Remarks

• The evidence reviewed included intermittent application of local cooling in the form of crushed ice between layers of a pad, or a gel pack, for 10 to 20 minutes in a single application to multiple applications in the first 48 hours after childbirth.
• In making this recommendation, the Guideline Development Group agreed that perineal pain relief should be individualized, considering the presence of perineal trauma, intensity of the pain, multiple sources of postpartum pain (e.g. perineal, uterine, breast pain) and the use of other forms of pain relief. Local cooling is low cost and unlikely to cause harmful effects if performed as instructed, and some women find it to be soothing.
• Non-pharmacological pain relief options can vary widely across settings and contexts, which might favour other non-pharmacological pain relief interventions and traditional and complementary medicine that were not evaluated during the guideline process, such as sitz baths, acupuncture or acupressure, aromatherapy, music, relaxation techniques, therapeutic ultrasound, transcutaneous electrical nerve stimulation (TENS) and laser therapy.
• All women should be asked about perineal pain and other perineal conditions (e.g. perineal trauma healing and haemorrhoids) during their postpartum stay in health facilities and at each postnatal care contact. Women should be advised on danger signs and symptoms, including any exacerbation of perineal pain as a manifestation of postpartum complications such as haematomas, haemorrhoids and infection.