Get access

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

Authors

  • Hannah G. Dahlen RN, RM, BN(Hons), M(CommN), PhD,

    Corresponding author
    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
      Hannah G. Dahlen, RN, RM, BN(Hons), M(CommN), Royal Prince Alfred Women and Babies, Missenden Road, Camperdown, NSW 2050, Australia.
    Search for more papers by this author
  • 1 Caroline S.E. Homer RN, RM, PhD,

    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
    Search for more papers by this author
  • 2 Margaret Cooke RN, RM, PhD,

    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
    Search for more papers by this author
  • 3 Alexis M. Upton RN, RM, RPN, BN,

    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
    Search for more papers by this author
  • 4 Rosalie Nunn RN, RM, GradDipAppSc, MMid,

    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
    Search for more papers by this author
  • and 5 Belinda Brodrick RN, RM, GradDip(NMan) 4

    1. 1Hannah G. Dahlen is the Clinical Midwifery Consultant for Sydney South Western Area Health Service and a researcher at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 2Caroline S.E. Homer is a Professor of Midwifery and 3Margaret Cooke is an Honorary Associate at the Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; 4Alexis M. Upton and Belinda Brodrick are Midwifery Managers at Royal Prince Alfred Women and Babies, Sydney; and 5Rosalie Nunn is a Midwifery Practitioner at the Canterbury Hospital, Sydney, New South Wales, Australia.
    Search for more papers by this author

  • Johnson & Johnson Medical, Sydney, New South Wales, provided funds for translation of questionnaires and consent and information forms. The company had no input into the design or content of the study.

Hannah G. Dahlen, RN, RM, BN(Hons), M(CommN), Royal Prince Alfred Women and Babies, Missenden Road, Camperdown, NSW 2050, Australia.

Abstract

ABSTRACT: Background: Perineal warm packs are widely used during childbirth in the belief that they reduce perineal trauma and increase comfort during late second stage of labor. The aim of this study was to determine the effects of applying warm packs to the perineum on perineal trauma and maternal comfort during the late second stage of labor. Methods: A randomized controlled trial was undertaken. In the late second stage of labor, nulliparous women (n = 717) giving birth were randomly allocated to have warm packs (n = 360) applied to their perineum or to receive standard care (n = 357). Standard care was defined as any second-stage practice carried out by midwives that did not include the application of warm packs to the perineum. Analysis was on an intention-to-treat basis, and the primary outcome measures were requirement for perineal suturing and maternal comfort. Results: The difference in the number of women who required suturing after birth was not significant. Women in the warm pack group had significantly fewer third- and fourth-degree tears and they had significantly lower perineal pain scores when giving birth and on “day 1” and “day 2” after the birth compared with the standard care group. At 3 months, they were significantly less likely to have urinary incontinence compared with women in the standard care group. Conclusions: The application of perineal warm packs in late second stage does not reduce the likelihood of nulliparous women requiring perineal suturing but significantly reduces third- and fourth-degree lacerations, pain during the birth and on days 1 and 2, and urinary incontinence. This simple, inexpensive practice should be incorporated into second stage labor care. (BIRTH 34:4 December 2007)

Get access to the full text of this article

Ancillary