Warm Compresses for a Smoother Labor: Reducing Perineal Trauma

Understanding the various methods to make your experience smoother and more comfortable is important, while you prepare for labor. One such method, is the use of warm compresses during labor. A few studies have shown that this simple, yet effective technique can play a role in reducing perineal trauma, a common concern among expecting mothers. 

Understanding perineal trauma

Perineal trauma during childbirth involves injuries to the perineum, the area between the vaginal opening and anus during vaginal delivery. These injuries range from minor tears affecting only the skin (first-degree) to more severe forms that involve deeper tissues and muscles (second-degree) or even the muscles around the anus (third degree and fourth-degree tears). Commonly occurring in first-time childbirths, this trauma can be influenced by factors such as the baby's size and position, the length of labor, and certain birth interventions like forceps delivery. While perineal tears are a natural part of childbirth, understanding their nature and how to minimize their severity is crucial for a safer and more comfortable birthing experience. 

How could warm compresses help reduce perineal trauma?

Warm compresses may be used in the labor process, specifically in the management and reduction of perineal trauma. These compresses, typically made from clean, soft materials like washcloths, are soaked in warm water and gently applied to the perineal area during the second stage of labor - the phase where active pushing occurs. The warmth from the compresses helps increase blood flow to the perineal tissues, making them more supple and elastic. This increased suppleness aids in the natural stretching of the perineum as the baby descends, reducing the likelihood of severe tearing. Additionally, the soothing warmth of the compresses can provide a sense of comfort and relief during contractions, making the birthing process more bearable. 

Clinical evidence on the benefits 

There have been a few studies about the benefits of using a warm compress during labor.

The article titled "Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis" from 2019 is about a study that looked into whether using warm compresses (like a warm, damp cloth) on the perineum during childbirth helps reduce injuries in that area. The researchers looked at data from seven different studies involving over 2,000 women who were giving birth naturally. In these studies, some women had warm compresses applied to their perineum during the second stage of labor. Other women in the study did not receive this treatment. The results were quite positive for the warm compress group. These women were less likely to have tears in their perineum, and if they did have tears, they were usually less severe. Additionally, fewer women in this group needed an episiotomy, a surgical cut made at the opening of the vagina during childbirth. 

Another article from 2023, "The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis", looked into the benefits of using warm compresses on the perineum during childbirth. The authors included 14 articles into their meta-analysis. They found that warm compresses greatly reduce postpartum pain and the likelihood of severe perineal tears. Additionally, fewer women needed an episiotomy, a surgical cut made during childbirth, when warm compresses were used. However, they didn’t significantly change the length of labor or the baby's immediate health after birth. The authors concluded that applying warm compresses during labor can make the process less painful and reduce the risk of certain injuries for the mother.

 A study, Perineal techniques during the second stage of labour for reducing perineal trauma, published in the Cochrane Database for Systematic Reviews in 2011 investigated the effects of different perineal techniques during the second stage of labor, aiming to reduce perineal trauma, which is common in vaginal births and can be particularly severe in the case of third- and fourth-degree tears. A total of eight trials were included, involving 11,651 women who were randomly assigned to different perineal techniques. The use of warm compresses significantly reduced the risk of third- and fourth-degree tears. This was based on the results from two studies involving 1,525 women.

Requesting warm compresses for your birth experience

If the idea of using warm compresses during labor appeals to you, it's important to communicate this preference clearly. Include it in your birth plan, ensuring that your midwife or attending healthcare professional is aware of your wishes. Be sure to have a discussion with your healthcare professional before you enter the critical pushing phase of labor can be beneficial.  

Could warm compresses be combined with perineal massage during labor?

The article titled "Effect of Perineal Massage and Warm Compresses Technique in Postpartum Pelvic Floor Dysfunction" discusses a study focused on two methods used during childbirth: perineal massage and warm compress application. The study aimed to see if these techniques could help reduce problems with the pelvic floor after giving birth. The study involved nearly 500 women who were divided into two groups. One group received perineal massage and warm compresses during childbirth, while the other group did not. The researchers then checked on these women after giving birth to see how their pelvic floor was doing, particularly looking at urinary symptoms which are a common sign of pelvic floor problems.

Here's what they found:

• The group that received the massage and warm compresses had better outcomes. They experienced fewer severe tears during childbirth and had a higher rate of completely intact perineum.
• Three months after giving birth, the women in this group reported fewer urinary problems compared to the other group.
• However, by six months postpartum, both groups had similar levels of urinary distress, suggesting recovery over time.

In simple terms, the study suggests that using perineal massage during labor and warm compresses during childbirth might help reduce immediate post-birth pelvic floor issues, especially urinary problems. This could make the postpartum recovery period more comfortable for new mothers. Your healthcare provider could do the massage with any perineal massage oil such as sweet almond oil. 

How to apply warm compresses during labor

The application of warm compresses during labor is a straightforward yet crucial process. Your healthcare provider will be the one doing this for you!

Here's how to apply them effectively:

1. Preparation of Compresses: Begin by selecting a clean, soft cloth such as a washcloth or a specialized perineal pad. It’s important that the material is gentle on the skin to avoid any irritation.

2. Warming the Compress: The cloth or pad is soaked in warm water. The temperature should be comfortably warm but not too hot to the touch. This is to ensure safety and avoid burns.

3. Timing of application: The best time to start applying the warm compress is during the second stage of labor, during active pushing. It's particularly beneficial when the baby's head starts to distend the perineum or when there's noticeable fetal descent.

4. Applying to the perineum: The warm, moist cloth is then placed against the perineum when the baby's head is stretching it. The compress should cover the area between the vaginal opening and the anus.

5. Reapplication: As the compress cools, it should be placed in the same bowl of water for reheating or replaced with another warm compress. This ensures consistent warmth throughout the process. If the pad becomes soiled, replace it with a new one. 

Talk to your provider if warm compresses are right for you 

As you prepare for one of life's most extraordinary events, consider discussing the use of warm compresses with your healthcare provider. Remember, every labor experience is unique, and what works best for you will be a personal choice made in consultation with your healthcare team. Stay informed, listen to your body, and look forward to the beautiful journey ahead. You are a short journey from labor and starting your postpartum care. Embrace yourself!