Feature & Benefits
- Sanitation – Hygienic warm compress.
- Blood flow promotion – Helps to encourage blood circulation in the perineal area before child birth.
- Labour support – Can help labour to progress naturally and minimise the need for surgical intervention or iatrogenic complications.
- Highly recommended – For use within home birth procedures, as increased blood flows to the key area can aid a natural birth at home.
- The best time to use the warm compress is during the second stage of labour. Heat compression, when applied during the second stage of labour, is an inexpensive low-risk treatment that can help reduce perineal trauma.
- Hold the Niche Instant Warm Perineal Compress against the perineum during and in between pushes in the second stage.
- Once applied, the gentle pressure will hold it in place, so the whole perineum will then benefit from the warmth of the compress.
- It is normal to feel a stinging and/or burning sensation.
Question: ‘How much fluid does the Perineal Warmer hold? We need to be able to report blood loss during child birth.’
Answer: ‘The Niche Perineal Warmer can absorb up to 200ml of fluid per pad.’
What types of perineal tears can occur during childbirth?
During vaginal birth, it is very common to experience a graze or tear of the labia or, more frequently, the perineum, which is the area between your vagina and anus. For most, these tears are minor and heal quickly. 1 st and 2nd degree: tears that involve muscle/skin that may require stitches. 3rd and 4th degree: severe tears which extend to the muscles that control the anus (the anal sphincter), requiring stitches. These are also called ‘Obstetric Anal Sphincter Injuries’ (OASI).
Am I at risk of a severe tear?
Severe tears (OASI) occur in 3-4 in 100 births. You are at significantly higher risk if:
- Forceps are used to help you give birth.
- This is your first vaginal birth
The following may also increase your risk:
- Your baby is born in the back-to-back position
- Your baby is over 4kg (9 lbs)
- You are of South Asian ethnicity
- Your baby is born quickly
- You are over 35
- Your baby’s shoulder gets stuck behind the pubic bone (shoulder dystocia)
- Ventouse is used to help you give birth
- The pushing phase of labour takes a long time
What about recovery?
Most women and birthing people who have a severe tear (OASI) repaired recover well, although it can take some time. Occasionally, long-term pain and a difficulty or inability to fully control the bladder, bowels or the passing of wind can occur. This could lead to:
- Feelings of depression, low mood, isolation
- Anxiety about leaving the house and not being able to quickly access a toilet
- Difficulty bonding with baby
- Concerns about leakage while exercising
- Concerns about having sex or giving birth again
If you experience any of the above after birth, contact your doctor or midwife as soon as possible to access specialist care.
How can I reduce my risk of a severe tear?
Perineal massage with a natural oil (such as coconut or almond) from 35 weeks pregnant until birth, as illustrated here. Visit this link for more information on how to do this.
OASI Care Bundle 2: abbhealthiertogether.cymru.nhs.uk #
As seen in the Cochrane Review there is evidence to suggest that warm compresses reduce perineal tearing. This effect was noted during the development of the care bundle, as similar evidence existed at that time. However, warm compresses were not included in the OASI Care Bundle because there is a lack of clarity over the methods of use and wide variation in practice. For example, whether the compress is held in place continuously, what is used for the compress, at what temperature, and when it is re-heated. The OASI Care Bundle aimed for a set of interventions to be applied consistently every time and so it was decided that the difficulty in ensuring standardisation of warm compress use made it unfeasible to include as a component of the care bundle. However, we recommend that those midwives/doctors who use warm compresses as part of their practice continue to do so. We recommend that warm compresses are used up until the point that MPP should be carried out to ensure adequate visualisation of the perineum.
Alternative uses for the perineal warmer
Heat will relax your muscles, increase blood flow to the area and, because your nerves are relaying the feeling of warmth to your brain, will dampen the pain signal. Warmth increases blood circulation to the area where it is applied. Blood circulation means more oxygen and nutrients to the site, promoting faster healing. For pain from a caesarean section incision, warm compresses will ease the pain around your abdomen and incision. Backache can be caused by tense muscles or by not using enough support while breastfeeding your baby. A heating pad may relieve the pain.
What is a Perineal Massage?
Antenatal perineal massage (APM) or birth canal widening (BCW) is the massage (painless stretching) of a pregnant woman’s perineum – the skin around the opening to the vagina or (‘birth canal’ – when a baby is in this passage), performed anywhere in the 4 to 6 weeks before childbirth. The practice aims to gently mimic the ‘massaging’ action of a baby’s head on the opening to the birth canal prior to birth, without using the baby’s head, doing some of the hard work of labour (birth) before the start of labour, making birth less stressful on baby. The intention is also to attempt to prevent tearing of the perineum during birth, and eliminate the need for an episiotomy during an instrument (forceps and vacuum extraction) delivery, to avoid infection (cellulitis and necrotising fasciitis), helping to keep antibiotics working into the future.
When should you start massaging the perineum and how often?
Studies show that from around 34 weeks it can be beneficial to begin massaging and ‘preparing’ your perineum. There can be benefits from as little as once or twice a week, but many recommend three to four times a week or even daily. Start by massaging for a minute then build up to around five to ten minutes a day. Ensure you are using nourishing plant oils such as organic sunflower, grapeseed, coconut, almond and olive oil. Alternatively, use soluble water-based lubricants.
When should perineal massage be avoided?
- Perineal massage should be avoided if you think you may have a vaginal infection
- You think your waters may have broken
- Post-Partum if you have had any stitches or tears following birth
- If anything feels uncomfortable, beyond the usual feeling of stretching tissues, stop and seek advice from your Midwife. Listen to your body and do what feels right.
‘Old wives tales’ to evidence-based care:
Hannah’s interest in perineal care started when she was a student midwife in the UK. She witnessed a labouring woman who, although close to giving birth, seemed scared of letting her baby emerge. The supervising midwife – an older woman, and very experienced – quietly got up and left the room, and returned a few minutes later with a bowl of steaming water. She proceeded to put a cloth in the water, wring it out, and place it gently on the woman’s perineum.
The woman’s face relaxed noticeably, and she gave birth to her baby. When questioned about what was in the water, the senior midwife answered, “just soothing the ring of fire ducky” (taking the stinging out of the birth). The results showed that warm packs reduce the most severe perineal tearing, as well as lowering women’s pain during the birth and the first couple of days afterwards. The study also found urinary incontinence was reduced three months following the birth.
Perineal warm packs are now accepted as an approved technique for use during childbirth thanks to a validated review of approaches to reduce perineal tearing. The report concludes the use of perineal warm packs is associated with decreased occurrence of perineal trauma and is acceptable to both women and midwives.
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. This is when the head is descending down from the womb through the cervix and into the birth canal. The ‘ring of fire’ is when the baby’s head is crowning.
Specification & Data Sheet
Successful clinical Perineal trial, May 27 2020: pubmed.ncbi.nlm.nih.gov/32460297
Successful clinical Perineal trial, July 2018: brieflands.com/articles/msnj-82588.html
Successful clinical Perineal trial, June 15 2019: pubmed.ncbi.nlm.nih.gov/31238205/
Blog from October 23, 2016: ‘old wives tales’ to evidence-based care
Episiotomy: When it’s needed, when it’s not: https://nicheofficesolutions-my.sharepoint.com
Treatment and healing for recovery: 2nd Degree Tear: Treatment, Healing, and Recovery Timeline (healthline.com)
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