I'm Michelle Collins, Certified Nurse-Midwife and Professor of Nursing at Vanderbilt University School of Nursing. We're talking about perineal tears that may occur during childbirth. Some ways that you can help to prevent the tissue of your perineum from tearing; first off, starts way back early in the pregnancy and that's with good nutrition. Tissue that is expose to really good diet during the pregnancy has better elasticity and so that definitely helps at the end in helping prevent some tearing. Also, perineal massage beginning at about thirty six weeks of pregnancy is very helpful to stretching that tissue in preparation for the time when the baby comes through and stretches it. So that, it can help prevent tearing. At the time that a woman is pushing, putting some warm compresses on her perineal area also helps to decrease tearing there and the position that she chooses, chooses to push in and to give birth in also makes a difference as far as the amount of tearing that may occur. Delivering on a, on your side is very helpful in preventing tearing; whereas, on your back in, with especially with legs and stirrups can actually cause more tearing. And you will want to talk to your midwife or physician about episiotomy which is a, a surgical incision or cut made in the lower opening of the vagina to enlarge it prior to birth and there is very good research to show that episiotomies may precipitate more extensive tearing of the perineum. And so, talking with your provider about just when that would be indicated is an important thing, discussion to have. Some providers in the past have done perineal massage at the time that the woman is pushing and giving birth. But, the latest research that we have on that says that, that actually may increase tearing because there is swelling of the tissue there as the baby's head is presenting and massaging that area can just further irritate it and cause more tearing. Also, many people choose to use oils on the perineum in the hopes of helping prevent tearing and some of the more recent data on that shows that while it may not be so helpful in preventing tearing, it may just feel comfortable to the woman. But, it may not actually prevent any tearing.