What can the midwife do to prevent tearing?

How the midwife works to prevent tearing:

• Warm towels: There is strong evidence showing that pressing warm, wet towels against the perineum during the actual delivery phase does reduce the risk of tearing. In addition, the warmth is generally perceived as something comforting by the one giving birth.
• Slow delivery: It is important to push out the baby’s head and body gently and slowly and to allow the tissue time to stretch. As the head becomes visible, it is common to experience a burning, sharp pain. The pain usually eases in between contractions. As the head comes out, it’s often best not to push actively and instead just breathe and allow the child to slide out. The midwife communicates with the woman and can assist with guidance at this stage. The midwife may place one hand on the baby’s head to slow down the process if it is too fast.

• Perineal support: The midwife holds one hand against the perineum to support the tissue. The other hand is kept on the baby’s head to control the pace. The evidence for perineal support is not clear, but it’s always recommended to apply the support during childbirth.
• Choosing delivery position: The delivery position should allow the midwife to reach and provide perineal support and to have a clear view of the perineal area. Standing on hands-and-knees or lying on the side can reduce the pressure on the perineum, and those positions may also slow down the delivery process.