Warm Red Bean Packs Ease Labor Pain in Landmark Randomized Trial

One of the most universally feared aspects of childbirth is the intense pain that accompanies the second stage of labor, the period when the cervix is fully dilated and the mother begins to push. While epidural analgesia and other pharmacological options remain mainstays of modern obstetric care, many women seek or require non-drug alternatives, whether because of medical contraindications, personal preference, or the simple reality that medications cannot always be immediately available. Into this gap steps a deceptively humble intervention: a warm pack filled with red beans, pressed against the perineum during the most demanding moments of delivery. A new randomized controlled trial conducted at a maternity hospital in Shanghai, China, and published in BMC Complementary Medicine and Therapies, offers some of the most rigorous clinical evidence to date that this simple technique can meaningfully reduce labor pain and improve maternal comfort, even if its effects on other birth outcomes appear more limited.

The study, led by Na Wu and Wei Li of Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, together with colleagues including JingHuan Gong, Hui Jiang, Rong Huang, and Hao Ying, enrolled 138 eligible women who were in the second stage of labor. Between May 20 and June 20, 2023, participants were randomly assigned to either an experimental group or a control group. Women in the experimental group received a perineal warm compress using a red bean pack continuously throughout the second stage of labor, while those in the control group received standard labor nursing care alone. The trial was registered prospectively with the Chinese Clinical Trial Registry on May 18, 2023, under registration number ChiCTR2300071552, and received ethics approval from the Institutional Review Board of the School of Medicine, Tongji University, adding methodological credibility to what might otherwise be dismissed as folk remedy enthusiasm.

The choice of a red bean pack as the heat-delivery medium is both practical and scientifically sensible. Warm compresses have long been recommended in routine labor nursing care as a non-pharmacological pain relief strategy, but the physical carrier of that heat matters. Granular fills such as red beans conform to the contours of the body, retain warmth for extended periods, and can be reheated and applied safely in a delivery room setting. Unlike water-based compresses, which cool quickly and require constant replacement, a bean-filled pack maintains a steady, gentle warmth against the skin. The pack used in this study was prepared by a midwife, XiYing Li, whose contribution the authors specifically acknowledge, underscoring the grassroots, bedside origin of the technique. In an era when obstetric interventions grow ever more technologically complex, there is a certain viral appeal to the idea that a bag of beans might outperform expectations in the delivery room.

The researchers structured their outcome assessments with careful timing. Measurements were taken at full cervical dilation, meaning ten centimeters, and again thirty minutes after the warm compress was initiated in the experimental group. For the control group, assessments occurred thirty minutes after the start of maternal pushing, ensuring that both groups were evaluated over comparable intervals of active second-stage labor. Data collection relied on three instruments: a demographic and obstetric characteristics questionnaire, the numerical pain rating scale, which asks patients to score their pain on a numeric continuum, and a specialized warm compress evaluation form designed for the study. This combination allowed the team to capture not only subjective pain intensity but also broader dimensions of the birth experience, including anxiety, self-control, and physical perineal outcomes.

The headline finding is straightforward and clinically important. In the experimental group, statistically significant differences were observed between pre- and post-intervention scores for pain intensity and maternal comfort following warm compress administration, with p values below 0.05. In plain terms, women who received the warm red bean pack reported less pain and greater comfort after the intervention compared with their own baseline measurements at full dilation. For a technique that costs almost nothing, involves no drugs, and carries essentially no pharmacological risk to mother or baby, a demonstrable reduction in labor pain is a result worth taking seriously. The numerical pain rating scale is a validated and widely used instrument, and the within-group design, comparing each woman to her own pre-intervention state, helps control for the enormous individual variation in pain perception and labor progression.

Equally instructive, however, are the outcomes that did not change. The researchers found no significant between-group differences in maternal anxiety levels, self-control capacity, perineal length and elasticity, perineal trauma, one-minute Apgar scores of the newborns, or the duration of the second stage of labor, with p values of 0.201, 0.853, 0.301, 0.668, and 0.160 respectively. This pattern of results is scientifically coherent rather than disappointing. Warmth applied to the perineum appears to act primarily through local mechanisms, modulating nociceptive signaling in the skin and underlying tissues and promoting relaxation and comfort, rather than altering the fundamental biomechanics of delivery. The second stage of labor lasts as long as it lasts, the perineum stretches as it must, and the baby’s condition at birth, as reflected in Apgar scores, remains unaffected. The intervention’s value lies squarely in how the mother feels during the process.

This distinction matters for how the findings should be translated into practice. Perineal trauma, including tearing and episiotomy, has been a longstanding target of perineal warm compress research, with earlier studies in the broader literature suggesting possible protective effects. The present trial, however, found no significant difference in perineal trauma between groups, and clinicians should therefore not oversell the technique as a way to prevent tearing based on this evidence. What the trial does support is a comfort and pain management role. The authors conclude that perineal warm compress with a red bean pack proved to be a convenient and effective non-pharmacological approach to alleviate labor pain and enhance maternal comfort during the second stage of labor, and they argue that these findings provide robust clinical evidence to inform evidence-based practice for non-pharmacological labor pain management in routine obstetric nursing care.

The broader context makes the result more compelling. Labor pain is among the most severe forms of acute pain that humans routinely experience, and the second stage, with the added sensations of pressure, stretching, and pushing, is often described as its peak. Non-pharmacological strategies, including breathing techniques, hydrotherapy, massage, movement, and warm compresses, occupy an important tier of the pain management ladder because they can be used alone, layered beneath epidurals, or deployed in settings where anesthesia services are limited. In many parts of the world, access to neuraxial analgesia is far from universal, and low-cost, low-technology interventions are not merely nice to have; they are the mainstay. A technique requiring only a fabric pack, a heat source, and a trained attendant fits comfortably within the resource envelope of nearly any maternity ward on earth.

There is also a physiological rationale worth articulating. Heat applied to the skin activates thermoreceptors that can partially gate the transmission of pain signals through the dorsal horn of the spinal cord, a phenomenon consistent with the gate control theory of pain. Local warmth also increases blood flow, reduces muscle tension, and may dampen the reflexive guarding of the pelvic floor muscles that can intensify the burning, stretching sensation women report as the fetal head crowns. The perineum, the region of tissue between the vaginal opening and the anus, bears enormous mechanical stress during delivery, and sensitizing of this tissue contributes substantially to second-stage pain. A warm pack addressing that tissue directly is mechanistically well matched to the problem, which may explain why the comfort and pain benefits emerged clearly even while more distant outcomes, such as neonatal Apgar scores, remained untouched.

Certain caveats deserve honest acknowledgment. The trial was conducted at a single maternity hospital in Shanghai over an enrollment window of roughly one month, and while randomization balances known and unknown confounders between groups, replication in other settings, cultures, and health systems would strengthen confidence in generalizability. The abstract reports statistically significant within-group changes for pain and comfort, and the absence of significant between-group differences on several secondary outcomes suggests that some of the observed benefit may reflect natural labor progression or the supportive presence of attentive nursing care. The study was funded by the Shanghai Association for Science and Technology under Grant No. 22DZ2203800, and the authors declare no competing interests. Still, the trial’s prospective registration, randomized design, and transparent reporting of null secondary outcomes mark it as a model of how simple bedside practices should be evaluated. For millions of expectant mothers and the nurses who care for them, the message is quietly empowering: sometimes the most effective tool in the delivery room is warm, simple, and filled with beans.

Subject of Research: Perineal warm compress with a red bean pack for labor pain relief during the second stage of childbirth

Article Title: Impact of a warm red bean pack compress applied to the perineum during labor: a randomized controlled trial

Article References: Wu, N., Li, W., Gong, J., Jiang, H., Huang, R., & Ying, H. (2026). Impact of a warm red bean pack compress applied to the perineum during labor: a randomized controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05531-y

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05531-y

Keywords: labor pain, warm compress, perineum, second stage of labor, randomized controlled trial, non-pharmacological pain relief, maternal comfort, obstetrics, midwifery, red bean pack, childbirth, complementary medicine