study on episiotomy care

1. DESERTATION
PRESENTATION
PRESENTED BY
PREETI
OBSTETRICS AND GYNECOLOGICAL NURSING

2. STATEMENT OF PROBLEM
A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF SITZ
BATH ON EPISIOTOMY WOUND HEALING AMONG POSTNATAL MOTHERS
AT SELECTED HOSPITALS AT HISAR.

3. OBJECTIVES OF THE STUDY
1. To assess the level of wound healing before and after administration of Sitz bath among
postnatal mothers in experimental and control group.
2. To assess the effectiveness of post test of episiotomy wound healing among the
postnatal mothers in both experimental and control group.
3. To compare the significant difference between the experimental group and control group
of post test of episiotomy wound healing among the postnatal mothers.
4. To correlate the post test of episiotomy wound healing among the postnatal mothers in
both experimental group and control group.
5. To determine the association between the post test of episiotomy wound healing among
the postnatal mothers in both experimental and control group with their selected
demographic variables

4. INTRODUCTION
“Communities and countries and ultimately the world are only as strong as the health of
their women.” – Michelle Obama
Giving birth is a powerful and life changing event with a lasting impact on women and
their families. Every women who became pregnant have to undergo the process of delivery.
Sometimes it may be normal or forceps, vacuum and caesarean section. In normal process of
delivery the baby is delivered per vagina, an episiotomy is performed by health care provider
or midwife.
Sitz bath use medicated solution as well as plain water. The present study intends to the
effectiveness of sitz bath with plain water and sitz bath among postnatal mothers with
episiotomy.

5. NEED FOR STUDY
Puerperium is a period when great changes take place in a woman‘s physical and mental
set up that may pose a challenge to postnatal women in various ways. Episiotomy causes
considerable distress and discomfort to many women following childbirth. Its severity is
frequently under-estimated and many women suffer unnecessarily, often in silence. It is the
period when women receive less care from the health team and their family, since the new
born receive most attention at this moment. A delay in healing may increase the duration of
perineal pain and leads to infection, this fosters the need for new alternative interventions.
Even though the sitz bath is an effective method of healing the episiotomy wound, it is not
widely used like other treatments. Hence the researcher felt the need to evaluate the
effectiveness of sitz bath in the healing of episiotomy wound.

6. RESEARCH HYPOTHESIS:
All Hypotheses were tested at 0.05 level of significance
 H1-There will be a significant difference between the experimental and control group of
post test of episiotomy wound healing among the postnatal mothers.
 H2-There will be a significant correlation between the post test levels of episiotomy wound
healing among the postnatal mothers in both experimental and control group.
 H3-There will be a significant association between the post test level of episiotomy wound
healing among the postnatal mothers in both experimental and control group with their
selected demographic

7. ASSUMPTION
 Sitz bath may fasten the episiotomy wound healing process.
 Sitz bath helps to reduce the infection.

8. POST-ASSESSMENT
PRE-ASSESSMENT
ASSESSMENT OF
WOUND HEALING
REEDA scale is used
to assess episiotomy
wound healing.
DEMOGRAPHIC
VARIABLES
 Age,
 Education
 Occupation
of women
 Family
income
 Husband’s
occupation
INTERVENTION
SITZ BATH
Perineal area / buttocks are
submerged in warm water
having a temperature of
105⸰
F to 110⸰
F for a period
of 20 minutes for five
consecutive days.
ASSESSMENT OF
WOUND HEALING
REEDA scale is used
to assess episiotomy
wound healing.
ADEQUATE
HEALING
INADEQUATE
HEALING
FIGURE 1: CONCEPTUAL FRAMEWORK BASED ON MODIFIED ROY’S ADAPTATION MODEL

9. REVIEW OF LITERATURE
The retrieved literature was done for the present study and presented in the following
headings.
 Section A: Literature review related to knowledge, attitude and practice episiotomy care.
 Section B: Literature review related to episiotomy wound healing.
 Section C: Literature review related to effectiveness of sitz bath on episiotomy wound
healing.

10. RESEARCH METHODOLOGY
• EVALUATIVE RESEARCH APPROACH IS USED IN THIS STUDY.
• QUASI EXPERIMENTAL DESIGN WAS USED.
• STUDY SETTING- JINDAL HEALTH INSTITUTE AND AADHAR HOSPITAL AT HISAR
• TARGET POPULATION- POSTNATAL MOTHERS WHO HAD UNDERGONE NORMAL VAGINAL DELIVERY AT
JINDAL INSTITUTE OF MEDICAL SCIENCES AND AADHAR HEALTH INSTITUTE, HISAR.
• SAMPLING TECHNIQUE: NON PROBABILITY CONVENIENT SAMPLING TECHNIQUE.
• SAMPLE SIZE: 60 POSTNATAL MOTHERS WHO HAD SATISFIED THE INCLUSION CRITERIA
(30=EXPERIMENTAL GROUP AND 30= CONTROL GROUP
• TOOL IS FORMULATED AS REEDA SCALE
• INTERVENTION- SITZ BATH
• ANALYSIS WAS USE AS INFERENTIAL STATISTICS.
• FINDINGS, SUMMARY, CONCLUSION, AND RECOMMENDATIONS
• COMMUNICATION AND FINDINGS

11. PILOT STUDY
Pilot study was conducted in Jindal Institute of medical sciences and Aadhar Health
Institute, Hisar during data collection period during the month of April (5/04/2022-
12/04/2022) for a period of one week. Initial permission was sought from the institution and
formal permission was sought from the medical officers for conducting the study.
Consent was obtained from the participants. 6 postnatal mothers were selected. Three
participants were administered Sitz bath and other three were administered routine care for
both morning and evening for five days. Results of the pilot study, gave the evidence that the
tools were reliable. Finding of pilot study also revealed that it was feasible and practicable to
conduct the study at the selected settings.

12. METHOD OF DATAANALYSIS
 Frequency and percentage distribution was used to assess demographic variables of
postnatal mothers, level of episiotomy wound healing.
 Mean and standard deviation was used to assess the effectiveness of Sitz bath.
 ‘t’ test was used to evaluate and compare post interventional level of episiotomy pain and
wound healing between experimental and control groups.
 Chi-square test was used to find out the association between the post interventional level of
episiotomy wound healing with the selected demographic in experimental and control
group.

13. ORGANIZATI ON OF FINDINGS
The analysis of the data is organized and presented under the following broad headings-
 Section I: Description of postnatal mothers based on their socio-demographic and obstetrical characteristics.
 Section II: Assessment of pretest and posttest level of episiotomy wound healing among the postnatal
mothers in both experimental and control group
 Section III: Comparison of pretest and posttest episiotomy wound healing among the postnatal mothers in
both experimental and control group
 Section IV: Comparison of posttest mean and SD score of episiotomy wound healing among the postnatal
mothers in both experimental and control group
 Section V: Find out association between the post test level of episiotomy wound healing among the postnatal
mothers in both experimental and control group with their selected demographic and obstetrical variables.

14. SECTION-A DEMOGRAPHIC VARIABLE PROFILE
Demographic variable
Experimental group (N=30) Control group (N=30)
Frequency Percentage Frequency Percentage
1. Age
18 to 21 years 4 13.33% 3 10%
22 to 25 years 10 33.33% 8 26.67%
26 to 29 years 13 43.34% 15 50%
Above 29 years 3 10% 4 13.33%
2. Educational status
Non formal education 0 0% 0 0%
High school 5 16.67% 2 6.67%
Higher secondary 7 23.33% 6 20%
Graduate or above 18 60% 22 73.33%
3. Parity
Primi para 21 70% 18 60%
Multipara 9 30% 12 40%
4. Occupation
Housewife 17 56.67% 20 66.67%
Working 13 43.33% 10 33.33%
5. Place of residence
Rural 14 46.67% 12 40%
Urban 16 53.33% 18 60%

15. 6. Types of episiotomy
Medio-lateral 30 100% 30 100%
Median 0 0% 0 0%
Lateral 0 0% 0 0%
J shape 0 0% 0 0%
7. Indication of episiotomy
Macrosomia 5 16.67% 3 10%
Inelastic perineum 22 73.33% 25 83.33%
Breech 3 10% 2 6.67%
8. Baby weight
2.1- 2.5 kg 7 23.33% 3 10%
2.6-3.0 kg 9 30% 11 36.67%
3.1- 3.5 kg 9 30% 9 30%
Above 3.5 kg 5 16.67% 7 23.33%

16. Section II:
Assessment of pretest and posttest level of episiotomy wound healing among the postnatal
mothers in both experimental and control group
0%
33.33%
50%
16.67%
16.67%
76.67%
6.67%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
No infection Mild infection Moderate infection Severe infection
Experimental group pre and post test Level of wound healing
Pre test
Post test
Bar diagram representing percentage distribution of postnatal mothers based on their level of
wound healing in experimental group

17. 0%
26.67%
66.66%
6.67%
10%
33.33%
56.67%
0%
0%
10%
20%
30%
40%
50%
60%
70%
No infection Mild infection Moderate infection Severe infection
Control group pre and post test level of wound healing
Pre test
Post test
Bar diagram representing percentage distribution of postnatal mothers based on their
level of wound healing in control grpoup

18. Section III:
Comparison of pretest and posttest episiotomy wound healing among the postnatal
mothers in both experimental and control group
Group PRE TEST POST TEST Mean
differenc
e
Paired ‘t’ test
At p<0.05
Mean SD Mean SD
Experimental
group
7.8 3.35 3.3 2.30 4.45 16.89**
Control group 7.43 3.24 5.7 2.10 1.73 15.43**
H1-There will be a significant difference between the experimental and control group of post test of episiotomy wound
healing among the postnatal mothers.
In experimental group pre test mean score was 7.8 with SD 3.35 and post test mean score was 3.3 with SD 2.30.
The mean difference was 4.45. the Calculated ‘t’ value was 16.89 at p<0.05 which is higher than table value, which
shows sitz bath was effective in episiotomy wound healing. Hence hypothesis H1 was accepted.
In control group pre test mean score was 7.43 with SD 3.24 and post test mean score was 5.7 with SD 2.10. The
mean difference was 1.73. The Calculated ‘t’ value was 15.43 at p<0.05 which is higher than table value.

19. Section IV:
Comparison of posttest mean and SD score of episiotomy wound healing among the
postnatal mothers in both experimental and control group
Group POST TEST Mean
difference
Un-Paired ‘t’
test
At p<0.05
Mean SD
Experimental group 3.3 2.30 2.4 4.73
Df=58
Control group 5.7 2.10
H2-There will be a significant correlation between the post test levels of episiotomy wound healing among
postnatal mothers in both experimental and control group.
In experimental group posttest mean (3.3) and SD (2.30) score of episiotomy wound healing was less than
the control group posttest mean (5.7) and SD (2.10) score of episiotomy wound healing. The mean difference
of posttest score was 2.4. The calculated ‘t’ value was 4.73 which was higher than table value. Which shows
Sitz bath was effective in episiotomy wound healing. Hence hypothesis H2 was accepted.

20. Section V:
Find out association between the post test level of episiotomy wound healing among the
postnatal mothers in experimental with their selected demographic and obstetrical
variables.
H3-There will be a significant association between the post test level of episiotomy wound healing among the
postnatal mothers in experimental with their selected demographic and obstetrical variables.
To see the association between the post test level of episiotomy wound healing among the postnatal
mothers in experimental with their selected demographic and obstetrical variables. In experimental group,
demographic variables such as age and education, baby weight are significantly associated with their posttest
level of episiotomy wound healing. Parity, occupation, place of residence, type of episiotomy, indication for
episiotomy, does not show any association with post test episiotomy wound healing.
Hence hypothesis H3 was accepted.

21. DISCUSSION
This chapter deals with the discussion of the findings of present study in accordance with the objectives
of the research problem. The findings of the study have been discussed with reference to the results
obtained .
In experimental group, pre test score shows that 50% had moderate infection, 33.33% had mild
infection and 16.67% had severe infection. After posttest 76.67% had mild infection, 16.67% had no
infection and 6.67% had moderate infection.
In control group, pre test score shows that 66.66% had moderate infection, 26.67% had mild
infection and 6.67% had severe infection. After posttest 56.67% had moderate infection, 33.33% had
mild infection and 10% had no infection.
experimental group pre test mean score was 7.8 with SD 3.35 and post test mean score was 3.3 with SD
2.30. The mean difference was 4.45. the Calculated ‘t’ value was 16.89 at p<0.05 which is higher than
table value, which shows sitz bath was effective in episiotomy wound healing. Hence hypothesis H1 was
accepted.
In control group pre test mean score was 7.43 with SD 3.24 and post test mean score was 5.7 with
SD 2.10. The mean difference was 1.73. The Calculated ‘t’ value was 15.43 at p<0.05 which is higher
than table value.

22. CONCLUSION
The present study shows that in experimental group posttest mean (3.3) and SD (2.30) score of
episiotomy wound healing was less than the control group posttest mean (5.7) and SD (2.10) score of
episiotomy wound healing. The mean difference of posttest score was 2.4. The calculated ‘t’ value was
4.73 which was higher than table value. Which shows Sitz bath was effective in episiotomy wound
healing.

23. SUMMARY
The study design consisted of an evaluative approach with one group pre test and post test control group
design. Convenient sampling technique was adopted. The tool developed and used for data collection was
REEDA scale.
In experimental group pre test mean score was 7.8 with SD 3.35 and post test mean score was 3.3 with
SD 2.30. The mean difference was 4.45. the Calculated ‘t’ value was 16.89 at p<0.05 which is higher than
table value, which shows sitz bath was effective in episiotomy wound healing. Hence hypothesis H1 was
accepted. In control group pre test mean score was 7.43 with SD 3.24 and post test mean score was 5.7 with
SD 2.10. The mean difference was 1.73. The Calculated ‘t’ value was 15.43 at p<0.05 which is higher than
table value.
In experimental group posttest mean (3.3) and SD (2.30) score of episiotomy wound healing was less
than the control group posttest mean (5.7) and SD (2.10) score of episiotomy wound healing. The mean
difference of posttest score was 2.4. The calculated ‘t’ value was 4.73 which was higher than table value.
Which shows Sitz bath was effective in episiotomy wound healing.

24. RECOMMENDATION
Based on the findings of the present study the following recommendations are made:
 1. Similar study can be replicated on a large sample.
 2. A True experimental study can be done with the administration of warm water sitz bath.

25. REFERENCES
1. Dutta.DC. (2014) THE TEXT BOOK OF OBSTETRICS.(6TH Edition.). London, new central book agency (p)Ltd
2. Basavanthappa PT (2012) .The Text Book Of Midwifery And Reproductive Health Nursing. (7th edition.).New Delhi: Jaypee publications.
3. Basavanthappa. B.T (2007).Nursing Research.(2nd Edition.). New Delhi : Jaypee publications.
4. Indrani TR. (2012) .TEXTBOOK OF MIDWIFERY . (5th edition). New Delhi . Jaypee.
5. Niza.S, Dr. M. Gandhimathi, "A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Knowledge about
Practice Regarding Episiotomy Using Lecture Method and LCD Method", International Journal of Science and Research (IJSR),
https://www.ijsr.net/get_abstract.php?paper_id=ART20173004, Volume 6 Issue 4, April 2017, 2318 - 2323, #ijsrnet
6. L. Kalaivani. A Study to Evaluate the Effectiveness of Sitz Bath on Episiotomy Wound Healing among Postnatal Mothers in Aravindan
Hospital at Coimbatore. International Journal of Nursing Education and Research. 2021; 9(3):281-6. doi: 10.52711/2454-2660.2021.00066
7. Thakur, Bhawna & Viswanath, Lekha. (2018). Effectiveness of Sitz Bath with Plain Water Versus Povidone Iodine Solution on Episiotomy
Healing and Pain among Postnatal Mothers. 4. 10.21088/jnmmh.2454.7506.4318.1.
8. Kapoor J, Rita. A comparative study to assess the effectiveness of medicated and non-medicated sitz bath on episiotomy wound healing
among postnatal mothers at govt. Smgs maternity hospital, Jammu (J&K). Int J Pregn & Chi Birth. 2018;4(2):92-96. DOI:
10.15406/ipcb.2018.04.00090

26. Cont…
1. Astha Gumber. 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. Int. J. of Advances in Nur. Management. 2021; 9(2):200-203. doi: 10.5958/2454-2652.2021.00045.7
2. Arati mahishale, Ashwini chougala (2013). Effect of therapeutic ultrasound and maternal cooling gel pad for preineal pain following vaginal delivery with episiotomy. Women Health Care. Nov. Vol 2(3).
PP: 2 4.
3. Dash,manju bala (2013) .Effectiveness of infrared rays on wound healing among caesarean section mothers. American journal of nursing research. Octo28, Vol 1(8). PP: 43 46.
4. Dudley LM, kettle C, Ismail KM. (2013) . Repair of episiotomy and perineal laceration associated with childbirth. Mar.Vol 9(3). PP:35 39.
5. Eolzuka,CCDim,Cochigbu .(2014).Prevalence and predictors of episiotomy among women at first birth in Enugu, south East Nigeria. Annual medical health science research. Nov.Vol 4(6). PP: 928 932.
6. Esa bose , Meena samant, Poonam lal. (2013). Comparison of impact of polyglactin 910 (vicryl rapide) and chromic catgut sutures on preineal pain. Journal of obstetrical and gynaecological . March.
Volume 2(6) . PP: 140 141.
7. Farideh,Fereshteh,Mohsen .(2013) .The impact of aloe vera and calendula on perineal healing after episiotomy in primiparous women. A randomized clinical trial. Journal Of caring science. Decem ,
vol2(7), PP:279 286.
8. Hoda A bed & Nahed Saied (2012) Effect of self perineal care instruction on episiotomy pain and wound healing of postpartum women. Journal of american science. Feb. Vol 8(6). PP: 98 102.
9. Ines melo, Leila katz .(2014) . Selective episiotomy versus implementation of a non episiotomy protocol: A randomized clinical trial. Reproductive health.Aug. vol 11(66). PP: 43 49.
10. Taehan Kanho Hakhoe chi (2013) Clinical trial on postpartum mothers perineal healing .journal of controlled clinical trial . Octo. Vol 49(2), PP 95-98.
11. Yashashi pore. (2014) .Effectiveness of moist heat and dry heat application on healing of episiotomy wound. Asian journal of multidisciplinary Studies. July. Vol 2(7) .PP: 75 84.
12. K. Jagminder, et. al. (2015) Knowledge and Attitude Regarding Episiotomy Wound Care Among Third Trimester Primigravida Mothers. International Journal of Obstetrics, Perinatal and Neonatal
Nursing. Vol. 1: Issue 1. www.journalspub.com
13. R. Chandraleka, et. al. (2019) Effectiveness of Sitz Bath Versus Infrared Ray Therapy on Level of Episiotomy Pain and Wound Healing Among Post Natal Mothers in Selected Hospital, Puducherry.
September 13, 2019 | Published: September 19, 2019. DOI: 10.26717/BJSTR.2019.21.003605