Rates of tearing and episiotomies are much higher in hospitals than they are at homebirth where the woman's body is left to do it's thing. Private hospitals are also worse for this than public. Being flat on your back on bed is not helpful to this yet this is what most women do for some or all of their labour, which is certain if you have an epidural. Not only does the chance increase from this, but once you have the epidural which can then lead to ineffective pushing (can't feel it properly if at all) then forceps may be used which often means an episiotomy.
Hospitals are there to control and manage the process of childbirth which doesn't run in our favour as birthing women. They have policies to protect themselves, speed things up and this often means these interventions. So you have to inform yourself about what you don't want, your rights etc.
Giving birth in water is brilliant for supporting the perineum as is birthing upright. Warm compresses can be used, and Ina May Gaskin has a manuvure she successfully uses which is discussed in one of her books.
Also when in fear, or anxious, some women don't relax their pelvic floor/perineum and the pushing fights against this - so educate yourself outside the hospital (New Active Birth by Janet Balaskas or The Thinking Woman's Guide to a Better Birth), get great support and trust your body!!! It is capable of blowing those stats out the water.
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