• Hannah G Dahlen, Caroline S E Homer, Margaret Cooke, Alexis M Upton, Rosalie A Nunn, and Belinda S Brodrick.
• Sydney South Western Area Health Service, Eastern Sector, Australia.
• Midwifery. 2009 Apr 1;25(2):e39-48.

Objectiveto determine women's and midwives' experiences of using perineal warm packs in the second stage of labour.Designas 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.Settingtwo hospitals in Sydney, Australia.Participantsa 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.Interventionwarm, moist packs were applied to the perineum in the late second stage of labour.Findingswarm 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.Key Conclusionsresponses 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.Implications For Practiceperineal warm packs should be incorporated into second stage pain relief options available to women during childbirth.

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