I believe that birthing with a midwife led to less tearing of my perineum, basically because it's a natural experience. The weight of the baby and the size of the baby will probably determines how much tearing will naturally occur. Sometimes in a hospital birth, the physician may decide to cut your perineum to let the baby out sooner, faster. But I don't think it's really necessary. The midwife I used never had to cut me. Any tearing that I did experience was very minimal and she sutured me up, a few sutures and we were done with it; there were no problems after that. It's pretty natural. Your body will give way for the baby's head and body pretty naturally.