Many pregnant women fear the possibility of tearing when they give birth.
It’s a very common concern and one that can be debilitating when you’re actually in labour.
As the baby descends, there is an intense sensation of stretching and pressure.
The feeling can be so overwhelming some women find it difficult to let go and work with their bodies to push their babies out.
In an undisturbed labour, pushing is a completely natural reflex, and a woman’s body can do it all by itself.
However, not many women give birth in situations where their labour hormones have been left undisturbed.
Often they are tired, stressed or afraid, and have to work hard to push.
Perineal Warm Packs – What All Women Need To Know
Fear increases stress hormones and makes muscles tense. The work of labour becomes harder and often more painful as a result.
A simple and accessible support measure is the use of warm packs on the perineum. When used properly by care providers, they can ease the tension and provide comfort to birthing women.
How Often Does Tearing Occur During Labour?
During labour, many women experience some minor tearing or grazing that doesn’t require any stitches and generally heals quickly.
A very small percentage of women will experience more severe tearing.
What Causes Tearing?
As baby’s head moves down into the vagina, the tissues begin to stretch. This is normal, as the hormones released during pregnancy and birth make it possible for the tissues to be more stretchy than usual.
The skin between the vaginal opening and the anus is called the perineum. This takes a lot of pressure as the baby’s head descends, and it becomes very thin and stretched.
Can We Prevent Tearing?
Perineal trauma is more likely to happen in certain circumstances, including:
- The birth of your first baby
- An assisted birth (use of forceps or vacuum)
- A long pushing stage of labour
- Having an epidural
- Lying on your back while giving birth, especially with your legs up in stirrups
- Malpositioning of baby’s head
- Giving birth to a baby over 4kgs
- Being from certain ethnic backgrounds
- Having a private obstetrician as a care provider (higher use of episiotomies)
There are ways to avoid some of these factors, but others might not be so easy to prevent.
There is a way, however, to offer comfort to women during labour and reduce the chances of perineal trauma.
Warm Packs – Aren’t They An Old Wives’ Remedy?
A review of key historical texts that mention perineal care showed midwives traditionally used warmth to ease discomfort of the perineum during birth.
Ten years ago, Professor of Midwifery at Western Sydney University, Hannah Dahlen, undertook what is known as the warm pack trial.
It was the world’s largest randomised controlled trial and it looked at whether the placing of a warm pack on a woman’s perineum reduced tearing and provided an increased sense of comfort.
The trial’s results showed warm packs did reduce the most severe perineal tearing. Women in the trial reported less pain during birth and in the days following. The study also showed a significant reduction in urinary incontinence three months after birth.
Professor Dahlen’s interest in this aspect of perineal care began when she was a student midwife in the UK. She witnessed an experienced midwife providing warm compresses to a woman who was struggling to let her baby emerge.
The midwife placed a cloth in steaming water, wrung it out, and placed it gently on the woman’s perineum, soothing the area and bringing relief. The baby was born soon after.
How To Use Warm Packs During Birth
Often it is the simplest things that make the most sense. A warm pack isn’t complicated and can be applied easily.
In this very useful video, Professor Dahlen and Dr Holly Priddis demonstrate how to make and apply a perineal warm pack:
Can I Have A Warm Pack At My Hospital?
A Cochrane review has confirmed the results of the warm pack trial; it is an approved technique used by many care providers.
It might not be something you are aware of, or have heard discussed during your antenatal classes.
Many women are concerned they might not like the sensation of someone touching them while they are giving birth.
It’s important to know this is an option for you to consider, and to discuss with your care provider before you go into hospital in labour. The option of having a caring support person to provide comfort during birth can ease your worries about tearing, and allow you to feel more positive about the experience.
Reducing your fears and providing you with options for support to reduce the chance of perineal tearing can make a big difference to the way you perceive your birth, and improve your recovery afterwards.