Hot abdominal compress after childbirth not necessary ­ —Expert

A  typical scenario, after a pregnant woman has been delivered of a baby  in Africa, is to have older women  press her tummy with very hot water as it is generally believed that this would help to return the tummy back to its normal size and promote abdominal pain relief.

Many women who have just been delivered of their babies  don’t mind this culturally deep-rooted practice. However, it has led to some  women sustaining burns or being scalded by the hot water. The question then is, does hot water pressing really tighten the belly? Does it help lochia drainage?

Experts at the University College Hospital  (UCH) Ibadan, who assessed the practice of hot abdominal compress among mothers seen at the postnatal clinic of the hospital, said “it has no scientific basis and clinical benefit.”

The hot compress is a practice in which a soft, absorbent cloth folded into several layers, dipped in hot water, barely wrung out and placed on the part to be treated.

The study was led by Dr Olutosin Awolude, Consultant Obstetrics and Gynaecologist at the hospital and published in the March 2019 edition of the Journal of Community Medicine and Primary Health Care.  Olagunju A.S and Agbana R.D participated in the study.

The participants in this study were women who came for post-natal care at the hospital between 1st December 2015 and 29th February 2016. Majority of the women were between the ages of 26 and 35years.

The study showed that the practice of hot abdominal compress was high and the reasons for the practice are more of tradition and cultural beliefs. Of the 290 participants, 264 (91.0%) were aware of hot abdominal compress and 51.7% practiced hot abdominal compress after they were delivered of their babies.

The return of womb to normal size (34.7%) and mothers’ encouragements (24.7%) were the commonest reason for the practice. Also, mothers’ and mothers-in-law’ assisted with   hot abdominal compress in 46.2% and 36.6% of cases, respectively. More women who had normal delivery practiced it.

Dr Awolude stated that though some traditional practices were beneficial to the mother and baby, others considered it to be beneficial and culturally acceptable like douching, sitz bath and hot abdominal compress in the community have no medical basis but harmful.

He said applying a firm pressure or hot water compress on the tummy has no implication on the normal process of the womb going back to its initial size

According to him, “the womb goes back to its normal size after childbirth at about 1cm per day.”

Using the gynaecological or obstetric method of assessing the womb, the womb will be at the level of the navel after a child delivery in a woman by three weeks. By 20 to 22 days, it will not be felt on touch because the pelvic, the bony cavity, would have accumulated it.

The expert said common cultural practice in Eastern Nigeria, like drinking hot gin, that  many women assume will help return the tummy to go back to its normal size, is also ineffective.

According to him, “the truth is that drinking hot gin does not work because the hot drink goes into the guts and the guts are separate from the womb, they are different tract.”

Moreover, he explained that hot abdominal compress has no clinical or scientific basis given the position of the womb in the body.

He added, “Before you get to the womb, you will have passed five different layers. So how do you think that applying hot water, say at 100-degrees centigrades, to the tummy,  will have effect on the womb? It would have burned the skin.

“That is one of the dangers that we see with hot compression. People can burn their skin or have a scar that could become big wound later.

“Of course, that area of the tummy that hot water compress was applied to would  become so dark compared to the rest of the body. This is a cosmetic disadvantage of hot abdominal compressor apart from the medical ones such as the scar, the burns, surgical site infection which would cause wound break down and wrinkling of the abdominal skin.”

Moreover, the hot abdominal compress he said has no effect on lochia drainage either.

“We encourage mothers to rub their hands on their tummy immediately after delivery because doing this elicit some stimulation that will make the womb to contract on its own and expel that blood.

“But after 24 hours, doing this will  have no effect. The natural process of the womb trying to go back to its normal size, which is called involution, would have started naturally. So, they do not need to apply any hot thing because what they stand to loss far outweighs whatever may be its benefit, if any.”

He, however, warned that in the process of applying a hot compress to the tummy  if an infection sets in, it could delay the natural process of the womb going back to its normal size.

“One of the critical thing is infection. It does not allow muscles to contract very well. You know that the womb itself is made up of muscles,” he added.

Hot abdominal compress has also been associated with unwanted masking of pain which can delay diagnosis and treatment of other problems after childbirth like the pelvic infection as the  pain could  be one of the earliest symptoms.

Dr Awolude, however, declared that maintaining  same waist size after childbirth only require tummy exercise

“That the tummy is flat is not a function of the womb. The womb will have gone back to its normal size. It is just the stretching of the walls of the abdomen and the fat that is there. All that is required are tummy exercises to get back to the initial shape,” he added

He added, however, that women who  had their babies through caesarian operation, need to wait for 2 to 3 months for the surgical cut to heal very well before they do the exercises to make the muscles in the tummy firm and trim.

While traditional practices such as using hot abdominal compress with no scientific basis and clinical benefit still go on in our environment, more studies are required to further evaluate them. The identified stakeholders in its practice like the mothers and mothers-in-law of must be involved because of the identified deep cultural association.