Warm compresses applied to the perineum during labour reduce trauma

Findings from a recent review in the December issue of the Cochrane Database of Systematic Reviews shows that applying warm compresses to the perineum during the second stage of labour is effective in reducing perineal trauma. The authors state that preventing tears ‘is complicated and involves many other factors in addition to the perineal techniques that are evaluated here, e.g. birth position, women’s tissue, speed of birth’. Trauma during birth is due to surgical incision (episiotomy) or may occur spontaneously. When the tears are 3rdor 4thdegree they extend into the anal muscosa and sphincters (internal and external) and are likely to cause incontinence in the short and longer terms.

Authors state ‘the objective of this review was to assess the effect of perineal techniques during the second stage of labour on the incidence of perineal trauma. We included eight randomised trials (involving 11,651 women) conducted in hospital settings in six countries. The participants in the included studies were women with no medical complications who were expecting a vaginal birth. We conclude that there is sufficient evidence to support the use of warm compresses to prevent perineal tears. The procedure has been shown to be acceptable to both women and midwives. From the meta-analyses we found significant effect of the use of warm compresses compared with hands off or no warm compress on the incidence of third- and fourth-degree tears. We also found a reduction in third- and fourth-degree tears with massage of the perineum versus hands off; and of ‘hands off’ the perineum versus ‘hands on’ to reduce the rate of episiotomy’.