Cold therapy after childbirth to reduce pain

Cold helps to reduce pain

In a review, they showed that six studies reported some evidence of the effectiveness of cooling for pain relief, 4 indicated that cooling reduced the inflammatory response and 2 reported high maternal satisfaction [1].
 

In a randomised controlled experimental study of 200 mothers, they compared cold gel pads applied to the perineum of mothers in the experimental group for 20 minutes postpartum, 2 hours and 4 hours after the first application, with standard maternity pads [2]. The cold gel group achieved significantly lower mean pain intensity scores during certain activities such as sitting, walking and breastfeeding after application of the cold gel. The difference between the experimental group and the control group was statistically significant after application of the cold gel compresses, with pain reduced by a factor of 2.5.
 

These results were confirmed in another randomised controlled study in which the experimental group achieved a lower mean pain score than the control group (1.6 vs 3.3) [3].

Cold application involves a reduction in analgesic use

In one study, participants were randomly divided into two groups: those who received gel compresses (for 20 minutes four hours after delivery and, if necessary, for up to 5 days) and the control group (who received standard hospital care). This study showed that analgesic use five days after delivery in the gel compress group was significantly lower than in the control group [4].

Cold gel pads may support wound healing

The evidence is very uncertain regarding the various measures of wound healing, for example, wound dehiscence upon inspection five days after delivery. [5]
 

An article reports the results of a randomised controlled trial that studied the effectiveness of localised cooling treatments for relieving perineal trauma [6]. 121 women who had reached full term and undergone an episiotomy were randomly assigned to one of three treatment groups (group 1 - no localised cooling; group 2 - ice pack; group 3 - refrigerated gel pads). Pain intensity, wound healing and women's level of satisfaction were the primary outcomes measured. 

The risk of wound dehiscence five days after delivery appeared to decrease in women who had used ice packs, but this level of evidence is very low [7]. This effect does not appear to persist until the tenth day. However, another study demonstrated that gel pads were more effective than ice packs at reducing pain (+ reduced oral analgesia use) and also for wound healing [8].

Perineal pad, the cold gel pack specifically designed to relieve pain after childbirth! It is also available in breastfeeding compress hot/cold, to relieve breast pain associated with milk let-down. 

Recent research has shown that cold can cause adverse effects [9]:

Cold and stabbing sensations (5 minutes after the application of ice packs, the temperature of the thigh reached 13.8°C) 

Numbness (10 minutes after application, the temperature reached 9°C)

Anaesthesia (15 minutes later, the temperature of the thigh was 7.8°C, and the first complaint of anaesthesia was reported; then after 20 minutes the temperature reached 6.5°C, and a greater number of subjects reported anaesthesia). Another study confirmed this effect [10].
 

No perineal lesions due to cooling were identified; however, the authors noted that further research evaluating the potential adverse effects of cooling should be carried out.

Most cryotherapy techniques currently in use are not capable of causing tissue damage, unless cold is applied directly and continuously to the skin for more than one hour and combined with pressure. Intermittent application of ice covered by a barrier for 10 minutes may prevent potential tissue damage.

• Rest and sleep
• Herbal sitz baths (to find out more, see our article: bath after childbirth)
• Choose the best pregnancy food supplements in advance, with vitamin C and collagen, to prepare the body
• A good post-partum nutrition
• Getting some sun
• Keeping warm

Studies on the application of cold therapy in the postpartum period can be mixed; they generally show a reduction in pain, a beneficial effect on healing, and an improvement in comfort. However, some studies are unable to conclusively prove a real effect. 

What has been proven is that the techniques used are safe when applied sensibly (cold not applied directly or continuously to the skin for more than one hour).