I used the epi-no birth trainer which you can use in the last 3 weeks of pregnancy to help make the perineum more flexible. I don't think it's that well known in this country (it comes from Germany) - it's basically a balloon device that you can use to stretch the muscles and build up flexibility, and you can also use it for pelvic floor training afterwards. I bought it because a family friend used it and felt it had helped her, and I didn't have any stitches and had only minimal blood loss despite DD having her hand up by her face during delivery. Obviously my experience is just anecdotal and maybe I wouldn't have torn anyway. But I definitely think the epi-no helped me psychologically, because it made me confident about the sort of sensation I'd experience and made me feel that I could cope with it, which I think helped me relax into the stretching when it came and generally made me feel much less scared about labour. It's expensive, but given how things worked out, I'm glad I bought it.