieving a slow and controlled birth through breathing techniques, avoiding directed pushing.
- Providing gentle support to the perineum with hands during the delivery of your baby's head.
- Speaking to your healthcare provider about your birth plan and its risks, benefits, and alternatives. Having your primary support person advocate for your health during delivery (this may mean asking for a C-section if possible when instrumented delivery is suggested).
- Ask your provider for a referral to PFPT or PFOT to optimize your pelvic floor for labor and start doing kegels.
- Perineal massages during the third trimester of pregnancy have also been associated with decreased risk of perineal tearing. See our guide in the next section.
Interested in learning more about the risks for vaginal delivery and c-section deliveries?
See the Royal College of Obstetricians & Gynaecologists consent advice.