Practice 10-20 kegels a day until delivery. Concentrate on releasing the muscles as well as tightening them. Women who have a scar from a previous episiotomy or tear often worry that they will tear again along the same line. Because scar tissue is less pliable than regular skin, some midwives recommend rubbing hypericum ointment into the area prenatally to prevent re-tearing. Perineal massage, in which the perineum is massaged with or without oil in the weeks preceding childbirth gets mixed results in medical studies.
Many studies show that massage protects against perineal trauma in first-time mothers.
Other studies contradict this finding, and show no benefits to perineal massage in any mothers. A homebirth study actually associates perineal massage with higher rates of damage. The position you assume when giving birth may be the most important factor in avoiding perineal damage. Side-lying is better than on the back, if necessary. Knees should be pointing forward, not to the sides.