Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Study

Abstract

Perineal warm packs are commonly used during childbirth in order to limit perineal trauma and lessen discomfort late in the second stage of labor. Perineal trauma following delivery may be associated with significant short- and long-term morbidity. In a randomized controlled trial, 360 nulliparous women in the late second stage of labor were assigned to have warm packs applied to the perineum, while 357 others had standard care delivered by midwives. All participants were at least 36 weeks pregnant, and all had singleton pregnancies with cephalic presentation. In all instances a normal birth was expected. None of the women had performed perineal massage or planned to do so. All midwives were trained in warm pack treatment and were regularly updated. Nearly 80% of women in both groups required perineal suturing, and there were no significant differences in the frequency of either minor or major perineal trauma or in the numbers of episiotomies carried out. Women given standard care, however, were twice as likely than those treated with warm packs to have a severe (third- or fourth-degree) perineal tear (odds ratio, 2.16; 95% confidence interval, 1.1–4.3). Women treated with warm packs had lower perineal pain scores at childbirth and on the first and second days after birth. There were no significant group differences in pain during sitting, walking, or intercourse. After 3 months, women given warm packs were significantly less likely to have urinary incontinence than those receiving standard care. The investigators believe that application of perineal warm packs is a simple, inexpensive, and effective practice that should be a routine part of care for women in the second stage of labor.