Perineal Tears: What They Are, The Different Degrees, How to Reduce Risk, and Why Tearing Does Not Mean You “Did It Wrong”

Written By Caryn Phillips

Lately, we’ve been hearing more shame around tearing during childbirth. If you’re pregnant or recently postpartum and carrying any of that — let’s pause right there.

Perineal tearing during vaginal birth is common. It does not mean you failed. It does not mean your body didn’t work. And it absolutely does not mean you didn’t give birth “well enough.”

Here’s your clear, evidence-based guide to what perineal tears actually are, the different degrees, how to reduce your risk, and how pelvic floor physical therapy can help you heal well.

What Is a Perineal Tear?

The perineum is the area between the vaginal opening and the anus. During vaginal birth, this tissue stretches to allow your baby to pass through.

Sometimes, that tissue stretches and returns.
Sometimes, it stretches and tears.

A perineal tear is simply a spontaneous tear in this tissue during childbirth.

According to the American College of Obstetricians and Gynecologists (ACOG), the majority of vaginal births involve some degree of tearing or require stitches.
(Source: ACOG Practice Bulletin on Obstetric Lacerations)

That statistic alone should help normalize this.

The 4 Degrees of Perineal Tears

Tears are classified by how much tissue is involved:

First-Degree Tear

  • Involves only the skin

  • Often small

  • May or may not require stitches

  • Typically heals well with minimal long-term symptoms

Second-Degree Tear (Most Common)

  • Involves skin and perineal muscles

  • Usually requires stitches

  • Heals well with proper support

  • Pelvic floor PT can be very helpful for recovery

Third-Degree Tear

  • Extends into the anal sphincter muscle

  • Requires repair

  • May increase risk of bowel symptoms if not rehabilitated properly

  • Strongly recommended: postpartum pelvic floor physical therapy

Fourth-Degree Tear

  • Extends through the anal sphincter and into the rectal lining

  • Requires surgical repair

  • Requires structured follow-up and pelvic floor rehab

It’s important to know: the majority of tears are first- or second-degree. Severe tears (third and fourth degree) are far less common.

What Increases the Risk of Tearing?

There are several known risk factors, including:

  • First vaginal birth

  • Assisted delivery (forceps or vacuum)

  • Baby in occiput posterior (“sunny side up”) position

  • Larger baby

  • Prolonged pushing

  • Rapid delivery

  • Midline episiotomy

However (and this is important) tearing can still happen even when none of these are present. Birth is dynamic. Tissue response varies. And sometimes, it simply happens.

Can You Prevent Perineal Tearing?

There is no guaranteed way to prevent tearing. But there are ways to potentially reduce severity and support tissue resilience:

1. Perineal Massage (Starting Around 34–36 Weeks)

Research suggests prenatal perineal massage may reduce the likelihood of more severe tearing, particularly in first-time births.

ACOG and other professional bodies support its use.

You can learn how to do it safely with guidance from your provider or pelvic floor PT.

2. Pelvic Floor Physical Therapy During Pregnancy

Working with a pelvic floor PT during pregnancy can help you:

  • Improve pelvic floor coordination

  • Learn how to relax during pushing

  • Optimize pushing mechanics

  • Improve tissue mobility

  • Address scar tissue from prior births

We often tell patients: It’s not just about strengthening. It’s about learning how to lengthen and yield.

If you’re local to the South Shore or Metrowest Boston, you can learn more about our prenatal pelvic floor support here: What We Treat

3. Controlled Pushing and Positioning

Evidence suggests:

  • Side-lying positions

  • Hands-and-knees

  • Warm compresses on the perineum

  • Slow, controlled crowning

…may reduce the risk of severe tearing.

Your provider and birth team play an important role here.

Let’s Talk About the Stigma

Somewhere along the way, tearing became associated with:

  • “My body failed.”

  • “I didn’t push correctly.”

  • “If I had prepared better, this wouldn’t have happened.”

  • “Other women didn’t tear — why did I?”

Let’s gently challenge that narrative.

Birth is not a performance. It is not graded. There is no gold medal for an intact perineum.

Tearing does not mean:

  • You were weak.

  • You didn’t prepare enough.

  • You pushed wrong.

  • Your body is broken.

It means your body stretched to bring your baby into the world. Sometimes tissue yields perfectly. Sometimes it needs stitches. Neither defines the quality of your birth.

Healing After a Perineal Tear

Most tears heal well. But “healed” does not always mean:

  • Comfortable intercourse

  • No pelvic pain

  • No leaking

  • No scar tightness

If you experience:

  • Pain with sitting

  • Pain with intimacy

  • Pulling or tightness at your scar

  • Bowel symptoms

  • Urinary leakage

  • Heaviness or pressure

…you deserve support.

Pelvic floor physical therapy can help with:

  • Scar mobilization

  • Tissue desensitization

  • Muscle retraining

  • Strength and coordination

  • Nervous system regulation

  • Whole-body recovery

The World Health Organization recommends postpartum pelvic floor rehabilitation as part of routine recovery.
(Source: WHO Postnatal Care Guidelines)

You can learn more about postpartum pelvic floor therapy here: What We Treat

A Final Word

Your worth as a mother is not measured by:

  • Whether you tore

  • The degree of tear

  • Whether you needed stitches

  • Whether you had an episiotomy

  • How long you pushed

You gave birth.
Your body did something extraordinary. And if you did tear, your body deserves thoughtful, respectful, skilled support in healing — not shame.

If you’re pregnant and want to feel prepared, or postpartum and not feeling quite like yourself, we’re here.

Have questions? Reach out anytime. We’d love to support you.

Caryn Phillips
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