New Device Aims to Reduce Perineal Tears
A midwife-developed clinical innovation called PeriPear has launched with the goal of reducing the incidence and severity of perineal tears during childbirth. The device is presented as a practical, scalable solution to a complication affecting up to 90% of women who have vaginal births.
- The device builds on existing clinical evidence that applying a warm compress during the second stage of labor can reduce the risk of third and fourth-degree perineal tears. Despite this evidence, the technique is currently used in less than 15% of births due to practical challenges. - Perineal tears are classified into four degrees of severity, from superficial injuries (first-degree) to those extending through the anal sphincter and into the rectal mucosa (fourth-degree). Severe lacerations, known as obstetric anal sphincter injuries (OASIS), occur in approximately 4% to 11% of vaginal deliveries in the United States. - PeriPear was co-founded by midwife Nina van Schaick, who developed the wearable device to provide consistent warmth and support after witnessing the impact of preventable birth injuries for over a decade. - Other evidence-based practices to reduce tearing include perineal massage in the weeks leading up to birth, controlled pushing techniques during the second stage of labor, and hands-on support from the midwife (the "Finnish technique"). - This innovation enters the field amidst a significant workforce shortage, with a global deficit of nearly one million midwives. In the Americas, the current workforce only meets about 15% of the need for midwifery care. - The U.S. Bureau of Labor Statistics projects a 12% growth for nurse-midwife jobs between 2022 and 2032, a rate faster than the average for all occupations. - In Virginia, new legislation (HB 1923) taking effect July 1, 2025, aims to improve the sustainability of midwifery practices by mandating equal insurance reimbursement rates for all licensed midwives providing the same services. - This issue is particularly relevant in Virginia, where about 36% of counties are classified as "maternity care deserts," lacking hospitals with obstetric care, birth centers, or a sufficient number of OB/GYNs and certified nurse-midwives.
