For seven and a half years I have been studying ways to reduce perineal trauma and increase comfort during birth as part of my PhD. It is something as a midwife and a mother that I know is vitally important to helping women begin motherhood in the best way possible. It is one of my great passions in life that women should see birth as triumph and not trauma, as victory and not failure.

When I was studying midwifery in the UK I remember very clearly helping a woman give birth who was really struggling. Every time the baby’s head was nearly born she would fight it and literally cross her legs and suck it back up! The burning feeling of the head stretching the perineum, referred to as the ‘ring of fire’ by midwives, was proving too much to cope with. An older midwife I was with left the room, returning minutes later with a bowl of steaming water. She rung out a warm cloth and placed in on the woman’s perineum.

With a sigh and a visible relaxation of her body the baby slid out into my hands with no tearing as a result. Later while studying the history of childbirth I found this technique was as old as birth itself. So why I began to ask has the practice almost disappeared while dangerous and damaging practices like episiotomies (surgical cut to the perineum) have been so widely taken up? Finally I have the evidence to validate an ancient practice that has been dismissed for so long as an, ‘old wives’ tale’.

The perineal warm pack trial

The trial that I conducted in Sydney at two different hospitals was a large, randomised controlled trial designed to test the effect of applying warm packs to the perineum of 717 first time mothers, just prior to giving birth. I wanted to see if we could reduce tearing and pain whilst the baby’s head was being born. By making it a randomised trial we used the most rigorous scientific research method we could. We also rang the mothers up at 6 weeks and 12 weeks after the birth to ask a whole series of health questions.

While there was no difference in the numbers of women who needed suturing following the trial we were surprised to find that warm packs seemed to reduce the most severe kind of tear (tear into the anus) by more than half. While this was important, other findings surprised us even more, like the fact that at twelve weeks, women having warm packs applied were significantly less likely to have urinary incontinence compared to the women who did not have warm packs applied.

The most exciting thing we found in this trial is that warm packs significantly reduced the pain women experienced when giving birth. Women who had warm packs were significantly less likely to say they had “bad pain” giving birth (25% vs 31%) or “the worst in my life” (34% vs 51%) compared with women who did not receive the warm packs. On the first and second day after the birth women also reported less pain in their perineum. Almost the same number of women and midwives (80%) felt that the warm packs reduced perineal pain during the birth. 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%).

This is the largest study yet to be conducted on perineal warm packs and two papers are about to be published in the international journals of Birth and Midwifery.

Page revised on 16th December 2021