Ren, I didn't need to ask, my midwife just did it. I was in a standing position, leaning on the raised bed, and the midwife was behind me on a stool, I think. She was using her fingers to massage the perineum during each push. I didn't tear at all though I did get three minor labial grazes which I hadn't considered as a possibility. Don't know how they would prevent those. Most of the burning pain was actually in front, not in the perineum.