Is warm perineal compress during delivery safe during pregnancy?

What does the evidence say about warm perineal compress during delivery during pregnancy?

1. The 2024 Cochrane review included 17 trials with 13,695 participants across several perineal techniques. For warm compresses specifically, moderate-certainty evidence indicated fewer combined third- or fourth-degree tears, while evidence for many other outcomes remained limited or uncertain. 1
2. The same 2024 review found little to no difference in second-degree tears and a probable reduction in perineal pain with warm compresses. Few studies reported blood loss, adverse effects, or patient experience, and no included study met every high-quality-method standard. 1
3. In a randomized trial of 717 nulliparous participants, warm packs did not significantly reduce suturing but were associated with fewer third- and fourth-degree tears and lower pain during birth and on the first two postpartum days. 2
4. A single-center randomized trial of 100 first-time mothers reported lower pain and fewer second- and third-degree tears with a warm perineal compress, but the small sample, one setting, and brief recruitment period limit generalizability. 3
5. A randomized trial of 1,211 healthy women compared warm compresses, massage with lubricant, and no touching until crowning. The distribution of genital tract trauma was equal across the three groups, so the trial did not show less overall trauma with either active technique. 4

Is warm perineal compress during delivery safe in each trimester?

• First trimester. A warm perineal compress is not a first-trimester practice. It is an intrapartum technique studied during the second stage of labor, after full cervical dilation and as vaginal birth approaches.
• Second trimester. This intrapartum technique is separate from prenatal perineal massage. Applying heat inside or around the vagina during mid-pregnancy is not a substitute for assessment of pain, pressure, bleeding, contractions, or fluid leakage.
• Third trimester. Add warm perineal compresses to birth-preference discussions before labor, then confirm in the moment. A trained birth attendant controls temperature, placement, and skin checks and can stop if the compress is uncomfortable or the clinical situation changes.