Warm perineal compress in labour - protecting your perineum

August 25

  • Birth

Warm perineal compress in labour - protecting your perineum

Using a warm compress on your perineum during the birth of your baby can help to reduce tearing.

5 min read By Karen McEwen, Registered Midwife

Did you know that using a warm compress on your perineum during the birth of your baby can help to reduce tearing? If you didn’t you won’t be alone, as although this is supported by robust research, it is not talked about much or offered very frequently as an option during birth. 

A number of research studies on using warm perineal compresses during the birth have been undertaken in recent years. When the results from these different studies are combined to give a more rounded conclusion it was found that not only did women have a better chance of having an intact perineum after the birth (no tearing) but, also, that they were significantly less likely to have a more severe tear (known as a 3rd or 4th degree tear) and less likely to need an episiotomy (a cut made to the perineum to widen the vaginal opening). 

So, you may be wondering…..why isn’t this option offered to birthing women in the UK? The reason for this is that when research comes out, it can take many years to filter into practice in the NHS and other institutions. We think this research is something that all women should be aware of so they are able to opt for it during their own births, should they choose to.

When discussing tearing in childbirth, many women like to know how to help reduce the likelihood of it happening during their births. Now you know that the research supports the use of warm compresses on the perineum to help reduce the likelihood and/or extent of tearing during birth, this blog will discuss how does a warm compress work, how would this be done and the best time to use the warm compress, and how to request this for your birth, if you choose to.

How does a warm compress work to reduce tearing?

We know that warmth can help blood vessels dilate and increase blood flow to areas of the body to improve tissue flexibility and stretch. Warmth via moisture/water is also hydrating, and women who labour and birth in water are known to have a reduced incidence of tearing, too. Applying a warm compress to the area which is stretching during the birth helps the tissues of the perineum warm up and improves their stretchiness during the birth.

How would this be done during my birth?

The beauty of the warm compress for the perineum is that it can always be provided if you request it. All midwives have easy access to swabs, which can be made into a compress, and bowls in the delivery pack which is used in hospital and home settings. The water should be made up of 300mls of boiling water and 300mls of cold tap water for optimum effectiveness. If you prefer, you can bring in your own cloth, such as a flannel or muslin cloth for your midwife or yourself to use - anything which is absorbent and large enough to be folded into a pad for this purpose. We have provided a guide for you and your midwife to help at the end of this blog.

When is the best time to use the warm compress?

The best time to use the warm compress is during the second stage of labour, when you are pushing and your baby’s head is descending. The compress is soaked in the water and squeezed out, then carefully applied to the perineum during contractions as your baby’s head is descending and crowning is starting. The compress is then removed between contractions and warmed again in the water before reapplying for the next one.

Crowning is when the baby’s head is visible and you can start to feel a stretching sensation (if you have an epidural this sensation may be muted, so be guided by your midwife as to the best time to apply the compress). Once applied, gentle pressure will hold it in place so the whole perineum will then benefit from the warmth of the compress. If you prefer, and are in a position to be able to, you could hold the compress there yourself as your baby’s head is birthed. 

It is normal to feel a stinging and/or burning sensation during crowning and women describe the application of the warm compress during this time as warming and soothing.

How to request this for your birth

So, after reading about warm compresses, and if you want to include this as part of the care you receive during labour, be sure to write this clearly in your birth plan so the midwife caring for you knows this. If possible, have a conversation with them, too, expressing your wishes before you reach the pushing stage of your labour and birth, and provide them with the guide below if needed.

Guide to using a warm compress for the perineum 

  1. 300mls of boiling water and 300mls of cold tap water in a clean bowl (does not need to be sterile).
  2. Use a pad or cloth for the compress.
  3. Apply when the baby’s head is stretching the perineum and the woman can feel the associated stinging.
  4. Hold pad/cloth on the perineum during a contraction and then rewarm between contractions.
  5. If the pad/cloth becomes soiled, then replace with a clean one.
  6. Continue until the birth of the baby’s head.
  7. If you need to replace the water due to cooling (after around 15 minutes) then start again. Never add boiling water to warm up current bowl as hot pockets of water can be created.

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