The moment of pushing during childbirth can feel like a whirlwind of excitement and intensity. With the baby almost there, everyone in the room is focused on safely guiding the newborn into the world. One common concern many expectant mothers have is how to avoid perineal tearing during delivery. You might have heard about using warm compresses on the perineal area to help with this—and you’re probably wondering, does it really work?
Let’s understand the evidence-based information to see how effective warm compresses are at preventing perineal tearing during childbirth.
What is Perineal Tearing?
Perineal tearing refers to tears that can occur in the area between the vagina and the anus (the perineum) as the baby’s head passes through the birth canal. These tears are categorized into four degrees based on their severity. While some level of perineal trauma is common in vaginal deliveries, there are techniques, such as warm compresses, that can help reduce the likelihood of more severe tears.
How Do Warm Compresses Work?
A warm compress is a clean cloth soaked in warm water that is gently applied to the perineal area. The warmth increases blood flow to the tissues, helping them become more elastic, which reduces the risk of tearing as the baby’s head emerges.
What Does the Evidence Say?
There’s good news for those considering warm compresses! Research supports the use of warm compresses in reducing the risk of severe perineal tears. A study published in the Cochrane Database of Systematic Reviews found that women who had warm compresses applied to their perineum during the second stage of labor (pushing) were less likely to experience third- and fourth-degree tears. While warm compresses may not prevent all types of tears, especially milder first- or second-degree tears, they are effective in reducing the risk of more significant ones that often require longer recovery times.
Does it Matter if You Have an Epidural or Not?
Whether you’re unmedicated or have an epidural, warm compresses can still help. For women with an epidural, the compresses provide a passive way to support the tissues, as sensation is reduced.
Unmedicated Births and Various Pushing Positions
During an unmedicated birth, mothers often move between different positions for comfort and to assist the baby’s descent.
Common positions include:
- Upright (squatting, standing, or using a birthing stool)
- Hands-and-knees or all-fours
- Side-lying
- Water births
Since these positions can shift frequently, applying warm compresses may require creativity and coordination from the birth team. In upright or hands-and-knees positions, the compress might need to be applied from underneath or behind the mother. In side-lying, the perineum is more accessible, making this an easier position for compress use. For water births, the entire body is already benefiting from the warmth of the water, so an additional compress may not be necessary.
Unmedicated Birth: Maintaining Focus
In unmedicated births, the intensity of pushing can make it seem difficult to focus on extra interventions like compresses. However, a supportive birth team can still offer this technique. Communicating preferences in advance and pacing the final pushes to allow the perineum time to stretch can also help reduce tearing, even without compresses.
Other Benefits of Warm Compresses
In addition to reducing the risk of tearing, warm compresses can:
- Provide comfort during crowning.
- Improve blood flow to the perineal tissues, promoting flexibility.
- Possibly aid faster healing after birth.
What Else Can Help Prevent Tearing?
While warm compresses can be helpful, they’re just one of many techniques that can promote a smoother delivery. Other methods include:
- Perineal Massage: Gently massaging the perineum during the weeks leading up to birth can help the tissues stretch more easily.
- Controlled Pushing: Slow, controlled pushing can give the perineum more time to stretch.
- Upright or Side-lying Positions: These positions may reduce pressure on the perineum compared to lying flat.
The Takeaway
Warm compresses during the pushing stage of labor are an evidence-based practice that can help reduce the risk of severe perineal tearing. Whether you choose to have an epidural or go unmedicated, the benefits of warm compresses remain the same. Not only do they provide comfort, but they also help the perineal tissues stretch more gradually, which is crucial in avoiding trauma.
If you’re approaching your due date and are interested in trying warm compresses during delivery, talk to your healthcare provider or birthing team. Every labor experience is unique, and they can help you decide if this technique is right for you!
Here’s to a smooth and safe delivery!