Best Birthing Positions to Prevent Tearing
Authored by Bodyful Physical Therapy and Wellness
Are You Afraid of Perineal Tearing During Vaginal Delivery?
Are you looking for prenatal pelvic floor physical therapy to help you feel more prepared for childbirth?
Do you want an evidence-based approach to birthing positions that may reduce your risk of perineal tearing?
You are in the right place. In this blog, you’ll learn research-supported strategies for preparing for childbirth, written from the perspective of a licensed pelvic floor physical therapist who works with birthing bodies every day.
Best Birth Positions to Help Reduce Perineal Tearing
There are many factors that can influence perineal tearing during vaginal delivery. Some are outside of our control—such as baby size, baby position, and the speed of birth.
However, birthing position is one factor we can often influence, and it matters more than many people realize.
The classic image we see in movies—lying flat on the back with legs in stirrups—is actually one of the least favorable positions for protecting the perineum.
Current evidence and clinical experience support alternative positions that allow for better pelvic floor mobility, reduced tissue strain, and improved nervous system support.
Side-Lying Birth Position
Side-lying is the birthing position least associated with perineal tearing.
This may be due to:
Reduced downward pressure on the perineum
Greater overall body support
Lower levels of involuntary muscle tension
Because pelvic floor relaxation is closely tied to nervous system state, supported positions like side-lying can be particularly protective.
Hands and Knees (All Fours)
Hands-and-knees is another excellent option for preparing for childbirth and protecting the pelvic floor.
Benefits include:
Four points of contact for stability
Increased ability to adjust hip rotation as the baby descends
Improved pelvic outlet adaptability
This position allows your body to respond more dynamically to what the baby needs during labor.
Deep Squatting
Deep squats can help lengthen and open the pelvic floor, particularly earlier in the pushing phase.
Because squats bias external hip rotation, they may be most helpful as the baby moves through the pelvic inlet rather than during final descent. A pelvic floor PT can help you determine when and how to use this position safely.
How to Avoid Tearing When Giving Birth: Pelvic Floor Relaxation
Beyond position, pelvic floor relaxation is one of the most important protective factors against tearing—and this is where prenatal pelvic floor physical therapy plays a critical role.
Perineal massage is often discussed, and it can be helpful. However, massage alone is rarely enough.
Muscles respond instantly to the nervous system. You could stretch your pelvic floor daily, but if your nervous system shifts into a stress response during labor—holding breath, clenching, bracing—the risk of tearing increases.
Nervous-System-Informed Pelvic Floor Delivery Prep
At Bodyful, we teach nervous-system-informed pelvic floor relaxation, not just tissue stretching.
This includes:
Guided diaphragmatic breathing under stretch and pressure
Learning how to stay resourced during intense sensation
Practicing pelvic floor yielding rather than gripping
This preparation closely mirrors what happens during birth and helps your body respond with coordination instead of tension.
Learning How to Push Without Tensing the Pelvic Floor
Many birthing people unknowingly contract their pelvic floor when asked to push.
From a pelvic health perspective, the pelvic floor’s role during birth is to:
Yield
Soften
Create space
Prenatal pelvic floor physical therapy helps you:
Differentiate between pushing and clenching
Coordinate breath with pelvic floor movement
Practice effective, protective pushing strategies
We can also collaborate with your doula, midwife, or medical provider so everyone is on the same page during labor.
When Positioning Isn’t Enough—and That’s Okay
It’s important to name this clearly: even with preparation, tearing can still happen.
Baby size, baby position, and delivery speed are not always modifiable. Experiencing a tear does not mean you failed or did something wrong.
Preparing for childbirth is about offering your body the best possible conditions—while holding compassion for how birth unfolds.
How Prenatal Pelvic Floor Physical Therapy Can Help You Prepare for Childbirth
Prenatal PT and prenatal pelvic floor physical therapy, may include:
Birth-specific pelvic floor relaxation training
Personalized education on birthing positions
Real-time feedback for pushing and bulging coordination
Perineal massage instruction (partner-inclusive if desired)
Scar tissue care for previous births or trauma
Preparation for postpartum recovery
Even if you’ve given birth before, reconnecting with your pelvic floor in a safe, resourced, and informed environment can make a meaningful difference.
Postpartum Support Is Part of Birth Prep Too
Our work doesn’t stop at delivery. We also support:
Healing perineal tears or C-section scars
Early diastasis recti care
Pelvic organ prolapse support
Return to exercise (lifting, running, Pilates, yoga, dance)
Preparing for childbirth includes planning for recovery—and prenatal PT helps set that foundation.
Work With a Prenatal Pelvic Floor Physical Therapist in Oakland, CA
If you want support preparing for childbirth and reducing your risk of perineal tearing, we’d love to work with you.
Even in the third trimester, it is never too late to begin prenatal pelvic floor physical therapy.
We offer:
In-person prenatal PT in Oakland, CA
Telehealth prenatal PT for California residents
Free discovery calls to explore your options
Your body is resilient. Preparation is empowering.
We’re here to support you every step of the way.
