How effective are warm compresses and perineal massage at reducing perineal trauma? A review of the evidence

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IntroductionThe second stage of labour is defined as full cervical dilation until delivery of the baby, but in reality it is so much more than this. The woman is encompassed in a paradox of physical strength but emotional vulnerability, as with each push she journeys closer to the life-changing rite of passage that is motherhood. For many years pregnancy internet forums have been littered with questions concerning the emotive topic of how to prevent tears, and it continues to be a frequently asked question at antenatal appointments. Researchers are forever seeking the elusive answer. Midwives utilise a variety of hand techniques that they believe help to reduce genital trauma rates. Such techniques include the use of warm compresses and perineal massage in labour with the aim of potentially reducing trauma due to the effects of vasodilation and increased blood supply, muscle relaxion, altered pain perception and improving stretching and extensibility of the tissues. Part of the midwife's role is to stay up to date with research in order to provide gold standard evidence-based care. However, midwives often feel uncertain about what can be done to reduce the chance of tearing and many women therefore accept it as a given that they will tear. Due to the lack of knowledge of both midwives and women regarding prevention techniques, the ‘caring for your stitches' leaflet is handed out all too often.

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