A quasi-experimental study to assess the effectiveness of saddle pillow on episiotomy pain and level of comfort during breastfeeding among postnatal mothers admitted in selected hospitals of district Mohali, Punjab

 

Ms. Astha Gumber

M.Sc Obstetrics and Gynaecological Nursing, Mata Sahib Kaur College of Nursing Balongi, Mohali, Punjab.

*Corresponding Author E-mail: asthagumber01@gmail.com

 

ABSTRACT:

Introduction: Episiotomy pain has immediate and long-term negative effects for women and their babies. One of the negative effects of episiotomy pain is that it interfere with breastfeeding and care of infant. Material and Methods: Quasi-experimental design was adopted. Study was conducted in civil hospitals of phase VI, Mohali and Kharar. 80 postnatal mothers were selected by using Non-probability purposive sampling technique. Result: The finding of the present study showed that postnatal mothers in the experimental group experienced less episiotomy pain and were found to be more comfortable as compared to the postnatal mothers in the control group. Conclusion: This study concluded that saddle pillow is helpful in reducing episiotomy pain and increasing comfort during breastfeeding among postnatal mothers.

 

KEYWORDS: Effectiveness, saddle pillow, episiotomy pain, level of comfort, breastfeeding, postnatal mothers.

 

 


 

INTRODUCTION:

Labour is an amazing act of nature and unique to every childbearing woman. Childbirth is a transformative event in woman’s life. The beginning of motherhood presents a unique set of physical, emotional and psychological challenges. The post-partum phase can become even more challenging when the new mother experiences perineal or genital tract trauma as a result of child birth.1

 

 

Breastfeeding is the best natural feeding and breast milk is best milk. Breastfeeding is the most effective way to provide a baby with complete food in a caring environment. It meets the nutritional, emotional as well as psychological needs of the infant.2

 

Breastfeeding promotes close physical and emotional bondage of newborn with the mother by frequent skin to skin contact, attention and interaction. Mothers should be comfortable and relaxed physically while giving breast feeding. Duration of breast feeding should be continued till the baby is satisfied. Many a times this duration of feeding is greatly affected by the health status of mother such as episiotomy or any physical trauma during delivery.2

 

All these factors described above and by personal experience of researcher during clinical posting in postnatal ward, it was found that most of the mothers who had undergone normal vaginal delivery with episiotomy had complaints of pain and discomfort, which distract the mother, interfere with initial bonding process with her baby, dominate the feelings of motherhood and has negative impact on woman’s ability to care for their newborns which, in turns significantly affects the breastfeeding. There are many alternatives provided to postnatal mothers as a part of regular care such as sitz bath, application of betadine ointment on episiotomy wound, which influence wound healing but do not act primarily on pain and discomfort. So, mothers were in great need for relief from pain and discomfort for effective breastfeeding and provide newborn care. Hence, all these factors evoked a thought in researcher’s mind that there is a strong need to evaluate the effectiveness of saddle pillow on episiotomy pain and level of comfort during breastfeeding among postnatal mothers.

 

MATERIAL AND METHODS:

Research approach:

The selected research approach for this study was quantitative research approach.

 

Research design:

Quasi-experimental research design was used.

 

Setting of the study:

The study was conducted in civil hospitals of phase VI, Mohali and Kharar.

 

Population:

In this study, the accessible population was postnatal mothers undergone normal or instrumental vaginal delivery with episiotomy admitted in civil hospitals of phase VI, Mohali and Kharar.

 

Sample technique:

The samples for this study were selected by using Non-Probability purposive sampling technique according to inclusive criteria and availabilitry of samples.

 

Criteria for sample selection:

The inclusion as well as exclusion criteria used for the present study is as follow:

 

Inclusion criteria:

Postnatal mothers who:

1    Had undergone normal or instrumental vaginal delivery with episiotomy in selected hospitals of district Mohali, Punjab.

2    Were willing to participate in the study.

3    Were able to read and understand english/hindi/punjabi.

4    Were available during data collection period.

 

Exclusion criteria:

Postnatal mothers who had:

1    Perineal tears.

2    Developed postpartum complications.

3    Contraindications to breastfeeding.

4    Babies with complications like cleft lip, cleft palate etc. (cannot took breastfeed).

5    Problem in breastfeeding due to breast and nipple complications.

6    Babies admitted in Neonatal intensive care unit (NICU).

 

Development of tool:

Numerical pain rating scale was used to measure the episiotomy pain during breastfeeding while self-structured comfort assessment scale was developed by the researcher to assess the level of comfort during breastfeeding.

 

Section A:

Socio-demographic variables: This section consisted of six variables to collect baseline information such as age, educational status, working status, type of family, monthly family income and dietary pattern.

 

Section B:

Clinical profile: This section consisted of two items which were body built and parity.

 

Section C:

Numerical pain rating scale: This horizontal scale consisted of 0 to 10 scores in which mother had to put tick mark on the number according to her intensity of episiotomy pain during breastfeeding. 0 being no pain and 10 being the worst pain experienced by the mother. Intensity of pain was divided into four categories that is no pain (0), mild pain (1-3), moderate pain (4-6) and severe pain (7-10).

 

Section D: Self-structured comfort assessment scale: This scale consisted of three landmarks indicating different level of comfort, on which mother have to put tick mark according to her presumed level of comfort during breastfeeding.

 

Data collection procedure:

Pre-test was conducted 6 hours after the delivery, during breastfeeding on postnatal day 0, for both experimental and control group. Saddle pillow was provided to postnatal mothers of experimental group, during breastfeeding from postnatal day 0, 1 and 2. Post-test was conducted on postnatal day 1 and 2, for both experimental and control group.

 

Saddle pillow is a comfort device of 16 × 18 inches in size and 1.3 inches thick with three parts - anterior pubic part, middle perineal part, and posterior coccyx part. It is made up of soft resilience foam throughout, but in the anterior aspect near the symphysis pubis region, there is card board to prevent adduction of legs and it has a hollow space (18 × 18 × 10cm) in the mid to accommodate the perineal area.

 

RESULTS:

SECTION I:

Frequency and percentage distribution of socio-demographic variables and clinical profile among postnatal mothers of both experimental and control group:

The obtained chi-square values in the socio-demographic variables and clinical profile of the groups revealed that there is no significant difference between the groups. It denotes that there is homogeneity between the groups.

 

SECTION II:

Pre-test episiotomy pain and level of comfort during breastfeeding among postnatal mothers in experimental and control group:

All the postnatal mothers experienced severe pain in the experimental group, whereas mild pain was reported by 1, moderate pain was reported by 2 and severe pain was reported by 37 postnatal mothers in the control group.

 

Not even a single postnatal mother experienced comfort in both the groups, none in experimental group and 2 in 56control group experienced mild comfort, while all postnatal mothers in experimental group and 38 in control group experienced no comfort.

 

SECTION III:

Post-test episiotomy pain and level of comfort during breastfeeding on postnatal day I and II among experimental and control group:

Considering post-test 1 and 2, none of postnatal mother reported no pain in both experimental and control group. In experimental group, 6 in post-test 1 and 35 in post-test 2 reported mild pain whereas in control group, 2 in both post-test 1 and 2 reported mild pain. 34 in post-test 1 and 5 in post-test 2 in experimental group and 3 in post-test 1 and 12 in post-test 2 in control group had moderate pain. None of postnatal mother reported severe pain in post-test 1 and 2 in experimental group, whereas 35 in post-test 1 and 26 in post-test 2 reported severe pain in control group.

 

Considering post-test level of comfort during breastfeeding between both the groups, 9 postnatal mothers in post-test 1 and 27 in post-test 2 were experienced comfort in experimental group while none of postnatal mother experienced comfort in post-test 1 and 2 in control group. 31 in post-test 1, 13 in post-test 2 in experimental group and 7 in post-test 1, 13 in post-test 2 in control group experienced mild comfort. None of the postnatal mother fall in the category of no comfort for both post-test 1 and 2 in experimental group whereas 33 in post-test 1 and 27 in post-test 2 falls in the category of no comfort from the control group.

 

SECTION IV:

Effectiveness of saddle pillow on episiotomy pain and level of comfort during breastfeeding among postnatal mothers:

Repeated ANOVA shows the episiotomy pain and level of comfort during breastfeeding among postnatal mothers in pre-test, post-test 1 and post-test 2 within the experimental group.

 

For episiotomy pain during breastfeeding, the pre-test mean was 9.03, it was reduced to approximately half in post-test 1 and further more reduced in post-test 2. So, the p-value (0.000*) was statistically highly significant. This shows that after the use of saddle pillow, episiotomy pain during breastfeeding decreases as the postnatal day advances.

 

For level of comfort during breastfeeding, the pre-test mean was 1.00, it was increased approximately to more than half in post-test 1 and further more increased in post-test 2. So, the p-value (0.000*) was statistically highly significant. This shows that after the use of saddle pillow, level of comfort during breastfeeding increases as the postnatal day advances.


 

 

 

Table 1: Unpaired t test showing episiotomy pain during breastfeeding among postnatal mothers in experimental and control group.          N=80

Episiotomy pain during breastfeeding

Mean

S.D.

unpaired t test

p-value

Pre-test

Experimental group

9.03

0.733

1.657

0.1015

Control group

8.60

1.446

Post-test 1

Experimental group

4.48

0.960

11.113

0.0000*

Control group

7.75

1.597

Post-test 2

Experimental group

2.38

1.030

15.160

0.0000*

Control group

6.90

1.582

(*significant)                                                                                                                                                                       P< 0.05

 

 

 

Table 2: Unpaired t test showing level of comfort during breastfeeding among postnatal mothers in experimental and control group.      N=80

Level of comfort during breastfeeding

Mean

S. D

unpaired t test

p-value

Pre-test

Experimental group

1.00

0.000

1.433

0.1554

Control group

1.05

0.221

Post-test 1

Experimental group

2.23

0.423

11.614

0.0000*

Control group

1.18

0.385

Post-test 2

Experimental group

2.68

0.474

12.728

0.0000*

Control group

1.33

0.474

(*significant)                                                                                                                                           P< 0.05

 


 

SECTION V:

Association between episiotomy pain and level of comfort during breastfeeding (post-test 2) with selected socio-demographic variables and clinical profile of postnatal mothers in experimental and control group:

The chi-square revealed that there is a significant association between the parity and episiotomy pain during breastfeeding in experimental group while, there is a significant association between the age and working status with episiotomy pain during breastfeeding in control group.

 

The chi-square revealed that there is a significant association between the age and level of comfort during breastfeeding in experimental group while, there is a significant association between the age and working status with level of comfort during breastfeeding in control group.

 

DISCUSSION:

This study showed that after the use of saddle pillow, episiotomy pain during breastfeeding decreases as the postnatal day advances, and level of comfort during breastfeeding increases as the postnatal day advances.

 

Similar findings were reported by Saidy TMK, Aboushady RMN, Soliman HFA. 2018 to assess the effectiveness of applying crushed ice gel pads on episiotomy pain among postpartum primiparous women in Egypt. Numerical pain rating scale was used to assess the episiotomy pain at day 1, 3 and 7. The results revealed that in experimental group on day 1, 98 postpartum mothers experienced severe pain, 2 experienced moderate pain, none of them experienced mild and no pain, while on day 3, 18 postpartum mothers experienced severe pain, 82 experienced moderate pain and none of them experienced mild and no pain. On day 7, none of them experienced severe, moderate and mild pain, whereas all of them experienced no pain.3

 

A similar study was conducted by Krishnan SN, Anbupriya M, Sivakumar V. 2017 in Tamil Nadu to find out the effectiveness of low-cost customized saddle pillow on pain in post-episiotomy patients. In comparing the post-test 1 and 2 for episiotomy pain, there was significant difference between the experimental and control group. The study conducted that saddle pillow reduces the episiotomy pain among the experimental group when compared to the control group.4

 

REFERENCES:

1.     Varghese RA, D Malathi. Effect of hot application on level of episiotomy pain: A quasi experimental study Research paper. 2016; 5(1), ISSN No.2277 - 8160.

2.     Dutta P. Pediatric Nursing. 2nd ed. Jaypee publisher 2009.

3.     Saidy TMK, Aboushady RMN, Soliman HFA. Effect of applying crushed ice gel pads on episiotomy pain and wound healing among postpartum primiparous women. International journal of nursing didactics. 2018. 8(07). Available from: https://doi.org/10.15520/ijnd.v8i07.2223

4.     Krishnan SN, Anbupriya M, Sivakumar V. Effectiveness of low-cost customized saddle pillow on pain in post-episiotomy patients. Asian Journal of Pharmaceutical and Clinical Research.2017; Vol.10. Issue 12. DOI: 10.22159/ajpcr.2017.v10i12.20932Available from: https://www.researchgate.net/ zpublication/321494167_Effectiveness_of_lowcost_customized_saddle_pillow_on_pain_in_post-episiotomy_patients#downloadCitation

 

 

 

 

Received on 19.12.2020          Modified on 13.02.2021

Accepted on 16.03.2021     ©AandV Publications All right reserved

Int.  J. of Advances in Nur. Management. 2021; 9(2):200-203.

DOI: 10.5958/2454-2652.2021.00045.7