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

The study, led by Silvia Rodrigues of the Escola Superior de Enfermagem at the Universidade do Minho in Portugal, together with colleagues from the Hospital of Braga and the Catalan Health Service in Barcelona, drew its participants from a larger randomized controlled trial designed to prevent perineal trauma during vaginal birth. Between March 2019 and December 2020, the researchers recruited women aged 18 or older who were between 37 and 41 weeks pregnant and planning a vaginal delivery of a fetus in the cephalic presentation, meaning head-first, the standard orientation for uncomplicated birth. Of the 848 women enrolled in the parent trial, 800 met the inclusion criteria for this secondary analysis and were allocated evenly: 400 women to the perineal massage and warm compresses group, and 400 to the control group, in which attendants used the hands-on technique of manually supporting the perineum as the baby’s head crowns.

The intervention itself was straightforward but carefully standardized. In the massage and compresses group, birth attendants applied warm compresses to the perineum and performed massage of the perineal tissue during the second stage of labor, the period of active pushing that precedes delivery. The control group received the hands-on technique, in which the midwife or physician places fingers against the perineum to provide counter-pressure and support as the tissue stretches. Both approaches are widely practiced, and the trial was designed to determine whether the gentler, warmth-based alternative could reduce not only tearing during birth, the focus of the parent study, but also the persistent and often debilitating pain that lingers in the weeks and months afterward.

To measure pain, the researchers used the Numerical Rating Scale, a validated instrument in which patients rate their pain intensity on a simple numeric scale, administered at three time points: 24 hours after birth, and again at three and six months postpartum. All 800 women were included in the 24-hour analysis, while 498 women were followed at the three- and six-month assessments. This longitudinal design is one of the study’s strengths, because most research on perineal techniques has focused narrowly on outcomes during delivery, such as the rate of tears or episiotomies, while paying far less attention to how women actually feel once they have gone home with their newborns.

The results told a nuanced story. Women in the massage and warm compresses group did report lower perineal pain at every measured time point compared with the hands-on group, a consistent directional trend across 24 hours, three months, and six months. But the differences were small enough that they could have arisen by chance, and the authors concluded that the technique was not statistically significantly better than the standard approach. Crucially, the intervention was also not associated with more postpartum perineal pain, which means that warm compresses and massage remain a safe option. For a technique with no demonstrated harms, a neutral result still carries practical weight: midwives who prefer the warmth-based approach can continue using it without fear that they are worsening their patients’ recovery.

Perhaps the most clinically consequential finding of the study concerns what actually drives postpartum perineal pain. The researchers found that the occurrence of obstetric anal sphincter injury, a severe tear involving the muscles that control the bowel, and the performance of episiotomy, the surgical incision made to enlarge the birth opening, were the main determinants of perineal pain at 24 hours, three months, and six months after birth. In other words, the severity of the trauma inflicted during delivery, rather than the technique used to support the perineum during crowning, dictated how much women suffered afterward. This aligns with a substantial body of prior research showing that genital trauma severity, suture techniques, and the angle of mediolateral episiotomies all correlate strongly with pain, dyspareunia, and long-term pelvic floor dysfunction.

The implications reach beyond a single hospital ward. Perineal pain after childbirth is not a trivial complaint. It can interfere with breastfeeding, mobility, infant care, sexual function, and the mother’s ability to assume her maternal role, a point the authors emphasize in their rationale for the study. Previous cohort research has documented persistent pelvic and genito-pelvic pain lasting a full year after delivery, and population-based surveys have linked perineal trauma to adverse postpartum psychological outcomes. If the interventions applied during the second stage of labor have only modest effects on downstream pain, then the field’s attention may need to shift toward preventing the severe injuries themselves, through judicious and selective use of episiotomy, improved recognition and repair of sphincter tears, and better postpartum follow-up in dedicated perineal clinics.

The new trial also adds texture to a contested and sometimes confusing evidence base. Systematic reviews and meta-analyses of warm perineal compresses have reported reductions in perineal trauma and pain intensity during labor, and randomized trials of perineal massage, both during pregnancy and during the second stage, have shown mixed effects on episiotomy rates and tearing. A Cochrane review of perineal techniques during the second stage of labor concluded that the evidence for reducing perineal trauma remains limited and heterogeneous. Trials comparing hands-on with hands-off or poised techniques have likewise produced inconsistent results, with some meta-analyses suggesting modest benefits for one approach or the other but no decisive winner. Against this backdrop, the Portuguese trial’s rigorous design, adequate sample size, and long follow-up make its null finding on pain a meaningful data point rather than an outlier to be dismissed.

There are, of course, limits to how far the results can be generalized. The study was conducted at a single center, the Hospital of Braga in Portugal, with ethical approval from the hospital’s ethics committee, and its participants were women planning uncomplicated vaginal births at term. Birth practices, staffing models, and episiotomy policies vary considerably across countries and institutions, and pain is inherently subjective, shaped by cultural expectations, analgesia use, and individual pain thresholds. The loss to follow-up between the 24-hour assessment and the later time points, with 498 of 800 women retained, also introduces the possibility of attrition bias, although the consistency of the pattern across all three time points lends some confidence to the direction of the effect. The trial is registered with ClinicalTrials.gov under identifier NCT05854888, and the authors report no relevant financial or non-financial conflicts of interest.

For clinicians and birthing women alike, the takeaway is one of reassurance rather than revolution. Warm compresses and perineal massage during the second stage of labor neither relieve postpartum pain dramatically nor cause harm, leaving the choice of technique largely to the preferences of the mother and her birth attendant. What matters far more, this study suggests, is whether the delivery ends with an intact perineum or with a sphincter injury or episiotomy, because those are the events that echo through the following six months and beyond. As maternity services worldwide work toward the World Health Organization’s vision of a positive childbirth experience, the message from Braga is clear: the gentlest hands in the delivery room may matter less than the skill to keep tissue intact, and the systems in place to recognize and properly repair the injuries that do occur.

Subject of Research: Effect of perineal massage and warm compresses during the second stage of labor on postpartum perineal pain

Article Title: Effect of Perineal Massage and Warm Compresses Technique in Postpartum Perineal Pain. A Secondary Analysis from a Randomised Controlled Trial

Article References: Rodrigues, S., Silva, P., Esperança, M., Silva, J. N., & Escuriet, R. (2026). Effect of Perineal Massage and Warm Compresses Technique in Postpartum Perineal Pain. A Secondary Analysis from a Randomised Controlled Trial. Reproductive Sciences. https://doi.org/10.1007/s43032-026-02204-6

Image Credits: AI Generated

DOI: 10.1007/s43032-026-02204-6

Keywords: perineal massage, warm compresses, postpartum pain, second stage of labor, randomized controlled trial, obstetric anal sphincter injury, episiotomy, perineal trauma, midwifery, childbirth, women's health, Reproductive Sciences