I haven't ever used the product as I believe it will stretch as much as it needs. One thing that I have personally found to make a huge difference is how the perenium is managed as the head is being born - with my last birth, my baby's head was a lot larger than the previous three were and I only got a very small graze that didn't need stitches - the previous three times I had an episiotomy and 2 2nd degree tears that all required stitches. They were all birthed the same way with me breathing them out once they crowned.