Effectiveness of salt water application on episiotomy wound among postnatal mothers
Abstract
Pregnancies, as a whole, has extended and widen changes for an antenatal mother. Maternal schemes play an important role in mother, baby and family during the antenatal period. 60 (30 experimental groups and 30 control group) patients (postnatal mothers) who met the inclusion criteria were selected by using non-probability convenience sampling technique. After selecting the sample, the investigator explained the purpose of the study and informed consent was obtained. Demographic variables were collected pre-test was done by using the REEDA scale (experimental and control group). For the experimental group, the saltwater application was given twice a day for five days in 8 hours. Control group receives the routine hospital care. On the third postnatal day, post-test was done for the experimental and control group. The data were tabulated and analysed by descriptive and inferential statistics. The result shows that in experimental group pre-test (3.33%) were mild healed, and 29(97%) were not healed and in control group 30(100%) were not healed. post-test in experimental group 22(73%) were healed, and 8(27%) were moderately healed, in the control group 2(7%) were healed, 15(50%) were moderately healed and 13(43%) were mild healed. The calculated‘t' value is significant at P< 0.005. The study indicates that the application of salt water is effective on episiotomy wound healing among postnatal mothers.
Keywords
Pregnancy, Post natal mothers, Episiotomy, Salt water application
Introduction
Pregnancies as a whole has extended and widen changes for an antenatal mother (Konar, 2015). Maternal schemes play a role an important role in mother, baby and family during the antenatal period (Christine & Kathleen, 1997). In a dynamic society where values, rules and practices concerning childbearing and rearing are changing rapidly, women and their families seek guidance from many sources. However, women rely on maternity nurses to provide specific, accurate and appropriate information about what they should expect and request from the health care system, and about what choices they have regarding their own care (Barbara & Erb, 1937).
From many years, there is a gradual rise in load on midwifery and other health care members to make hands-on practice more efficiently based on up to date research upgrades- honored beliefs, on the basis of mothers facing difficulties the intervention has been provided (Wold, 1997). The survey of the committee on nursing enabled bases for implementing interventions. Individual accountability requires maternity nurses to examine the care they provide. Hereafter, important that maternity nurses have improve the skill-based of research approvals (East & Webster, 1995). Over 1975, it has been anrisein the number of projects, in the investigation of maternity development.
A multiple series of the process occurs during child-birth. One such event is the practice of episiotomy, which has undergone changes in popularity, with a rationale for clinical practice (Dale & Cornwell, 1994). Perineal incision, which include episiotomy is a long standard process for the outcome of vaginal delivery. An episiotomy is incision of the perineum during delivery to enlarge the vaginal orifice, has been, in practice since 1742, when a perineal incision was used to facilitate difficult deliveries. Episiotomy has not become common till the early 1900s when the shift from home to hospital delivery occurred. The popularity of episiotomy among obstetricians continued to grow with the introduction of local anesthetic and suture material and as a result of advocacy for its performance by two obstetricians, De Lee and Pomeroy (Maier, 1997). It was claimed that an episiotomy should be performed for every women delivering her first child to avoid perineal lacerations and damage to the pelvic floor (Cravchik, amuel, Muñoz, & Bortman, 1998).
Perineal trauma prevention is the most important consideration during delivery. It gives many midwives a sense of pride to complete a birth with no perineal trauma (Draper & Newell, 1980). However, this should not be at the expense of trauma to the vaginal mucosa (Chiarelli & Cockburn, 1999). Episiotomy range varies over worldwide, depending on the procedure is used in the hospital set up. Worldwide episiotomy rate is 27%,54% are nulliparous, and 6% are multiparous women (WHO 2003). In India, the birth rate is very high, 72.3 per thousand birth. The incidence of episiotomy was high. More moderate forms of genital cutting which account for an estimated 80% practice worldwide (Eason & Feldman, 2001).
Episiotomy care would begin after delivery, and it includes local care over the incisional area and pain reliving measures (Calvert & Fleming, 2000). The care of episiotomy is different from hospital to hospital. More maternity care are in process to reduce pain and improve the episiotomy wound healing. It includes warm soaks, warm sitz bath, infrared radiation and cooling pads, application of antiseptic solutions. Betadine an antiseptic skin cleanser is widely used in the hospitals for the healing of episiotomy wound. It is an antiseptic skin cleanser. It contains povidine iodine 10%. It helps to reduce bacteria that potentially cause skin infection. The simple principle of episiotomy wound healing is good blood flow, oxygen, nutrients, and absence of infection.
Objectives
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Assess the pretest level of episiotomy wound healing among postnatal mother in both experimental and control group before the intervention.
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Assess the posttest level of episiotomy wound healing among postnatal mother in both experimental and control group after intervention.
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Compare the pretest and posttest level of episiotomy wound healing among postnatal mother in both experimental and control group.
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Associate the episiotomy wound healing among postnatal mothers with selected demographic variables.
Materials and Methods
A descriptive study was chosen for the effectiveness of salt water application on episiotomy wound healing among postnatal mothers at Thiruvallur District Head Quarters.60 samples were selected who comes under the inclusive criteria by using non-probability convenient sampling technique. Data was collected by using demographic variables, which includes age, educational status, family type, haemoglobin level etc…and by REEDA scale. The tools were translated to the Tamil language. Informed consent was obtained, and data was collected from the sample. The data were analysed by inferential statistics.
Results and Discussion
|
Demographic variables |
Group |
|||
|---|---|---|---|---|
|
Experimental |
Control |
|||
|
No |
% |
No |
% |
|
|
Age: |
||||
|
18-21 years 22-25 years 26-29 years > 29 years |
7 16 4 3 |
23% 53% 13% 10% |
9 13 5 3
|
30% 43% 17% 10% |
|
Religion: |
||||
|
Hindu Christian Muslim Others |
15 9 6 0 |
50% 30% 20% 0% |
16 7 7 0 |
54% 23% 23% 0% |
|
Educational status: |
||||
|
Non formal Primary Secondary Graduated |
9 12 9 0 |
30% 40% 30% 0% |
4 17 5 4 |
13% 57% 17% 13% |
|
Occupation: |
||||
|
House wife Permanent workers Temporary workers |
18 1 11 |
60% 3% 37% |
13 4 13 |
43% 13% 43% |
|
Residential status: |
||||
|
Rural Urban Sub urban |
15 15 0 |
50% 50% 0% |
13 17 0 |
43% 57% 0% |
|
Type of family: |
||||
|
Big family Small family Extended family |
5 25 0 |
17% 83% 0% |
10 20 0 |
33% 67% 0% |
|
Income: |
||||
|
Rs2000/week Rs2000-3000/week Rs3000-4000/week |
0 9 21 |
0% 30% 70%
|
4 8 17 |
13% 27% 57% |
|
Hemoglobin level: |
||||
|
Less than 10g/dl 10-12g/dl More than 12g/dl |
7 15 27 |
23% 50% 27% |
12 13 5 |
40% 43% 17% |
Socio-demographic variables of postnatal mothers
Present study Over 30 samples in experimental group 7(24%) comes under the age group of 18-21, 16(53%) belongs to the age group of 22-25, 4(13%) belongs to age group 26-29, 3(10%) belongs to the age group of above 29. Regarding religion in experimental group 15(50%) belongs to Hindu, 9(30%) belongs to Christian, 6(20%) belongs to Muslims. Regarding education in experimental group 9(30%) belongs to nor formal, 12(40%) belongs to primary education, 9(30%) belong to secondary education. Regarding occupation in experimental group 18(60%) belongs to housewife, 1(3%) belongs to permanent workers, 11(37%) belongs to temporary workers. Regarding residence in the experimental group, 15(50%) belongs to rural, 15(50%) belongs to urban. Regarding family type in experimental group 5(17%) belongs to the joint family, 25(83%) belongs to the nuclear family. Regarding income status in experimental group 9(30%) consume 3000-3000Rs salary, 21(70%) consume more than 4000Rs salary. Regarding haemoglobin level in experimental group 7(23%) has less than 10g/dl Hb , 15(50%) has 10-12 g/dl Hb , 8(27%) has 12g/dl Hb.(Table 1),(Figure 1).
According to (Ragbih & Etal, 2010), A comparative study was conducted to assess the effectiveness of normal saline and betadine application on episiotomy wound. This study included 120 multiparous women with episiotomy and were randomly assigned into the experimental and control group. For the patients in the experimental group, 10cc normal saline, 9 in 1000 cc, was sprinkled on episiotomy wound by a sterile syringe, three times a day for ten days. In the control group, 10% povidone-iodine solution, three tablespoons in four glasses of water three times a day. Episiotomy wound were checked based on the standard REEDA checklist on the fifth and tenth day after episiotomy. The result shown that there is no significant difference in the healing of episiotomy wound in both groups. The study concluded that betadine has no effect on episiotomy wound healing (Ragbih & Etal, 2010).
Present study Over of 30 samples in control group 9(30%) comes under the age group of 18-21, 13(43%) belongs to the age group of 22-25, 5(17%) belongs to age group 26-29, 3(10%) belongs to the age group of above 29. Regarding religion in control group, 16(54%) belongs to Hindu, 7(23%) belongs to Christian, 7(23%) belongs to Muslims. Regarding education in control group 4(13%) belongs to nor formal, 17(57%) belongs to primary education,5(17%) belong to secondary education, 4(13%) belongs to graduate. Regarding occupation in control group 13(43%) belongs to housewife, 4(13%) belongs to permanent workers, 13(43%) belongs to temporary workers. Regarding residence in control group 13(43%) belongs to rural, 17(57%) belongs to urban. Regarding family type in control group 10(33%) belongs to the joint family, 20(67%) belongs to the nuclear family. Regarding income status in control group 1(3%) consume less than 2000Rs income, 4(13%) consume 2000-3000Rs salary,8(27%) consume 3000-4000Rs salary, 17(57%) consume more than 4000Rs salary. Regarding haemoglobin level in the control group, 12(40%) has less than 10 grams Hb, 13(43%) has 10-12 grams Hb, 5(17%) has 12grms Hb. (Table 1),(Figure 1).
According to ShahanazTorkZaharani, SedigheAmirali, (Zahrani, Amir, & Valaei, 2002), A comparative study was conducted to assess the effect of Betadine and water in the episiotomy wound healing. The objective of this study was to assess the cost-effectiveness of the solutions which is been used for the healing of episiotomy wound. The study included 100 samples. They were randomly divided into Betadine (n=50) and water (n=50) groups. The result shown that swelling was less than 1cm at first and 5th day was 56% and 60% in betadine group and 46% and 62% in the water group. Redness, less than 3mm, was 60%, 46% and 68% respectively, but it was 60%, 38% and 66% in the water group. There were no signs of wound opening and infection in both groups. The study concluded that Betadine has no effect on episiotomy wound healing, and there is no indication for its uses (Zahrani et al., 2002).
Conclusion
The study concluded that there was a significant improvement of healing in experimental compared with control group due to the application of salt water solution on episiotomy wound in the experimental group than the application of hospital routine care in control group. Moreover, it is not cost-effective and not harmful.