Warm Perineal Compress: Why NHS Maternity Teams Are Reviewing Their Approach to OASI Prevention
A Warm Perineal Compress may seem like a simple maternity intervention, but it is receiving increasing attention from NHS maternity teams reviewing how they support women during the second stage of labour and reduce the risk of severe perineal trauma.
This interest is particularly relevant because current NICE intrapartum guidance specifically recommends offering a warm wet compress once the presenting part distends the perineum during the second stage of labour. NICE advises continuing the compress until birth while checking that its temperature remains comfortable for the woman or pregnant person. The recommendation does not apply to births in water.
NICE Intrapartum Care guidance can be viewed in full here:
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
For NHS maternity departments, OASI leads, consultant midwives, labour ward teams and procurement professionals, this raises an important practical question: how can evidence-based warm perineal care be delivered consistently and conveniently within a busy maternity environment?
This is where the Niche Instant Warm Perineal Compress provides maternity teams with a purpose-designed option for delivering warmth during the second stage of labour.
Product information:
https://www.nicheofficesolutions.co.uk/product/niche-instant-warm-perineal-compress/
What Is a Warm Perineal Compress?
A warm perineal compress involves applying warmth to the perineum during the second stage of labour.
The perineum is the area between the vaginal opening and anus. During vaginal birth, this tissue stretches considerably as the baby descends and is born.
Warm compresses have been investigated as one intervention intended to reduce perineal trauma during childbirth.
NICE specifically refers to the use of a warm wet compress during the second stage of labour once the presenting part distends the perineum.
The temperature of the compress should be comfortable for the woman or pregnant person, and individual preferences should always be taken into account.
What Does NICE Say About Warm Perineal Compresses?
Current NICE guidance provides one of the strongest reasons for NHS maternity teams to review their warm perineal compress procedures.
Within NICE guideline NG235, Intrapartum care, NICE addresses interventions intended to reduce perineal trauma during the second stage of labour.
NICE recommends discussing preferences for techniques intended to reduce perineal trauma and supporting the woman’s choices.
NICE recommendation 1.9.13 states that once the presenting part distends the perineum during the second stage of labour, healthcare professionals should offer to apply a warm wet compress to the perineum and continue this until birth, while checking that its temperature is comfortable.
The recommendation was originally introduced in 2023 and amended in 2025 to clarify that it does not apply to births in water.
NICE guidance:
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
This provides NHS maternity teams with a clear national reference point when reviewing their existing perineal care procedures.
Why Did NICE Recommend Warm Perineal Compresses?
NICE did not make its recommendation in isolation.
Its evidence review considered different interventions intended to reduce perineal trauma during labour.
When reviewing warm packs, the NICE committee noted that evidence did not show a clear effect on episiotomy or second-degree perineal tears. However, the evidence showed a reduction in third- and fourth-degree tears, urinary incontinence and postpartum perineal pain compared with standard care. This evidence informed the recommendation to offer a warm wet compress during the second stage of labour.
The complete NICE evidence review is available here:
It is important that this evidence is communicated accurately.
A warm perineal compress cannot guarantee that a perineal tear or OASI will be prevented. Instead, it should be considered an evidence-supported intervention within a wider approach to perineal protection and safe maternity care.
What Is OASI?
OASI stands for Obstetric Anal Sphincter Injury.
OASI describes severe third- and fourth-degree perineal tears involving the anal sphincter complex.
These injuries can require specialist repair and follow-up. While most women or birthing people who experience OASI recover well, RCOG explains that some can experience longer-term problems including pain and difficulties controlling the bladder, bowels or passing wind.
Further information about OASI is available from the Royal College of Obstetricians and Gynaecologists:
Reducing the risk of severe perineal trauma wherever possible is therefore an important consideration within modern maternity care.
Is a Warm Perineal Compress Part of the OASI Care Bundle?
This is an important distinction.
Warm perineal compresses are not one of the formal components of the OASI Care Bundle.
The OASI Care Bundle brings together four practices intended to be used together to reduce the risk of severe perineal tearing, with each component subject to the woman’s informed consent.
RCOG information about the OASI Care Bundle can be found here:
RCOG also addresses warm compresses within its OASI Care Bundle FAQs.
RCOG explains that evidence suggesting warm compresses reduce perineal tearing was considered during the development of the care bundle. However, warm compresses were not included because of uncertainty and variation surrounding how they were used, including what was used as the compress, temperature, timing and reheating.
RCOG states that midwives and doctors who already use warm compresses as part of their practice can continue to do so.
OASI Care Bundle FAQs:
This distinction is important.
The OASI Care Bundle and the NICE warm-compress recommendation are separate, but both form part of the wider national conversation around reducing severe perineal trauma and improving maternity care.
Why Are NHS Maternity Teams Reviewing Their Current Processes?
The NICE recommendation provides maternity services with a reason to consider not only whether warm compresses are offered, but also how they are delivered.
Traditional warm-compress methods may involve sourcing an appropriate cloth, swab or flannel, preparing warm water, checking its temperature, maintaining warmth and potentially reheating or replacing the compress.
These processes can vary between maternity units and individual clinicians.
For a busy maternity team, this creates several practical questions.
Is the compress readily available when required? Is an appropriate source of warm water available? How is temperature managed? How much preparation is required? Can the intervention be incorporated easily into the second stage of labour? Is practice consistent between clinicians?
These are important questions when translating national guidance into routine clinical practice.
Introducing the Niche Instant Warm Perineal Compress
The Niche Instant Warm Perineal Compress has been developed to provide maternity professionals with a practical, purpose-designed method of delivering warmth to the perineal area.
The compress is single-use and uses an instant-activation system, meaning an external electrical warming device is not required.
According to the current product specification, the compress has a three-year shelf life when stored appropriately at room temperature and away from extreme temperatures.
The product should always be used according to the current Instructions for Use, local maternity policies and professional clinical judgement.
Full product information:
https://www.nicheofficesolutions.co.uk/product/niche-instant-warm-perineal-compress/
From Traditional Preparation to a More Standardised Approach
One of the most interesting issues surrounding warm perineal compresses is standardisation.
The clinical principle is straightforward: provide warmth to the perineum during the relevant stage of labour.
The practical delivery can be less straightforward.
Traditional methods can vary depending on the material used, water temperature, preparation method, reheating frequency and local clinical practice.
A purpose-designed single-use compress may provide maternity departments with an opportunity to establish a more consistent process.
This does not mean that the product itself guarantees improved outcomes or compliance with NICE guidance.
Successful implementation still requires appropriate clinical procedures, staff familiarisation, professional judgement and patient involvement.
However, reducing unnecessary variation in preparation may help maternity teams incorporate warm perineal care into their existing clinical workflow.
Supporting Midwives During the Second Stage of Labour
Any product introduced into a maternity environment needs to make sense in real clinical practice.
During the second stage of labour, midwives may simultaneously be monitoring maternal and fetal wellbeing, assessing progress, supporting positioning, communicating with the woman and her birth partner and preparing for birth.
An intervention that requires additional preparation needs to fit around these responsibilities.
A self-heating compress offers an alternative approach by providing warmth without requiring an external electrical heat source.
For maternity departments reviewing their processes, convenience and standardisation may therefore be important considerations alongside clinical evidence.
What Does This Mean for NHS Procurement Teams?
Clinical procurement decisions should be made collaboratively.
When a maternity product is intended to support an intervention identified within national clinical guidance, procurement teams should involve the healthcare professionals who will actually use it.
This may include consultant midwives, labour ward coordinators, OASI or perineal trauma leads, obstetric teams, clinical governance professionals, infection prevention teams and procurement specialists.
When evaluating a warm perineal compress, teams may wish to consider its intended use, Instructions for Use, single-use status, shelf life, storage requirements, staff familiarisation requirements and how the product would fit into existing maternity pathways.
The purpose should not simply be to introduce another consumable.
The objective should be to determine whether the product provides a practical way of supporting an identified clinical requirement.
Why Patient Choice Remains Essential
Evidence-based care and patient-centred care should work together.
NICE recommends discussing the woman’s preferences for techniques intended to reduce perineal trauma and supporting her choices.
NICE also states that perineal massage with a water-soluble lubricant can be considered during the second stage if it is acceptable to the woman or pregnant person and they prefer it to a warm compress.
This recommendation also does not apply to births in water.
Full NICE recommendations:
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
Warm perineal compresses should therefore not be viewed as an automatic procedure for every vaginal birth.
They should sit within individualised care, appropriate clinical judgement and informed decision-making.
Could a Purpose-Designed Compress Help NHS Trusts Implement NICE Guidance?
This is ultimately the question NHS maternity teams need to consider locally.
NICE provides the clinical recommendation.
Individual maternity services then need to determine how that recommendation can be implemented within their own environment.
A purpose-designed instant warm compress may provide one practical option for teams seeking a more standardised approach to warm perineal care.
The Niche Instant Warm Perineal Compress does not replace NICE guidance, professional judgement, patient choice or existing OASI prevention measures.
Instead, it provides maternity teams with a product specifically designed to support the practical delivery of warmth to the perineal area.
Frequently Asked Questions About Warm Perineal Compresses
Does NICE recommend warm perineal compresses during labour?
Yes. NICE recommends offering a warm wet compress once the presenting part distends the perineum during the second stage of labour and continuing its application until birth. The temperature should be checked to ensure it remains comfortable.
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
When should a warm perineal compress be used during labour?
NICE recommends offering the compress once the presenting part distends the perineum during the second stage of labour.
Healthcare professionals should follow the complete NICE recommendation alongside local maternity policies, clinical judgement and the woman’s preferences.
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
What does OASI stand for?
OASI stands for Obstetric Anal Sphincter Injury and refers to third- and fourth-degree perineal tears involving the anal sphincter complex.
More information is available from RCOG:
Can a warm perineal compress prevent OASI?
No intervention can guarantee that OASI will be prevented.
However, NICE’s evidence review found that warm packs showed a reduction in third- and fourth-degree tears compared with standard care, contributing to its recommendation to offer a warm wet compress during the second stage of labour.
Are warm perineal compresses part of the OASI Care Bundle?
No. Warm perineal compresses are not a formal component of the OASI Care Bundle.
RCOG explains that variation in traditional methods made standardisation difficult when the care bundle was developed.
Why weren’t warm compresses included in the OASI Care Bundle?
RCOG identifies variation in practice as an important issue. This included questions surrounding what was used as the compress, temperature, whether it was held continuously and when it was reheated.
The care bundle was intended to provide interventions that could be applied consistently.
Does NICE recommend warm perineal compresses during water birth?
No. NICE explicitly states that its recommendation to offer a warm wet perineal compress does not apply to births in water.
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
Does NICE recommend perineal massage?
NICE says perineal massage with a water-soluble lubricant can be considered during the second stage of labour if it is acceptable to the woman or pregnant person and they prefer it to a warm compress.
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
Is the Niche Instant Warm Perineal Compress single-use?
Yes. The Niche Instant Warm Perineal Compress is a single-use product.
Healthcare professionals should use the product in accordance with the current Instructions for Use and their organisation’s local clinical procedures.
https://www.nicheofficesolutions.co.uk/product/niche-instant-warm-perineal-compress/
Does the Niche Instant Warm Perineal Compress require electricity?
No. The product uses an instant-activation system and does not require an external electrical warming device.
https://www.nicheofficesolutions.co.uk/product/niche-instant-warm-perineal-compress/
What is the shelf life of the Niche Instant Warm Perineal Compress?
The current Niche Healthcare specification sheet states a shelf life of three years, with the product stored at room temperature and protected from extreme temperature conditions.
Can the Niche Instant Warm Perineal Compress be used as a moist warm compress?
Niche Healthcare provides guidance for clinicians wishing to use the product as a moist warm compress. Healthcare professionals should follow the current product Instructions for Use and their organisation’s local clinical policy.
https://www.nicheofficesolutions.co.uk/product/niche-instant-warm-perineal-compress/
Can community maternity teams use warm perineal compresses?
A self-heating product may offer practical advantages in environments where conventional warm-water preparation is less convenient. Suitability for home birth, community maternity or other settings should be determined by the responsible maternity service in accordance with local policies and clinical governance requirements.
Does a warm perineal compress replace other OASI prevention measures?
No.
Warm perineal compresses should be considered within a wider evidence-based approach to reducing perineal trauma. They do not replace professional judgement, patient choice or other appropriate perineal protection measures.
Where can midwives read the clinical evidence?
NHS midwives and maternity professionals can review the NICE guideline and supporting evidence directly:
https://www.nice.org.uk/guidance/ng235
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
RCOG information on the OASI Care Bundle is available here:
Warm Perineal Compress: Turning National Guidance Into Everyday Maternity Care
The Warm Perineal Compress represents a relatively simple intervention within a much wider approach to evidence-based maternity care.
What makes the subject particularly relevant for NHS maternity teams is that there is now a clear NICE recommendation addressing warm wet compresses during the second stage of labour.
At the same time, national work surrounding OASI continues to reinforce the importance of reducing severe perineal trauma and establishing consistent, evidence-informed maternity practices.
For NHS trusts, this creates an opportunity to review not only whether warm compresses are being offered, but also how the intervention is being delivered in everyday clinical practice.
The Niche Instant Warm Perineal Compress provides maternity professionals with a purpose-designed, instant-activation option for teams reviewing their current approach to warm perineal care.
Niche Healthcare welcomes enquiries from NHS maternity departments, consultant midwives, OASI and perineal trauma leads, labour ward teams, clinical governance professionals and procurement teams interested in learning more about the product.
Niche Instant Warm Perineal Compress:
Niche Instant Warm Perineal Compress
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Read more about perineal trauma in childbirth:
Perineal Trauma in Childbirth: Why Prevention Has Never Been More Important in 2026
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Authoritative Clinical Resources
NICE – Intrapartum Care NG235:
https://www.nice.org.uk/guidance/ng235
NICE – Intrapartum Care Recommendations:
https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
NICE – Evidence Review: Interventions to Reduce Perineal Trauma:
RCOG – OASI Care Bundle:
RCOG – OASI Care Bundle FAQs:
Published by Maisie McNamara | Clinical Marketing Team
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