In this chapter, we will examine the risk factors and strategies that can be used to reduce severe perineal lacerations during childbirth. These injuries pose significant morbidity to mothers as well as to their ability to care for their infants. We will review the various risk factors and evidence from the literature. A multidisciplinary approach to the strategies that may reduce severe perineal lacerations will be examined. Outcomes because of using this program over 2 years at multiple obstetrical hospitals will be described.