Reduction of perineal trauma and improved perineal comfort during and after childbirth : the Perineal Warm Pack Trial

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The Perineal Warm Pack Trial investigated the effects of applying warm packs to the perineum during the late second stage of labour on perineal trauma and maternal comfort. A randomised controlled method was used. In the late second stage of labour, primiparous 1 women (n = 717) giving birth were randomly allocated to having warm packs (n = 360) applied to their perineum or standard care (n = 357). Analysis was on an intention-to-treat basis. The primary outcome measure was the requirement for perineal suturing and the secondary outcome measure was maternal comfort. There was no statistically significant difference in the number of women who required suturing following birth. There were significantly fewer third-and fourth-degree tears in the warm pack group. However, the study was underpowered to assess the uncommon outcome of severe perineal trauma. Women in the warm pack group had significantly lower perineal pain scores when giving birth, on day one and day two following the birth. At twelve weeks, women in the warm pack group were significantly less likely to have urinary incontinence compared to the women in the standard care group. Warm packs were highly acceptable to both women and midwives as a means to relieve pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both women and midwives were positive about using warm packs in the future. The majority of women (85.7%) said they would like to use perineal warm packs again for their next birth and similarly would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of care in the second stage of labour. Both women and health professionals place a high value on minimising perineal trauma during childbirth and the potential associated morbidity. Perineal warm packs are widely used in the belief that they reduce perineal trauma and increase comfort during the late second stage of labour. This study demonstrated that the application of perineal warm packs in the late second stage does not reduce the likelihood of primiparous women requiring perineal suturing but significantly reduces perineal pain during the birth and on day one and two following the birth. Urinary incontinence also appears reduced at twelve weeks postpartum, though it is unclear as to the reason for this. The practice of applying perineal warm packs in the late second stage was highly acceptable to mothers and midwives in helping to relieve perineal pain and increase comfort and should be incorporated into second-stage pain relief options available to women during childbirth.
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