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During pregnancy, we are drilled into avoiding heat! We are told not to have our baths too hot and to avoid saunas, steam rooms, and Jacuzzis!
Essentially we want to avoid anything that raises our core body temperature, especially in early pregnancy. An increased core body temperature in early pregnancy can increase the risk of birth defects, but this doesn't rule out heat completely!
Infact heat can be a wonderful way of supporting your body throughout birth pregnancy and postpartum in fact heat can:
Improve circulation, bringing more blood to the area and reducing pain / promoting healing.
Relax tight muscles and joints, reducing pain and stiffness.
Provide a distraction from pain and soreness making it more easy to cope with!
Heat during pregnancy
Is it safe to have a hot bath in pregnancy?
I'm sure you'll be pleased to hear you can continue your relaxation ritual of having a hot bath in pregnancy - yes really!
One study showed that
Pregnant women can use a hot bath of 40 °C or a dry sauna of 70 °C for 20 min and maintain their temperature within safe limits'
Ravanelli et al. (2018)
Use that hot bath to ease aching muscles and joints, use Epsom salts to enhance the pain-relieving effects and maybe even give you a mineral boost (many minerals are absorbed through the skin)
You could add your favorite essential oils (mixed in a carrier oil or an unscented bubble bath) or create a herbal infusion from herbs like calendula, chamomile, and yarrow (pop in a sock or a muslin bag to avoid a messy cleanup).
Hot water bottles or heat pads during pregnancy
Again as long as we aren't raising our core body temperature, we are safe, a topical application of heat on a small area of your body is not going to significantly increase your body temperature.
I purchased an electric heat pad in my second pregnancy and it was honestly one of my best purchases!
I mainly used it on my bum and hips in bed to relieve pelvic pain, but heat application can also be used on any area of your body to combat sore muscles and cramps!
Pregnancy can be full of round ligament pain, rib pain, and back pain, and heat is a great coping mechanism for all of these! Your hot water bottle may just be your new best friend!
Heat as a coping mechanism during birth
A systematic review of available data in 2022 concluded that:
'Current evidence shows that heat therapy effectively decreases labor pain intensity and shortens the duration of labor in the first stage, and it can be used as nonpharmacological management for labor pain.' (Goswami et al 2022)
With that in mind let's look at the ways you can use heat in labour
Crack out the heat pad and/or hot water bottle again! Some heat pads you can velcro around your waist to provide heat where you need it (front or back!) or you can get your birth partner to hold things in place!
Hot water - At home, you can use your bath or a shower if you have planned a home birth or are heading somewhere else to give birth a birth pool can be used to provide some relief.
A warm compress on the back of your neck to relieve shoulder, and neck tension and headaches.
Heat to help with the 'ring of fire' and help protect from tearing?
Perineal support is controversial, and I certainly do not want this to be a 'we must avoid tearing at all costs' post because I believe our bodies are very clever and are built to stretch, tear, and repair but...
There is no getting away from the fact that crowing is INTENSE for some people, and we would all prefer not to tear if possible so:
A review of data in 2024 showed that a warm compress on the perineum:
Warm compress on the perineum may result in little to no difference in second‐degree tears (RR 0.94, 95% CI 0.72 to 1.21; 2 studies; low‐certainty evidence), but likely results in a reduction in third‐ or fourth‐degree tears (RR 0.46, 95% CI 0.27 to 0.79; 3 studies; moderate‐certainty evidence)
Warm compress likely results in a large reduction in perineal pain (mean difference (MD) ‐0.81, 95% CI ‐1.18 to ‐0.44; 1 study; moderate‐certainty evidence).
I will link the full review in the references! It doesn't have to be a midwife or Dr holding the compress, you can hold it yourself (if you can reach it)!
Staying warm to help birth the placenta and prevent bleeding?
Traditional midwifery has always stressed that keeping mum and baby warm after birth is essential for the safe delivery of the placenta and to reduce bleeding.
We know that maintaining your 'nest' for the third stage is important in supporting your hormones and keeping warm seems to be an extension of that!
Ideas on how you can incorporate warmth into the third stage:
Put on some fluffy socks.
Cover you and your baby in warm dry blankets or towels from the tumble dryer.
Use a fan heater in the birth space and turn it on after birth.
Use your hot water bottle or heat pad.
A warm herbal tea with honey
Warmth for postpartum
Warmth is a theme in many traditional postpartum rituals.
In Traditional Chinese Medicine post-birth mothers are considered to have lost some of their warmth through blood and remain vulnerable and 'open' to cold. Many of the practices in the postpartum using warmth are to re-balance the mother.
Women are even encouraged not to wash or wash their hair for fear of the cold (and when they do wash it is with warming ginger water).
They are given only warm food and drink, with ingredients not only being 'warm' in the temperature sense but warming foods like ginger and black vinegar.
Women are kept warm and dress warmly and heat packs are used for comfort and healing.
The idea of putting an ice pack on your perineum is forbidden, this is something that would make many people cringe in traditional postpartum practices around the world!
Warmth for sore muscles and afterpains
Birth is a workout! It's normal to feel sore in places you didn't know existed, again hot water bottles and hot baths can come to your rescue.
Some ideas of things to put in your bath include:
Epsom salts, Chamomile (soothing), Comfrey (healing), Lavender (antiseptic and analgesic), Yarrow (relaxing and healing), Witch hazel (healing and pain relieving) and Rose (balancing).
Warmth for perineal healing
Yes, I know padsicles are all the rage!
The jury is out on whether they help:
'There is limited very low‐certainty evidence that may support the use of cooling treatments, in the form or ice packs or cold gel pads, for the relief of perineal pain in the first two days following childbirth. It is likely that concurrent use of several treatments is required to adequately address this issue, including prescription and non‐prescription analgesia.'
Ice restricts blood flow to the area (potentially not great for healing), and can reduce swelling and pain (through the gate control theory, essentially a distraction).
Heat can work the same way but increases blood flow to the area to promote healing.
Either way, the best thing for perineal healing is airflow and rest! So you don't want anything in your pants restricting airflow and creating a moist environment for bacteria growth!
Instead:
A warm (or cold) sitz bath using the herbs I mentioned above
Make up a warm jug of water using the herbs above to pour over the area when you are Weeing.
Make sure you pat yourself dry after!
Warmth for sore boobs
When your milk comes in most people have a few days of their boobs going into overdrive feeling heavy and sore!
using a warm pack on your boobs before feeding or pumping can help dilate milk ducts, increase the supply of blood to the breast tissue and nipple, and help encourage an effective letdown, it also feels really nice!
Using Ice does have its place though to reduce swelling and pain after feeding, so alternating and doing what feels best for you is a great strategy!
It's a lot to remember!
Don't worry, you certainly aren't supposed to be able to hold all of this in your pregnant brain! This is why working with me as a virtual doula can be beneficial right through pregnancy birth and postpartum, so you can come to me with an issue and I can suggest something to help solve it!
Also as with anything following your body and instincts is key! Feel like warmth might help? Give it a go, there are no 'rules', your body has its own wisdom!
References
Goswami S, Jelly P, Sharma SK, Negi R, Sharma R. The effect of heat therapy on pain intensity, duration of labor during first stage among primiparous women and Apgar scores: A systematic review and meta-analysis. Eur J Midwifery. 2022 Nov 28;6:66. doi: 10.18332/ejm/156487. PMID: 36474673; PMCID: PMC9703937.
Ravanelli N, Casasola W, English T, Edwards KM, Jay O (2019) Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis. Br J Sports Med 53(13):799–805. 10.1136/bjsports-2017-097914
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