Effectiveness of Infra Red Light Therapy and Sitzbath on Episiotomy Wound Healing Status and Level of Pain Perception among Postnatal Mothers in OBG Ward at Pondicherry Institute of Medical Sciences

 

Mrs. Pon Princess Mano¹, Mrs. Jeyasankari. S², Mrs. Leena L Raju³, Sr. Sumy PJ⁴,

Dr. Rebecca Samson⁵, Dr. Mary Daniel⁶, Dr. Ravichandran⁷

¹Lecturer, College of Nursing PIMS, Puducherry, India

²Vice Dean, College of Nursing PIMS, Puducherry, India

³Asst. Professor, College of Nursing PIMS, Puducherry, India

⁴Asst. Professor, College of Nursing PIMS, Puducherry, India

⁵Dean, College of Nursing PIMS, Puducherry, India

^6.Professor & HOD OBG Department, PIMS, Puducherry, India

^7.Biostatistician, PIMS, Puducherry, India

 

ABSTRACT:

Episiotomy is a common surgical procedure performed during second stage of labor. This is to widen the perineum and prevent severe perineal tears. Episiotomy was introduced as an obstetric procedure more than 200 years ago. However this procedure became a common practice only from the beginning of 20th century. It is now very important to improve new birthing technique that maintains the integrity of the perineum which does not involve surgical procedure. The present study is aimed to compare the effectiveness of infra red light therapy vs. sitz bath on episiotomy in terms of episiotomy wound healing among postnatal mothers. Formal permission was obtained from the Director Principal, Institutional review board, Dean-College of Nursing, Nursing Superintendent and HOD- OBG Department of the P.I.M.S Pondicherry. Consent was obtained from the participants. Reassurance and confidentiality were maintained. Post test only control group design was used. Convenience sampling method was adopted to select the sample based on the inclusion criteria. First thirty five postnatal mothers allocated to group I received sitz bath to the episiotomy for 15-20 minutes. Next 35 postnatal mothers allocated to group 2 received infra red light to the episiotomy for 15 minutes. Each therapy was provided twice daily for three consecutive days. Healing of wound was observed after giving the treatment using REEDA Scale and by using visual analog scale to assess intensity of episiotomy pain. The obtained data was analyzed by using descriptive and inferential statistics. The study findings showed that sitz bath was effective in reducing the episiotomy pain perception (p=0.005) and episiotomy wound healing (p=0.02) compared to infrared light.

 

 

 

 

BACKGROUND OF THE STUDY:

Child birth is a process which is beautifully designed by nature, and also it is a joyous event for the women, family and caregivers. But that joyous event is also associated with some level of pain. The mother may suffer much distress after childbirth due to episiotomy wound and pain. (Annamma Jacob, 2005).

 

Episiotomy is a common surgical procedure performed during second stage of labor. This is to widen the perineum and prevent severe perineal tears. Episiotomy was introduced as an obstetric procedure more than 200 years ago. However this procedure became a common practice only from the beginning of 20th century. It is now very important to improve new birthing technique that maintains the integrity of the perineum which does not involve surgical procedure. (Dutta D.C, 2004).

 

Common reasons to perform an episiotomy were Prolonged second stage of labor, Fetal distress, Vaginal delivery requires assistance with use of forceps or a vacuum extractor, Baby in a breech presentation, Twin or multiple deliveries, Large-sized baby, Abnormal position of the baby's head, and When the mother has a history of pelvic surgery.³

 

Episiotomy is done to enlarge the vaginal introitus to facilitate easy and safe delivery of the fetus, minimize overstretching, rupture of perineal muscles and fascia.

 

OBJECTIVES:

1.     To assess the level of episiotomy wound healing status and level of pain perception among postnatal mothers with sitzbath and infrared light therapy.

2.     To find out the effectiveness of episiotomy wound healing status and level of pain perception among postnatal mothers with sitzbath and infrared light therapy.

 

MATERIAL AND METHODS:

RESEARCH APPROACH:

Quantitative approach

 

STUDY PERIOD:

6 weeks

 

RESEARCH DESIGN:

Post test only control group design

 

RESEARCH SETTING:

Postnatal ward PIMS

 

Population:

The population for the present study comprises of postnatal mothers who delivered vaginally.

 

Sample:

Postnatal mothers who delivered vaginally with right or left mediolateral episiotomy in Pondicherry institute of Medical Sciences.

 

 

 

Sample Size:

The total sample: 70 (Experimental group: 35, Control Group: 35)

 

Sampling Technique:

Convenience sampling technique

 

Sampling Criteria:

1.     Inclusion Criteria:

Postnatal mothers:

·       Includes both primi and multi mothers who had a vaginal delivery with left or right medio lateral episiotomy.

·       Who are in 1^st - 3^rd postnatal day.

 

2.     Exclusion Criteria:

Postnatal mothers:

·       With infected or lateral episiotomy wound and perineal tear.

 

Tool for Data Collection: 

Structured interview schedule was used for the data collection and visual analog scale was used to assess the intensity of episiotomy pain. Tool consists of 2 sections namely section A and Section B.

 

Section A:

It consists of demographic data of subjects such as age, education, occupation, income, type of family, parity.

 

Section B:

Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale was used to assess the episiotomy wound healing status among postnatal mothers. REEDA scale to assess postpartum healing of the perineum following an episiotomy wound.

 

Score Interpretation:

REEDA scale was used to measure the episiotomy wound healing status which has the total score of 15. The score was interpreted as follows,

0 -10 - Good.

11-15 - Excellent.

 

Section: C

Numerical scale was used to assess the intensity of episiotomy pain.

 

Score Interpretation:

Total score - 10. The score was interpreted as follows,

 

 

Procedure:

Formal permission was obtained from the Director Principal, Institutional review board, Dean-College of Nursing, Nursing Superintendent and HOD- OBG Department of the P.I.M.S Pondicherry. Consent was obtained from the participants. Reassurance and confidentiality were maintained. Convenience sampling method was adopted to select the sample based on the inclusion criteria. First thirty five postnatal mothers allocated to group I received sitz bath to the episiotomy for 15-20 minutes. Next 35 postnatal mothers allocated to group 2 received infra red light to the episiotomy for 15 minutes. Each therapy was provided twice daily for three consecutive days. Healing of wound was observed after giving the treatment using REEDA Scale and by using visual analog scale to assess intensity of episiotomy pain. The obtained data was analyzed by using descriptive and inferential statistics.

 

RESULTS:

SECTION A: Socio Demographic Variables of Postnatal Mothers Regarding Episiotomy Wound Healing In Sitz Bath and Infrared

Table 1: Frequency and percentage distribution of Socio Demographic Variables of postnatal mothers regarding episiotomy wound healing in both group.                                                                                                                                                         n=35+35

 

51.4 % postnatal mothers in the group 1 were in the age group of 18-24 years and 54.3% postnatal mothers in group 2 were more than or equal to 25 years. 77.1% were Hindus in both the groups. With regard to education   48.6% in group I and 51.4% in group II were graduates. 94.3.% in group I and   82.9 % in group II were Homemakers. Majority of them, 77.1% earn less than or equal to 10,000 in group I, but 68.6 % in group II earn more than 10,000. 54.3% belong to nuclear family in Group I and 74.3 % belong to joint family in group II. Majority of them 54.3 % have only one child. Majority of them 38(59.4%) have female child.

 

 

 

 

 

Level of episiotomy pain perception in Group I and Group II                                                                n=70

 

 

Level of episiotomy wound healing in Group I and Group II                                                                       n=70

 

 

Comparison of infra red light therapy and sitz bath therapy in terms of Episiotomy pain perception among the postnatal mothers on day 3.               n=70

Post pain score	Group		Total	p value
	Sitzbath	Infrared
No pain	17	5	22	0.005
Mild pain	14	26	40
Moderate pain	4	4	8
Total	35	35	70

   

Comparison of infra red light therapy and sitz bath therapy in terms of wound healing scores among the postnatal mothers on day 3.                                  n=70

Wound healing	Group		Total	p value
	Sitzbath	Infrared
Good	18	30	48	0.002
Excellent	17	5	22
Total	35	35	70

 

DISCUSSION:

There was a statistically significant difference in level of pain perception and episiotomy wound healing between experimental and control group.

 

CONCLUSION:

The study findings showed that sitz bath was effective in reducing the episiotomy pain perception and episiotomy wound healing compared to infrared light.

 

REFERENCE:

1.      Dutta DC (2004) Text book of obstetrics including perinatology and contraception. (6th edn), New central Book Agency, Calcutta.

2.      Annamma jacob

3.      https://www.healthline.com/health/pregnancy/intrapartum-cepisiotomy

4.      https://www.ukessays.com/essays/health-and-social-care/episiotomy-rates-vary-widely-worldwide-health-and-social-care-essay.php

5.      World health organization (WHO) 1998, Report.

6.      World Health organization (WHO) 2000, Report

7.      Fraser DM, Cooper MA (2003) Myles text book for midwives. (14th edn), Churchill Livingstone Philadelphia.

 

 

 

Received on 01.07.2019         Modified on 18.07.2019

Accepted on 03.08.2019       ©A&V Publications All right reserved