title: 'Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour.
abstract: OBJECTIVE
  to determine women's and midwives' experiences of using perineal warm packs in the second stage of labour.
  
  
  METHODS
  as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births.
  
  
  METHODS
  two hospitals in Sydney, Australia.
  
  
  METHODS
  a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or 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. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women.
  
  
  METHODS
  warm, moist packs were applied to the perineum in the late second stage of labour.
  
  
  RESULTS
  warm packs were highly acceptable to both women and midwives as a means of relieving 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 midwives and women were positive about using warm packs in the future. The majority of women (85.7%) said that they would like to use perineal warm packs again for their next birth and 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 routine care in the second stage of labour.
  
  
  CONCLUSIONS
  responses to questionnaires, eliciting experiences of women and midwives involved in the Warm Pack Trial, demonstrated that the practice of applying perineal warm packs in the late second stage of labour was highly acceptable and effective in helping to relieve perineal pain and increase comfort.
  
  
  CONCLUSIONS
  perineal warm packs should be incorporated into second stage pain relief options available to women during childbirth.
authors.affiliation: Sydney South Western Area Health Service, Eastern Sector, Australia.
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Dahlen
authors.forename: Caroline S E
authors.initials: CS
authors.lastname: Homer
authors.forename: Margaret
authors.initials: M
authors.lastname: Cooke
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Upton
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Nunn
authors.forename: Belinda S
authors.initials: BS
authors.lastname: Brodrick
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D048949:Labor Pain / Q000628:therapy*; D007748:Labor Stage, Second / Q000502:physiology*; D008880:Midwifery / Q000379:methods*; D015404:Nursing Methodology Research; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D017060:Patient Satisfaction; D010502:Perineum; D011247:Pregnancy; D055815:Young Adult