I am wondering this, there seems less perineal trauma at home births, where women adopt more facilitive positions, but also are allowed to work better with their bodies and push their baby out physiologically.

Or is it multips? comfortable in the knowledge they can do this, know their midwife, educated enough to know home birth is the ideal?

Is it just genetics and tissue viability? pot luck?

What is it and why?

Women 'escaping' after birth with no or little perineal damge seem to be rare, why?

Apologies if this is a dumb question, it is something I am thinking about alot.

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I think it has a lot to do with many things. Strong kegal muscles to help the woman control her pushing efforts. Allowing the woman to push as her body says it needs to. Allow mom to move around and change positions.

I have had directed pushing with all three of my babies and have never needed a stitch. I do my kegals religiously, though and feel that this is what helped me. However, allowing a woman to push on her own could give the tissue more time to stretch as baby descends. Once they hit that ring of fire, most moms I've seen usually stop for a minute, it's such a shock! That gives the skin some more time to stretch. Of course, there are those babies that just rocket out. So I don't really have a perfect answer for you!

I've seen primips do beautiful with barely a skid and multips tear from one end to the other (okay, that's dramatic, but bad tears). Counselling moms on doing their kegals, excellent nutrition and lots of visualization I think will give them the best chances.

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

What are kegals?

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the kegal muscles are the muscles of the perineal floor. Kegal exercises are where you tighten and relax the muscles. Every woman should do it. Great for a lot of things, like preventing incontinence, helps you reach the big "O" during intimacy, and is very integral during childbirth and recovery. If you want me to find something that explains how to do the exercise, let me know and I'll find a website. I do them all the time, heehee.

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

So what we call Pelvic Floor exercises?

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That's what it is!

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

Thank you

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We just call em pelvic floor exercises, also bit of random research off the top of my head knowledge, we got taught off a woman who runs a perineal repair/physio etc unit, and her research has shown that women who suffer constipation are more likely to tear as perineum has been so stretched that its got thin and also due to a bizarre trend in girls thinking "I don't want to get pregnant and thus allowing/having anal sex is alot more common and they tear aswell-how random is that for a drunken saturday night? God I know some weird stuff lol.
Also loadsa research on antenatal pelvic floor/kegal exercises and perineal massage is proven to prevent tears, there is lots on it, I did an essay on it and found it really interesting.

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Are women who have torn (?!) more likely to tear again next time round?

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They reckon so, it often depends on their circumstances, smoker drinker, unhealthy diet, or just a really bad repair of tear/unnoticed tearing that wasn't repaired are all more likely and those that don't do pelvic floor but I've seen previous 3rd degree women, deliver a bigger baby with an intact perineum, but with non-directive, and sort of semi-directed pushing so who knows, but the others are all higher risk factors x

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Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)