Vaginal Tearing: Why It Happens and How to Reduce Risk
Published Date:December 3, 2025
By Ali Weatherford
I’ve done an article addressing how to help with pain and discomfort in your lower region after a vaginal birth. But you might also want to know how this happens and whether there is anything you can do to prevent it.
How a Baby is Born
For most of labor, your body is not actually trying to push your baby out, and neither are you. Most of your labor contractions are focused on getting your cervix open. That’s the lower segment of the uterus that gets stretchy and soft so it can open to let the baby out. The uterus sort of looks like a head and neck. The neck is the cervix. The very muscular round part of the uterus flexes over and over during labor, causing the cervix to change. Once the cervix is fully open, your body can shift into pushing mode. You might get involved in this too! You’ll probably start to put effort into pushing your baby out by using some muscle energy, just like you might while having a bowel movement. This is when the baby’s head starts to move out and you become at risk for tearing.
What is Tearing?
Depending on a lot of factors, including the baby’s size and position, your position, your pushing abilities, your muscle strength, your tissues might just stretch enough to let the baby move through, or there might just be a little too much pressure or less than ideal conditions, and your tissues tear. You might tear a little or a lot. The tear might be deeper or more shallow. You might tear up, down, or sideways.
Most People Tear Down
In most cases, the tearing goes in the direction of the anus, on an area called the perineum. That includes all the tissue in between the vaginal opening and the anal opening. In a lot of cases, the tear is very superficial and only affects the thin skin right around the vaginal opening. Sometimes it goes deeper or further down toward the anus. When it goes farther, stitches are usually recommended to aid in healing. In the most severe cases (which are very rare), repairs might even be done in the operating room to ensure a very good result.
Some People Tear Up
In some cases, more rarely, tears can occur in an upward direction toward the labia and even the clitoris, either straight up or off to the side. It can be more complicated to have a severe upward tear because it could involve the urethra and affect your ability to urinate. Sometimes if it looks like an upward tear is beginning, a provider might apply some downward stretching manually or even offer an episiotomy, which is a managed cut of the perineum. The idea would be to create some opening downward so the pressure is reduced for the upper tissues.
Grades of Tearing
A tear can be categorized on a scale of 1-4 depending on how deep and how far the tearing goes.
Grade 1: This is the least severe. It is a tear affecting only the thin skin right around the vaginal opening. It’s very superficial and likely does not require stitches. These heal quickly and probably won’t cause too much discomfort.
Grade 2: These tears are a little deeper and go a little further toward the anus. A grade 2 tear will likely need stitches but usually heal quickly and the discomfort should be manageable without much intervention.
Grade 3: This tear moves into the muscle tissue around the anus and definitely needs stitching. Sometimes these are repaired in the operating room. The more severe tears tend to be harder to recover from in part because of where they are. When the area around the anus is affected, you might have trouble getting comfortable while sitting and bowel movements can be a lot more difficult.
Grade 4: This is the most severe tear, going all the way from the vaginal opening through to the anus. It’s very important that these be repaired very carefully, most often in the operating room, to ensure there is no cross contamination between the anus and vagina.
Fortunately, severe tears are relatively rare. Grade 3 tears may account for 6-8% of perineal tears, and Grade 4 tears only about 2-3%.
Can You Prevent Tearing?
There has been a lot of research looking at possibilities for reducing a person’s risk for tearing. First, it’s important to remember that there are no guarantees. There is nothing you can do to guarantee that you won’t tear at all. The good news is that there are some strategies that have been shown to reduce the risk of tearing at all or at least lower the risk of more severe tears.
Pushing Positions
Evidence shows that the position of putting a person on their back with feet and knees pulled back or in stirrups is associated with higher rates of severe tearing. This is called the lithotomy position. There are also other associated risks with this position including increased incidence of abnormal fetal heart rates, longer pushing stage, increased risk for instrumental deliveries using vacuum or forceps, and others.
More upright positions are shown to be better. Some examples include:
- Reclining
- Sitting up
- Side-lying
- Kneeling
- Lunging
- Standing
And even better than that is being able to choose the best position for you. When you can choose the position that allows you to have the most control and comfort, you’ll be less likely to tear.
Warm Compresses
Allowing someone on your care team to apply a warm compress to your perineum can reduce your risk for tearing. The warmth can help soften and relax the skin and muscles, helping things to stay flexible and stretchy. It can also feel very soothing. When you are more comfortable and relaxed, you are less likely to tense the muscles that should be loosening to allow your baby to come out freely.
Open-Glottis Pushing
Most people imagine pushing the way we see in the movies. There’s a big inhale, then you hold your breath and bear down while people in the room count or chant “push, push, push!” This is one way to do it and can be a very strong and effective way to push with some benefits. It just might not be necessary in every situation and is also more likely to allow tearing to happen. Instead, you can take a deep breath in, but then push while you let some air out. You can blow through pursed lips, let it out in a long sigh, growl, or even roar. Be sure to really push all the air out. This allows your pushing muscles to engage gently but strongly.
Slow and Gradual Pushing
Babies don’t usually come out all at once. A lot of times there is “crowning” where you can see the top of the baby’s head and then it goes back in when the push ends. That’s ok and might even be a good thing for your perineum. It comes back and shows a little more of the head with the next push and on that way. This can be helpful for gradual stretching. The baby’s head can come all the way out, and then there might be some more pushes before the rest of the body is born. This is normal and probably a good thing for preventing tearing. Sometimes people are even encouraged to slow the pushing down or push more gently by taking small panting breaths or by taking breaks in between contractions.
Perineal Massage
This is sometimes recommended to prepare for pushing. Perineal massage can be done with a partner or by yourself. A partner would insert the ends of two lubricated fingers into the vagina while you recline comfortably. They should apply pressure on the perineum toward the anus and begin to sweep the fingers from side to side while applying some downward pressure. If you’re doing this yourself, you would use a lubricated thumb to do the same thing. This will be uncomfortable. Your goal is to recognize the sensation and work to relax while it’s happening. When you can practice that, it should get easier to stay relaxed. When you’re in labor and pushing, you can recognize the intense stretching sensation, not panic, and be able to relax and allow your baby to be born. When people feel the stretching and tension, and contract their pelvic floor muscles in response, it can increase the risk for tearing. So perineal massage done prenatally as a way to help prepare for the sensations of pushing might be helpful, but there isn’t great evidence that it’s a helpful thing to do during pushing.
A “Hands Off” Approach
There have been some studies looking at the effects of hands off approaches. This essentially means that the laboring person leads the way. They’ve been managing their labor and then they decide when and how to push. They are not coached or encouraged into any particular position. No one touches the perineum as the baby is moving out. When this can be achieved, there is some evidence that tearing rates can be reduced. This would be helpful in the case of an unmedicated birth where a person can feel everything that is happening and respond accordingly.
What If These Things Don’t Happen?
All is not lost. These measures are shown in research to potentially lower risks, but can not guarantee perfect outcomes. We all want an intact perineum after giving birth. It does happen. It does happen often! And there truly are some things you can do to improve the chances it happens that way for you. It’s also true that everyone can do everything exactly WRONG and still end up with no tearing. And also know that if you have a common tear the first time, you are not more likely to tear again. In fact, people giving birth for the second time are even less likely to tear although that may be different in the case of severe tears. There is mixed evidence there. Even if you can’t guarantee the outcome you want, it is empowering to understand your risks and how to reduce them.
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