A Quasi Experimental Study to Assess the Effectiveness of Sitz Bath on Episiotomy Wound Healing Among Postnatal Mothers Admitted In Postnatal Ward, District Hospital, Maternity Sector Morar, Madhya Pradesh

INTRODUCTION

Pregnancy is a creative and productive period in the life of women and the process of delivery purely depends on the mother and the fetus; here the mother plays a major role in delivering the fetus. Inorder to deliver the baby safely. The birth canal plays a safe and vital role. The structure of this canal varies from individual to individual. Some may have thick vaginal tissues which may not dilate even after the application of fetal axis pressure. So an incision(episiotomy) is made to create the passage sufficiently during the second stage of labor. In this a well-integrated postnatal care has an important role in assisting the transition to promote physical and psychological well-being of mother and baby, Care of the perineum is important for comfort and cleanliness as well as to prevent odour and infection. If the mother has had an episiotomy than it is promoted by keeping this area clean and to increase wound healing sitz bath will be effective

1. To assess the healing of episiotomy wound for experimental and control group. 2. To provide sitz bath to the experimental group. 4. To find out the association between episiotomy wound healing with selected demographic variable and obstetric variables.

H1- There will be significant difference between the healing score of experimental group and control group. H2 - There will be significant association between the healing score of experimental and control group of mothers with selected demographic and obstetric variable.

MATERIAL AND METHODS:

Quantitative research approach and quasi experimental research design was used to conduct the study.

The study was conducted in postnatal ward at district hospital maternity sector morar Gwalior.

A total of 30 postnatal mothers, among 30 mothers 15 were selected for experimental group and remaining 15 for control group were selected by purposive sampling technique.

Inclusive Criteria:

1. Mothers who had vaginal delivery with episiotomy. 2. Mother who have delivered not more than 2 times. Exclusive Criteria: 1. Mothers who had been diagnosed of GDM, AIDS/HIV positive. 2. Mother who have multigravida

Para, economic status, Education, Income type of family, Area, BMI, History of perineal Infection, Hemoglobin level, Type of episiotomy, Suture material, Infant birth weight, Type of episiotomy and its suture,

The wound score was made through REEDA scale. The wound score system includes normal healing process, healing with bruising /edema, ecchymosis, discharge and approximation. The maximum wound score is 15 and the progress of wound status was assessed by REEDA scale. The scale has two ends, lower end indicates wound healing and higher end indicates poor wound healing respectively.

Variables are concepts at different levels of abstraction that are concisely defined to promote their measurement and manipulation within a study. 1. Independent variable: Application of sitz bath on episiotomy.

Progress of wound healing process.

Age, Gravida, Para, economic status, Education, Income type of family, Area, BMI ,History of perineal infection, hemoglobin level, Type of episiotomy, Suture material, Infant birth weight, Type of episiotomy and its suture.

The content validity of the tool was done by experts from the departmentment of obstetric and gynaecological nursing and obstetrician and gynaecologist from the department of morar maternity hospital. The reliability of the tool was established by using data collected from 8 postnatal mothers in district hospital morar Gwalior.The reliability was established by test-retest method which showed (r = 0.995),which was considered as highly reliable and adequate for the study.

Regarding the educational status, 5(33%) were illiterate and 6(40%) had a primary education in experimental group. With regards to occupation, 8(53%) were house wife and 7(47%) were employed in experimental groups. Regarding the monthly income, 12(80%) were between Rs.2000-1000 and 3(20%) Were Rs1000& above in experimental group. Regarding type of family, 8(53%) were nuclear family and 7(47%) joint family in experimental group. With regards to the area 11(73%) rural, and 4(27%) were urban area in experimental group. Considering the BMI 8(53%) were below normal and 7(47%) were normal in experimental group. Regarding the knowledge of episiotomy on postnatal mother 15(100%) did not have knowledge about episiotomy in experimental group. Regarding the age of postnatal mother7 (47%) belongs to the age group of 17 to 20 years, and8 (53%) belongs to the age group of above 20 years in control group. Regarding the educational status, 3(20%) were illiterate and7 (47%) %) had a primary education 11(73%) and 11(73%) control group. Regarding the monthly income 8(53%), were between Rs.2000-1000 and 7(47%) had 1000& above in control group. Regarding type of family, 9(60%) were nuclear family and 6(40%) joint family in control group With regards to the area 11(73%) were rural and 4(47%) were urban in control group. Considering the BMI 8(53%) were below normal and 7(47%) were normal in control group. Regarding the knowledge of episiotomy on postnatal mother 15(100%) did not have knowledge about episiotomy in control group.

Table No. (2) Shows distribution of demographic variable of experimental and control group. Regarding the gravida of mothers, 8(53%) mothers were primi gravid,7(47%) mother were multigravida in experimental group. Considering the parity of mothers, 8(53%) mothers were primipara and 7(47%) were multipara in experimental group. Regarding infection diseases in reproductive tract, 10(66%) did have infection diseased and 5(34%)is having infection disease (virginities) in experimental group. Regarding haemoglobin level, 8(53%) was less than normal and 7(47%) normal in experimental group. Regarding the episiotomy performed, 9(60%) is performed by doctor and 6(40%) is performed by nurse in experimental group. Considering the type of episiotomy, 15(100%) were done mediolateral in experimental group. Regarding the suture material used 15(100%) were used absorbable suture in experimental group. Considering the perineal suture, 7(47%) which performed by doctor and 8(53%) is performed by nurse in experimental group. Regarding pain on incision area, 8(53%) is having pain and 7(47%) is not having pain experimental group. Regarding on antiseptic solution, 15(100%) were using providone iodine on sitz bath in experimental group. Considering on infant birth weight 8(47%) were having 2.5 - 3 kg and 7(47%) were having 3kg infant birth weight in experimental group. Regarding the gravida of mother, 8(53%) mother were primigravid,7(47%) mother were multigravida in control group. Considering the parity of mother, 10(66%) mother were primipara and 5(34%) were multiipara in control group. Regarding any previous surgery on perineum, 1(7%) having surgery and 14(93%) did not have surgery in control group. Regarding infection diseases in reproductive tract, 7(47%) does not had infection diseased on reproductive tract and 8(53%) was having infection disease (virginities) in conrol group. Regarding haemoglobin level,7(47%) was less than normal and 8(53%) normal in control group. Regarding the episiotomy performed, 5(34%) is performed by doctor and 10(40%) is performed by nurse in control group. Regarding the suture material used 15(100%) were used absorbable suture in control group. Considering the perineal suture, 7(47%) which performed by doctor and 8(53%) is performed by nurse in control group. Regarding pain on incision area, 7(47%) is having pain and 8(53%) is not having pain control group. Regarding on antiseptic solution, 7(47%) were used providone iodine,3(20%) were used dettol and 5(34%) was not used any solution on self perineal care in control group. Considering on infant birth weight 4(27%) were having 2.5 - 3 kg and 3(20%) were having 3kg and 8(53%) was had above 3kg infant birth weight in control

that there is association between gravida and healing score in experimental group. Regarding parity the calculated value of χ2 is greater than the tabulated value of χ2 at 5%level of significant; it is concluded that there is an association between parity and healing score in experimental group. Regarding surgery on perineum the calculated value of χ2 is less than the tabulated value of χ2 at 5%level of significant; it is concluded that there is no association between surgery on perineum and healing score in experimental group. With regards to previous infection disease in reproductive tract the calculated value of χ2 is less than the tabulated χ2 at 5%level of significant; it is concluded that there is no association between infection and healing score in experimental group. With regards to hemoglobin the calculated value of χ2 is greater than the tabulated value of χ2 at 5%level of significant; it is concluded that there is an association between hemoglobin and healing score in experimental group. Regarding episiotomy performed the calculated value of χ2 is less than the tabulated value of χ2 at 5% level of significant; it is concluded that there is an association between episiotomy performed and healing score in experimental group. With regards to type of episiotomy the calculated value of χ2 is greater than the tabulated value of χ2 at 5% level of significant; it is concluded that there is an association between type of episiotomy and healing score in experimental group. Regarding suture material used the calculated value of χ2 is less than the tabulated value of χ2 at 5%level of significant; it is conclude that there is no association between suture material and healing score in experimental group. Considering perineal suture performed the calculated value of χ2 is less than the tabulated value of χ2 at 5%level of significant; it is conclude that there is no association between perineal suture and healing score in experimental group. Regarding pain on incision area the calculated value of χ2 is greater than the tabulated value of χ2 at 5% level of significant; it is concluded that there is an association between pain and healing score in experimental group. With regards to antiseptic solution used the calculated value of χ2 is greater than the tabulated Regarding infant birth weight the calculated value of χ2 is less than the tabulated value of χ2 at 5% level of significant; it is concluded that there is an association between infant birth weight and healing score in experimental group.

From, the table no,(7) With regards to age the calculated value of χ2 is less than the tabulated value of χ2 level of significant, it is concluded that there is no association between age and healing score in control group. Regarding education the calculated value of χ2 is less than the tabulated value of χ2 at level of significant; it is concluded that there is no association between education and healing score in control group.

Pertaining to occupation the calculated value of χ2

is less than the tabulated value of χ2 at level of significant; it is concluded that there is no association between occupation and healing score in control group. Regarding to family income the calculated value of χ2 is less than the tabulated value of χ2 at level of significant; it is concluded that there is an association between family income and healing score in control group.

Regarding type of family the calculated value of χ2

is less than the tabulated value of χ2 at level of significant; it is concluded that there is an association between type of family and healing score in control group. area and healing score in control group. Regarding to B.M.I the calculated value of χ2 is less than the tabulated value of χ2 at level of significant; it is concluded that there is an association between B.M.I and healing score in control group.

With regards to knowledge the calculated value of χ2

is less than the tabulated value of χ2 at level of significant; it is concluded that there is no association between knowledge of episiotomy and healing score in control group.

The table no,(3) represents that the healing score 1 to 5 was found in majority of cases in experimental group in term of 100% after three days of the treatment and healing score 6 to 10 was found in majority in control group in terms of 80% after three days. This proves that experimental group is more effective than control group.

The mean score of the mothers before receiving the treatment (for experimental group) was 8 and it decreased to 4 on the final day after the treatment process. This proves that the treatment has shown positive difference in the wound healing process The calculated‘ value 15.250 was compared with the table value 2.15 at 14 degree of freedom with 0.05 level of significance; the calculated value was much higher than the table value and the mean score of the mothers for control group was 7 and it decreased to 6 on the final day of observation process. This proves that the control group has shown less difference in the wound healing process. The calculated‘ value7.359 was compared with the table value 2.05 at 29 degree of freedom with 0.05 level of experimental group is higher than control group. This proved that sitz bath in the episiotomy is effective in wound healing.

This study is mainly intended to assess the effectiveness of sitzbath in episiotomy wound. The effect of these treatment modalities was found by comparing of first and final day wound healing score. Mother‘s wound status was assessed soon after 3days of episiotomy and before starting treatment. The finding of the study have been discussed with the reference to the objectives stated in chapter-1

Out of 30 postnatal mother majority 47% were in the age group of 17-20 years in experimental group and 47% were in control group.40% were primary education in experimental group and 47%were in control group.47%were coolie in experimental group and 60% were house wife in control. 80% were getting family income of Rs 2000-10000 in experimental group and 54% were in control group.53%were belong to nuclear family and 60% were in control group.74% were living in rural area in experimental group and 74% were in control group.53% were having normal B.M.I in experimental group and 53% were in control group. In obstetrical value out of 30 posnatal mother majority 53% were gravid one in experimental group and 53% were in control group.47% were parity zero and 66% were in control group.93% were not having surgery on perineum in experimental group and 94% were not in control group.66% were not having infection disease on reproductive tract and 53% were not having in control group.53% were having <9gm heamoglobin level in experimental group and 47% were in control group.60% had done episiotomy by doctor on experimental group and 66% had had by nurse on experimental group.54% had done median episiotomy in experimental group and 53% in control group.53% had done perineal suture by nurse in experimenal group and 53% in control group.53% were having pain on incision area and 53% were not having pain in control group.53% were having infant birth weight 3kg in experimental group and 53% were having infant birth weight on control group.

Table no (4) the pretest of experimental and control group were assess through the REEDA scale with

(2) To provide sitz bath to the experimental group. Before giving sitz bath to experimental group observation was done and mother was co-operated and given good response to the investigator. After observation the researcher provided sitzbath twice a day i‘e at morning and evening for continous three days on the experimental group and healing of wound was observed after three days.

From, the table no,(5) It is concluded that there is an association between demographic variable that is age education, occupation, type of family B.M.I, with episiotomy wound healing but there is no association as between family income, area, and knowledge of episiotomy. From, the table no (6) It is stated that there is an association between obstetrical variable that is gravida, parity, hemoglobin, antiseptic solution used with episiotomy wound healing but there is no association as between any previous surgery in perineum, episiotomy performed by, suture material used. From, the table no (7) It is concluded that there is an association between demographic variable that is, family income, type of family with episiotomy wound healing but there is no association as between area, age education, occupation, B.M.I, and knowledge of episiotomy. From, the table no (8) It is stated that there is an association between obstetrical variable that is gravida, haemoglobin, but there is no association as between any previous parity, surgery in perineum, episiotomy performed by, suture material used, antiseptic solution used with episiotomy wound healing month at Morar district hospital (Maternity Centre).Totally 30 mothers were studies. Mothers were allotted for experimental group and control group.Sitz bath was given for experimental group and self perineal care for control group. The wound score were assessed after 4 days of episiotomy. The wound healing score was made through REEDA scale. The scale was used before and after application of treatment modalities for experimental group. The treatment modalities were given for three days.

The pre study has been supported by a series of other studies, which confirmed that sitz bath are effective in wound healing process of episiotomy mothers, enhancing comfort and decreasing of pain .From this analysis and result, it is concluded that sitz bath is effective in wound healing process.

• It was identified from the study that the sitz bath is effective in episiotomy wound healing of the postnatal mothers. Therefore the sitz bath can be applicable for regular practice during postnatal period of episiotomy mother. Most human beings accustomed to the existing methods will take some time to adapt to the new methods. The nurses should also be introduced to the awareness programmes, to make them understand the benefits of the methods.

• With the emerging health care trends nursing education must focus on innovations to enhance the nursing care. The nursing students should be taught the importance of wound healing in postnatal mothers. Therefore the nursing students should be introduced with the methods of wound healing in postnatal mothers to deliver the nursing care effectively. Nurse educators should orient the students Nursing Administration

• Sitz bath can be used as a routine intervention among mothers with episiotomy in hospitals and corporation health centres with final assessment of perineal discomfort and wound healing score. • More studies are required to evaluate the short term and long term effects of sitzbath on perineal would healing and pain reduction.

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40. Hur MH, Han SH Clinical trial of aromatherapy on postpartum mother's 41. G.Cario and M.H Jones)A study was done on random controlled trial comparing restricted and liberal use of episiotomy was conducted in MJ house charing cross hospital west London Journal of Obstetrics, Gynecology.

43. Pazandeh F, Savadzadeh Sh, Faraz Mojab H. (2007) A study was conducted to assess the effects of chamomile essence on episiotomy healing on primiparous women referring to Talesh Hospital of Shaheed Norani in 2007 Journal of Obstetrics, Gynecology

WEB REFERENCE

1. http://schlor.google.com 2. http:// www.pubmed .com 3. http://pt.wkhealth.com

Associate Professor, Obstetrics& Gynecological Nursing devimadhubala33@gmail.com