title: Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice.
abstract: OBJECTIVE
  To investigate use of pharmacological and non-pharmacological methods of perineal analgesia used by midwives during the second stage of labour and perineal repair in the UK.
  
  
  METHODS
  Postal survey.
  
  
  METHODS
  Self-complete questionnaires were sent to Heads of Midwifery in all 219 maternity units in the UK. Information was requested on the number and type of deliveries undertaken in the previous year and on the midwifery procedures used to provide pain relief immediately before delivery and for perineal repair. Details were also sought on local anaesthetics given before episiotomy or perineal repair.
  
  
  RESULTS
  207 completed questionnaires were returned providing information on 210 maternity units. Midwives reported using a variety of non-pharmacological analgesic methods to control pain at the end of the second stage of labour. Hot packs were used in 70 (33%) maternity units, cold packs in 44 (21%) and perineal massage in 109 (52%). Midwives in 131 (62%) maternity units used injectable local anaesthetics to control perineal pain. All units advocated use of local anaesthetic before episiotomy or perineal repair, but the reported doses used varied widely.
  
  
  CONCLUSIONS
  The literature on levels of pain experienced immediately before spontaneous vaginal delivery and during perineal repair is sparse, but what evidence exists suggests that, for some women, these occasions are accompanied by severe pain. Findings from this survey show that there is considerable variation in what midwives provide to control pain. Formal evaluation of the perineal analgesia offered to women during the second stage of labour is urgently required.
authors.affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK. julia.sanders@bristol.ac.uk
authors.forename: Julia
authors.initials: J
authors.lastname: Sanders
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
mesh_terms: D016362:Analgesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local; D004841:Episiotomy / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007748:Labor Stage, Second; D008880:Midwifery / Q000379:methods*; D010146:Pain / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D006113:United Kingdom
chemical_list: D000779:Anesthetics, Local