Local cooling for relieving pain from perineal trauma sustained during childbirth

Perineal tears are common during the birth of a baby. In addition, sometimes the caregiver will cut the perineum to give extra space for the baby to be born (episiotomy). These tears and cuts often cause pain for women in the hours, days and sometimes months after the birth. This can reduce a woman's ability to walk and to sit comfortably, and it may affect her ability to care for her baby, including breastfeeding. Women often use a number of methods to relieve the pain, including cold baths, ice or cold packs on the area. It is important to know if cooling works, and that, even though it is unlikely to occur in this region of the body, too much cooling may possibly delay healing or cause ice burns.

This review looked to see if local cooling for a short period of time helped to relieve perineal pain for women and helped with healing. We found 10 studies including 1825 women that compared cooling treatments such as ice, cold gel pads, or cold bath with no treatment, or other treatments. One study found that women reported less pain 24 to 72 hours after giving birth when they used the ice packs for 10 to 20 minutes, rather than when they had no treatment. No effect on healing was identified. 

There is only a small amount of evidence of how safe and effective cooling treatments are to relieve perineal pain.

Authors' conclusions: 

There is only limited evidence to support the effectiveness of local cooling treatments (ice packs, cold gel pads, cold/iced baths) applied to the perineum following childbirth to relieve pain.

Read the full abstract...
Background: 

Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments.

Objectives: 

To evaluate the effectiveness and side effects of localised cooling treatments compared with no treatment, other forms of cooling treatments and non-cooling treatments.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 January 2012), CINAHL (1982 to 10 January 2012), the Australian New Zealand Clinical Trials Register (10 January 2012) and contacted experts in the field.

Selection criteria: 

Published and unpublished randomised and quasi-randomised trials (RCTs) that compared localised cooling treatment applied to the perineum with no treatment or other treatments applied to relieve pain related to perineal trauma sustained during childbirth.

Data collection and analysis: 

At least two review authors independently assessed trials for inclusion, assessed trial quality and extracted data. A sub-set of data were double checked for accuracy. Analyses were performed on an intention-to-treat basis where data allowed. We sought additional information from the authors of three trials.

Main results: 

Ten published RCTs were included (involving 1825 women). Comparisons were local cooling treatments (ice packs, cold gel pads (with or without compression) or cold/iced baths) with no treatment, gel pads with compression, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam (Epifoam), oral paracetamol or warm baths. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (risk ratio (RR) 0.61; 95% confidence interval (CI) 0.41 to 0.91; one study, n = 208). Women preferred the utility of the gel pads compared with ice packs or no treatment (RR 0.82; 95% CI 0.73, 0.92). Differences detected in a composite of perineal oedema and bruising and overall wound healing were noted in one small study, favouring cold gel pads (n = 37) over ice (n = 35, mean difference (MD) 0.63 on a scale of 0 to 15; 95% CI 0.20 to 1.06) or no treatment (n = 39, MD -2.10; 95% CI -3.80 to -0.40) three to 14 days after giving birth. Women reported more pain (RR 5.60; 95% CI 2.35 to 13.33; one study, 100 women) and used more additional analgesia (RR 4.00; 95% CI 1.44 to 11.13; one study, 100 women) following the application of ice packs compared with PET.