Let's talk perineal prep and care! Many women wonder if they will tear during a vaginal birth and if they can do anything to prevent it. 

WHY DO TEARS HAPPEN?
Contrary to popular belief, a baby with a larger head isn't always the cause of tears. They typically happen when the perineum doesn't have enough time to gradually stretch due to a baby who's emerging very quickly or if the skin doesn't easily stretch even with a slowly emerging head. During the pushing stage, you might have a provider tell you to slow down your urge to push if they believe the skin hasn't fully stretched. This is easier said than done, but some controlled breathing, small grunts, or laying on your side can help slow down the process.

Tears may also occur if baby is malpositioned. Getting in certain positions can encourage baby to turn into an ideal position to prevent a tear. Laboring upright for too long can also apply too much pressure on your perineum. I suggest you switch positions every 30 minutes. Pushing with an Epidural means you may end up with directed pushing, where the nurse tells you when and how long to push. Directed pushing could sometimes be ineffective and exhausting because you can't properly feel the urge to push or recognize the muscles required to push. I recommend you turn down/off the Epidural at 8-9 cm. so that you can feel your pushing urges and listen to your body. It'll know how and when to push.
Lastly, you're more likely to tear for your first vaginal delivery than subsequent ones.

CAN TEARS BE PREVENTED?
While no one can predict if you'll tear, you can definitely help yourself during labor by forgoing numbing meds such as an epidural or getting a low dose of them. If you are unable to feel your urge to push, the staff will likely direct you to push before your body is ready, before your perineum is ready. This unnecessary pressure against your perineum can increase your chances of tearing.

During labor, a warm compress to the area can help relax the muscles, provide counterpressure, and help you focus on where your pushing muscles are.

Studies have also shown that laboring with a midwife or at a birth center/home setting reduces your chances of tearing. Midwives are known to do fewer interventions, which can lead to tearing. Laboring in a comfortable environment such as your home leads to better outcomes due to your relaxed nature.

When choosing a provider, remember that YOU are the customer and you have choices. If you're not vibing with your provider, move on and find someone who will support you.

Be honest with your doctor and tell them there are a few important questions you'd like to ask. If they don't even take the time to hear you out then that's your sign to find someone else. It's best to know early on if they're a good match for your labor experience. Keep in mind that there is no labor police and you have total autonomy over your body and baby's. Provider preference/recommendation is not law and you have the right to choose what feels right to you, even if it's outside of the norm.

If you truly have no say about which provider you get and you're not quite comfortable with them, consider switching to a midwife, a home birth, laboring as long as possible at home, or having a rockstar support partner with you at the hospital.

QUESTIONS TO CONSIDER WHEN CHOOSING A PROVIDER:

-Do you support unmedicated births and what are your views on them?
-How do you support medicated births and what are your views on them?
-Do you support breech births, how?
-Who are your backups and will I meet them?
-How do you feel about doulas?
-How do you feel about birth plans?
-What are your induction and C-section rates?
-Do you support a VBAC and how do you ensure it'll be as successful as possible?
-How do you view pain during labor?
-What is your plan if I go past my due date?
-How many hours will you allow me to labor after my water breaks?
-How long will you allow the umbilical cord to remain attached?
-Will you administer Pitocin to deliver the placenta?

Remember that if you choose an OB you will likely only labor with them for a short while, as they tend to cover multiple births at a time. Still, knowing ahead of time how they can support you during the expected and unexpected can help you decide who better aligns with your wishes. 
For an even better experience, choose your hospital wisely and get support from a doula, or make sure you and your birth partner are well-educated and able to make decisions during complex situations.