INTRODUCTION:

For Women, Postpartum is a very special period for a woman and her family because of their closer affinity to their children, it is usually joyful when a pregnant mother gives birth to a baby she has expected. Despite the pain and discomfort, birth is a long-awaited grand ending of a pregnancy and a start of a new life. A mother is the beginning of a new chapter of human life. That’s why mothers are special and labour is precious.²

Frazer DM.et.al., (2005) has stated that pain in labour is a universal experience for childbearing women. Following the birth of the baby and expulsion of the placenta, the mother enters a period of physical and psychological recuperation. From a medical and physiological view point this period is called the puerperium, which is a crucial period for the mother. During this period, mother’s experience some discomforts maybe as a result of trauma during child birth, due to an episiotomy, a spontaneous tear or a combination of both. They are considered as normal common discomforts of puerperium period. These common discomforts such as after birth pain, perineal pain, fatigue, constipation, breast engorgement, lactation suppression, headache, backache, can lead to physical discomfort, psychological distress and a poor quality of life for the mothers.¹

Thorpe H, (2014) explained that Episiotomy was introduced as an obstetric procedure more than 200 years ago and became a common practice from the beginning 20thcentury. Episiotomy (“unkindest cut of all”), defined as a surgical procedure performed during second stage of labour to enlarge the vaginal intriotus and to shorten the second stage of labour in cases of foetal distress. Episiotomy is protective against more severe perineal lacerations. Considerable evidences of risks are also associated with episiotomy such as pain, oedema, infection, and ultimately dyspareunia. The prompt use of the best selected treatment for any injury including, an episiotomy, ensures it will heal completely, in the shortest possible time, with the least amount of complications. So midwives have an important role to play in the care of perineal wounds following childbirth.³

There are several treatments for relieving perineal pain and promoting wound healing. There are Several Pharmacological and non-pharmacological methods used to treat this discomfort. Pharmacological pain relief methods are not advisable because it is associated with serious adverse effects such as constipation, gastric irritation, passage of the drug to maternal milk, and prolonged bleeding time. The common non-pharmacological methods are the use of ice packs, and heat application. Ice packs during the first hours postpartum is a traditional method used for the immediate symptomatic relief of pain since it anesthetizes the perineum.⁷

NEED FOR THE STUDY:

Sister Cary cororia. (2013) A sitz bath involves immersion of the perineal area/ buttocks in warm water (potassium permanganate) at a temperature of 105 to 110 degree F for 15 to 20 minutes. It is used to relive discomfort. The bath promotes wound healing by cleaning the perineum and anus, increasing circulation, and reducing inflammation, it also helps to relax local muscles.⁸

Sheoran.P and Chand. S done a comparative study on effectiveness of infrared light therapy vs sitz bath on episiotomy wound healing among 60 postnatal mothers with episiotomy in Karnataka reveals that sitz bath was significantly more effective in promoting episiotomy wound healing as compared to infrared light.

Postnatal mothers with episiotomy wound experience pain and discomfort that dominates the feeling of motherhood and it has many negative impacts on women’s ability to care for their newborns, their ability for breast feeding and attending to their babies needs would decrease significantly. So it is important to facilitate safe motherhood among postnatal mothers with episiotomy wound by reducing the pain and discomfort with effective measures of wound healing. Findings of above studies shown that sitz bath is effective in episiotomy wound healing. So the researcher felt the need for selecting this topic to draw generalization of findings.

Regarding effectiveness of sitz bath on episiotomy wound healing.³

STATEMENT OF THE PROBLEM:

A study to evaluate the Effectiveness of sitz bath on episiotomy wound healing among postnatal mothers in Aravindan hospitals at Coimbatore.

OBJECTIVES OF THE STUDY:

1. To assess the episiotomy wound healing among postnatal mothers both in experimental and control group.

2. To administer Sitz Bath Application to mothers in Experimental Group

3. To evaluate the effectiveness of sitz bath on episiotomy wound healing among postnatal mothers in experimental group.

4. To compare the effectiveness of sitz bath on episiotomy wound healing among postnatal mothers between experimental and control group

5. To find out the association between the post observational episiotomy wound healing scores of postnatal with selected demographic variable.

HYPOTHESIS:

H1: There will be a significant difference between pre and post observational episiotomy wound healing scores of postnatal mothers in experimental group.

H2: There will be a significant difference between post observational episiotomy wound healing scores of postnatal mothers both in experimental and control group.

H3: There will be a significant association difference between post observational episiotomy wound healing scores of postnatal mothers with their selected demographicvariables both in experimental and control group.

MATERIAL AND METHODS:

Research approach and design:

Quantitative research approach was adopted in this study. Research design adopted for this study was quasi experimental design.

Table 1. Research design

Groups

Day-1 Pretest (01)

Day-1 to Day-5

Intervention (X)

Day-5 Post test (02)

Experimental

group

Assess theepisiotomy

wound healing status by using REEDA and

Visual Analog pain scale

Application of sitzbath twice a day for 5 days

Reassessment of episiotomyWound healing status by using REEDA and Visual Analog pain scale

Control Group

No intervention

Setting of the study:

The study was conducted among Postnatal mothers with episiotomy wound in Aravindan Hospital in Coimbatore.

Population and sampling:

The population for the study were postnatal mothers with episiotomy wound at Aravindan Hospital in Coimbatore.

Sample technique and sample size:

Non probability convenient sampling technique was used in this study. The sample size for the study was 60 postnatal mothers. Among which 30 were in the experimental group and 30 mothers were in control group. They were selected based on inclusion criteria.

Inclusion criteria:

1. The samples who are willing to participate in the study

2. Postnatal mothers who had normal vaginal delivery with right or left Mediolateral episiotomy

3. Normal delivery following 12 hours of episiotomy.

Exclusion criteria:

1. Postnatal mothers with infected perineum and sexually transmitted disease.

2. Postnatal mothers who had instrumental delivery with episiotomy.

Instrument and tools of data collection:

Section A: Demographic variables :

This section consisted of ten items pertained to the postnatal mothers namely age, religion, educational status, occupation, monthly income, type of family, place of residence, source of information ,type of episiotomy and state of parity.

Section B Clinical estimation of wound healing based on Reeda scale was selected on the basis of the objectives of the study as it was considered to be the most appropriate instrument to observe and evaluate the condition of episiotomy wound

Section -C:- Visual Analog Pain scale to assess level of pain for postnatal mothers.

Scoring and interpretation For REEDA scale:

The standardized REEDA scale was used by the investigator reviewing literature in text books of Obstetrical and gynecological nursing and also from the electronic sources. This tool is considered to be a reliable tool for assessment of episiotomy wound healing.

There were totally 5 aspects in the REEDA scale for assessing the episiotomy wound healing status among postnatal mothers.

Each assessment area such as Redness, Edema, Ecchymosis, Discharge and Approximation of the wound (REEDA Parameters) were given as minimum scores of one and maximum scores of three.

The interpretation of REEDA scale score is as follows: -

REEDA Range Percentage:

1 No infection -0 -0%

2 Mild infection 1-5 1-33.3%

3 Moderate infection 6-10 33.34-66.6%

4 Severe infection 11-15 66.67-100%

For Pain scale:

The pain scale having 4 categories for assessing the level of pain for postnatal mothers. This tool was used by the investigator reviewing literature in text books of Obstetrical and gynecological nursing and also from the electronic sources.

The interpretation of Pain scale score is as follows:

No Pain 0%

Mild Pain 1-3 -1-30%

Moderate Pain 4-6- 31-60%

Severe Pain 7-10 -61-100%

Ethical consideration:

Formal permission was obtained from the Managing Director of Aravindan hospital Coimbatore. Informed consent was taken from the samples of the studyafter explaining about the purpose of the study and about the confidentiality. No ethical issues rouse during the study.

Data Collection Procedure:

Permission was obtained from the Managing Director. The investigator identified the mother that fulfilled the inclusion criteria. The mothers were explained about the purpose of the study in a compassionate manner and necessary precautions were taken to provide privacy and confidentiality. Pretest was conducted by assessing the episiotomy wound based on the Reeda and visual analog pain scale. On the same day sitz bath application was administered two times a day to the experimental group mothers for five consecutive days. On the fifth day posttest was conducted to both experimental and control group mothers by using the same assessment scale to find out the effectiveness.

DATA ANALYSIS AND INTERPRETATION:

Table 2- Pre-test Percentage distributions of REEDA scale for episiotomy wound both in experimental and control group (n=60)

Reeda	Experimental Group		Control Group
Reeda	F	%	F	%
No infection	0	0	0	0
Mild (1-33.33)	0	0	0	0
Moderate (33.34-66.66)	0	0	0	0
Severe (66.7-100)	30	100	30	100
Total	30	100	30	100

Table 3:- Pre-test Percentage distributions of pain scale for episiotomy wound both in experimental and control group(n = 60)

Pain	Experimental Group		Control Group
Pain	F	%	F	%
No Pain	0	0	0	0
Mild	0	0	0	0
Moderate	0	0	0	0
Severe	0	0	0	0
	30	100	30	100
Total	30	100	30	100

The findings reveal that application of sitz bath is highlyeffective on severe redness (63.3%), severe oedema (876%), severe ecchymosis (83.3%), severe discharge (93.3%) and poor approximation of wound (90%). Post-test on 3rd revealed that they had moderate redness (30%), moderate oedema (34.3%), mild ecchymosis (27.6%), moderate discharge (38.6%) and improveapproximation of wound(27.6%).For all parameters of REEDA calculated t-value >p-value, which infers that application of sitz bath is statistically highly effective for healing ofepisiotomy at 0.05 level of significance. Hence H1 is accepted.

Table 4: Effectiveness of sitz bath on episiotomy wound healing based on the parameters of REEDA score in experimental group(n=30)

Parameters		Mean		Standard deviation	Paired ttest	P- Value (0.05, df=29
Parameters		F	%	Standard deviation	10.3	2.05
Redness	day -1 (pretest)	1.9	63.3	0.3
Redness	Day5-posttest)	0.9	30	0.53
Oedema	day -1 (pretest)	2.63	87.6	.6 0.5	17	2.05
Oedema	Day5-posttest)	1.03	34.3	0.41	17	2.05
Ecchymosis	day -1 (pretest)	2.5	83.3	0.5	11.4	2.05
Ecchymosis	Day5-posttest)	0.83	27.6	0.52	11.4	2.05
Discharge	day -1 (pretest)	2.8	93.3	0.4	11.6	2.05
Discharge	Day5-posttest)	1.16	38.6	0.50	11.6	2.05
Approximation of wound	day -1 (pretest)	2.7	90	0.2	14	2.05
Approximation of wound	Day5-posttest)	0.83	27.6	0.59	14	2.05

Table 5. Effectiveness of sitz bath on episiotomy wound healing by using pain scale in experimental group (n=30)

	Mean	Standard Deviation	T test	P value
Day-1 (pre -test)	7.7	1.09	22*	2.05
Day-5 (post test)	1.56	1.09	22*	2.05

Table 6:- post-test analysis of effectiveness of sitz bath on episiotomy woundhealing based on the parameters of REEDA score between experimental andcontrol group (n=60)

Parameters		Mean		Standard deviation	Unpaired t test	P- value (0.05, df=29
Parameters		F	%	Standard deviation	8.18*	2.663
Redness	Experimentalgroup	0.9	45	0.53
Redness	control group	1.8	90	0.4
Oedema	Experimentalgroup	1.03	34.3	0.41	6 6.09*	2.663
Oedema	control group	1.7	6.6	0.51	6 6.09*	2.663
Ecchymosis	Experimentalgroup	0.83	27.6	0.52	2 2.26	2.663
Ecchymosis	control group	1.6	53.3	0.58	2 2.26	2.663
Discharge	Experimentalgroup	1.16	38.6	0.50	1 1	2.663
Discharge	control group	1.6	53.3	0.77	1 1	2.663
Approximation of wound	Experimentalgroup	0.83	27.6	0.59	1 1.8	2.663
Approximation of wound	control group	1.46	48.6	0.60	1 1.8	2.663

The table 5 depicts calculated t-value is 22 > 2.05, which infers that application of sitz bath is statistically highly effective for healing of episiotomy wound at 0.05 level of significance. Hence H1 is accepted.

The table 6 depicts the application of sitz bath is highly effective in experimental group based on REEDA parameters as per redness (45%) in experimental group when compared to control group redness (90%), discharge (38.6) in experimental group when compared to control group discharge (53.3%), edema (34%) in experimental group when compared to control groupedema (56.6%), ecchymoseis (7.6%) in experimental group when compared tocontrol group ecchymosis (53.3%) and on approximation of wound (27.6%) when compared to control group approximation of wound (47.6%). Hence H2 is accepted.

The findings also depicts calculated ‘t’ value >P value for all parameters of REEDA infers that application of sitz bath for experimental group is statistically highly effective for healing of episiotomy wound at 0.05 level of significance for experimental group. Hence H2 is accepted.

Table 7: Post-test analysis of effectiveness of sitz bath on episiotomy wound healing by using pain scale between experimental and control group (n=60)

Mean

Standard Deviation

Unpaired

T test

P value

(0.05, df=58)

Expermental

Group (post -test)

1.56

1.09

5.58*

2.663

Control group

(post test)

2.9

0.95

The above table depicts calculated t- value is 5.58 > 2.663, which infers thatapplication of sitz bath is statistically highly effective in healing of episiotomy at 0.05 level of significance for experimental group. Hence H2 is accepted.

MAJOR FINDINGS OF THE STUDY:

— Maximum respondents in experimental group 11(37%) were in the age groupof 25-30 yrs and in control group 10(33%) were in the age group of 20-25yrs.

— Maximum respondents in experimental group 12(40%) were from Hindu religion and in control group 10(33%) were from Muslim religion.

— Maximum respondents in experimental group 11(36%) had secondaryeducation and in control group 12(40%) had non formal education.

— Maximum respondents in experimental group 17(57%) were unemployed and in control group 19(63%) were unemployed.

— Maximum respondents in experimental group 18(60%) family income were Rs 5,000-10,000 and in control group 22(73%) family income was Rs 5,000-10,000.

— Maximum respondents in experimental group 14(47%) were from nuclearfamily and in control group 13(43%) were from extended family.

— Maximum respondents in experimental group 9(30%) were from rural area and in control group 11(37%) were from semi rural area.

— Maximum respondents in experimental group 16(53%) were obtainedinformation through health care provider and in control group 17(57%) wereobtained information through health care provider.

— Maximum respondents in experimental group 16(53%) had lateral episiotomyand control group 16(53%) had Mediolateral episiotomy.

— Maximum respondents in experimental group 13(43%) were h primiparaand in control group 11(37%) were multipara.

— In pre test scores of REEDA scale all 60(100%) of postnatal mothers hadsevere infection both in experimental and control group.

— In pre test scores of pain scale out of 60 postnatal mothers, majority 26(87%) had severe pain followed by 4(13%) had moderate pain in experimental groupand in control group 23(77%) had severe pain followed by 7(23%) hadmoderate pain.

— Overall post-test (on 5th day i.e, after the application of sitz bath for 5 days) mean scores of REEDA scale (4.76 with SD±0.98) in experimental group found tobe less when compared to the pre test (Day-1) mean scores (12.5 with SD±0.71) and the difference was statistically significant (i.e paired t-value 36.80>2.05 at 0.05 level (of significance).The findings infer the application of sitz bath was highly effective to experimental group.

— Over all Post test (on 5th day i.e after the application of sitz bath for 5 days) mean scores of pain scale 1.56 with SD±1.09 in experimental group found to be less when compared to the post test (day-1) mean scores 7.7 with SD±1.09 and the difference was statistically significant (i.e paired t-value 22>2.05 at level of (significance). The findings infer that the application of sitz bath was highly effective to experimental group.

— Post test (on 5^th day) mean scores of REEDA scale found to be significantlylow 4.76 with SD±0.98 in experimental group when compared to control group 8.33 with SD±1.96 and the difference was statistically significant (unpaired t-value 10.2>2.663 at 0.05 level of significance). The findings infer that the application of sitzbath was highly effective to experimental group.

— Post test (5^th day) mean scores of pain scale found to be significantly low 1.56 with SD±1.09 in experimental group when compared to control group 2.9 with SD± 0.95 and the difference was statistically significant. (Unpaired t-value 5.58>2.663 at 0.05 level of significance). The findings infer that application of sitz bath was highly effective to experimental group.

— Findings revealed that there was no association between post observationalwound healing scores of postnatal women and selected demographic variables such asage, religion, educational status, occupation, family income, type of family, place ofresidence, source of information, type of episiotomy and state of parity both inexperimental and control group.

REFERENCES:

1. Zainur Z. Postpartum morbidity-what we can do.Medical journal of Malaysia.2006 Dec; 61(5): 51-6.

2. Frazer DM, Cooper MA, Myles.Text book for midwives. 14th edition. Churchill Publications. 2005; 2(1): 10-14.

3. Noronha J. Effectiveness of self perineal care on episiotomy wound healing. Indian Journal of Nursing and Midwifery. 2003 Sep; 6: 1.

4. Thacker SB, Banta HD. Benifits and risks of episiotomy. Journal of Medical Association of Obstset and Gynecol. 1983; 38(6): 322-38.

5. Thorpe H, Bowes W. Effect on perineal trauma. Journal Obstet and Gynecol.1992; 79: 945-49.

6. Robinson S, Thompson A. Midwives research and child birth. Journal of Midwifery. 2007 June; 2: 199-251.

7. Joyce H, Lucila C. Pharmacological and non pharmacological treatment for relief of perineal pain after vaginal delivery. 2009; 7(2): 194.

8. Sister Cary Cororia. Text book of principles and practice of nursing art of nursing procedures. 1st edition. Jaypee Publications. 2013; 1: 57-8.

9. Adegbola O. Absorbable suture materials for primary repair of episiotomy andsecond degree tears. The WHO Reproductive Health Library; Geneva. RHL Commentary. 2001 Apr 1st.

Received on 20.01.2021 Modified on 14.02.2021

Int. J. Nur. Edu. and Research. 2021; 9(3):281-286.

DOI: 10.52711/2454-2660.2021.00066