2. INTRODUCTION
Motherhood is more than a premium birth Centre – It is a way of experiencing
birth as a normal, natural, completely unique and personal event in a family. We give
utmost priority to a woman needs and preferences during the most special moment of
life. We also believe in educating our clients and their families about every procedure
to assist them in making informed health care choices.
Child birth through vaginal mode seems to be the safest mode for the majority of
women. The perineum is a very important part of a woman’s body and it plays a
special role during child birth. During a normal vaginal birth, the fetal head exerts
significant pressure on the tissues of the perineum and vaginal vault. Some women
seem to have tissue that tears easily others will give birth over intact perineum.
3. To prevent this nowadays episiotomy is done so, during childbirth, the women may
sustain some degree of perineal trauma due to perinealtear or surgical incision called
episiotomy. The outcome of episiotomy is found that delayed wound healing due to
wound separationor clinical infection. So the care of episiotomy is an important aspect
of postnatal care.
In this era of advanced modern technology all mothers are looking hopefully in nurses
to help in bringing down maternal morbidity rate and relieve them form pain and
discomfort soon after birth. Thus, it becomes the nurse’s responsibility to identify the
ways of reducing and preventing maternal problems as well as to identify the cost-
effective measures in relieving pain.
4. Episiotomy wound can cause a considerable discomfort and pain the perineum . This
discomfort interferes with the rest and sleep. Mother feels discomfort even when she
holds her baby and it affects breast feeding and newborn care.
The application of water externally to the body for therapeutic effect is practice called
Hydrotherapy or water therapy. One of the most popular methods of using hydrotherapy
is the sitz bath. Doing this repeatedly is said to stimulate the lymphatic system, increase
circulation and remove toxins. The sitz bath is a procedure in which only the pelvis and
abdominal area are placed in the water. It helps for women after child birth whether she
had done episiotomy or not. Sitz bath is one of the oldest, cheapest, and safest
treatments for curing many common ailments.
5. The researcher felt that, when postnatal mothers cared with definite nursing measures
during postpartum period and the severity of infections can be reduced. So the
researcher intended to plan study on postnatal mothers with episiotomy using two
specific nursing procedures, in a view to reduce the complications of episiotomy.
There were two groups given two different type of Sitz bath procedures to compare the
effectiveness of Betadine and Neem.
Betadine has anti-inflammatory and anti-septic effects and Neem also have a powerful
anti-bacterial, anti- fungal, anti- viral, anti- inflammatory, anti- diabetic and also
strengthens the body’s over all immune responses. Neem oil contains fatty acids which
build collagen, promote wound healing and maintain skin elasticity. This keeps any
wound leison free from secondary infection by micro organisms.
6. STATEMENT OF PROBLEAM
A comparative study to assess the effectiveness of betadine sitz bath versus neem
extract sitz bath on episiotomy wound healing among post-natal mothers in selected
hospital of Junagadh.”
OBJECTIVES
To compare the pre and post test level of Episiotomy wound healing scores among post
natal mothers in experimental group I (Betadine sitz bath)
To compare the pre and post test level of Episiotomy wound healing scores among post
natal mothers in experimental group II (Neem extract sitz bath).
To compare the effectiveness of post test level of Episiotomy wound healing scores
among postnatal mothers between experimental group I&II.
7. HYPOTHESIS
H1: There will be significant difference between the mean pretest and post score on
episiotomy wound healing among postnatal mothers in experimental group I.
H2: There will be significant difference between the mean pretest and posttest score on
episiotomy wound healing among postnatal mothers in experimental group II.
H3: There will be significant difference between the mean post test scores on
episiotomy wound healing among postnatal mothers between experimental group I and
experimental group II.
8. DELIMITATIONS
The study is delimited to 60 samples
Four weeks of data collection
The mother who are willing to participate
The obstetrical variables are not included.
PROJECTED OUTCOME
This study helps the mother to promote wound healing during postnatal period. It promotes
interest in pharmacological & non pharmacological treatment approach to episiotomy wound
healing. The comfort and relief may help the mother to have postnatal period without any
complications and also it helps for maternal and infant wellbeing.
9. RESEARCH APPROACH
An evaluative and comparative approach was used to assess the effectiveness of neem
extract sitz bath and betadine sitz bath on episiotomy wound healing in quantitative
approach.
RESEARCH DESIGN
In this study Quasi experimental research design is used by the researcher.
10. VARIABLE
Two types of variables identify in the study are:
Independent variable: In this study the Neem extract sitz bath, betadine sitz bath were
independent variable.
Dependent variable: The dependent variable was Episiotomy wound healing.
11. SETTING
The study was conducted in selected Hospital(GMERS Hospital) of Junagadh. It
is a 695 bedded hospital specialized in obstetric & gynecological unit, pediatric unit,
family planning unit, medical & surgical unit, and cardiology unit and about 600
antenatal mother’s visits out patients department monthly. On an average 300-400
deliveries are conducted in a month among this 250 were normal deliveries and 100-
150 were caesarean deliveries. The postnatal ward was situated near to labor room.
There were 35 beds are in each postnatal ward.
12. SAMPLING SIZE
The Sample consists of the subject of the population selected to participate in the
research study. Total sample composed of 60 primi postnatal mothers who had
undergone episiotomy, fulfilling the selection criteria from Selected Hospital
Junagadh. The sample were divided in to two groups. Among them 30 samples were
assigned to experimental Group I, remaining 30 samples were assigned to
experimental Group II.
SAMPLING TECHNIQUE
Purposive sampling technique.
13. CRITERIA FOR SAMPLE SELECTION
The samples were selected based on the following inclusion and exclusion criteria:
Inclusion criteria:
• Primi postnatal mothers
• Postnatal mothers with episiotomy
• Postnatal mothers who are willing to participate
• Postnatal mothers who are present during the time of study
Exclusion Criteria:
• Postnatal mothers who are seriously ill
• Postnatal mothers with both episiotomy and perineal tear
• Postnatal mothers with puerperal infection
• Postnatal mothers who have obstetric complications like GDM and PIH etc.
14. DESCRIPTION OF TOOL
The tool was designed in to two parts.
SECTION – A
To assess the demographic profile, the structured questionaries was used. It
comprised of demographic data of episiotomy wound healing such as age,
educational status, occupation, family income, religion, type of family. No score
was given to this demographic profile. The data was used for descriptive statistics.
SECTION – B
REEDA scale assessment of episiotomy wound healing: REEDA acronym is used as
a nursing tool when evaluating an episiotomy wound which is invented by Nancy
Davidson – (1974). REEDA stands for redness, edema, ecchymosis (purplish patch
of bloodflow), discharge, and approximation (closeness of the skin edges).
15. SCORING INTERPRETATION
The level of infection was interrupted as follows;
Observational checklist of REEDA Scale is scored as no infection-0, mild
infection 1-5, moderate infection 6-10 and severe infection 11-15.
LEVEL OF
INFECTION
SCORE PERCENTAGE %
No Infection 0 0
Mild Infection 1-5 7-33
Moderate Infection 6-10 34-66
Severe Infection 11-15 67-100
16. VALIDITY
The prepared instruments along with the objectives, operational definition, and check
list for validation were submitted to 8 experts which includes 7 nursing experts and 1
medical expert. There was no change made inthe standardized tool. The demographic
data consists of 6 items according to the experts opinion.
RELIABILITY
In order to establish the reliability of the tool, split-half method was used. The
reliability of REEDA scale was assessed by inter-rater reliability method and Karl
Pearson co-efficient formula. The tool was found to be reliable (0.98).
17. PILOT STUDY
The pilot study was conducted in Lotus women’s hospital of Junagadh for a period of
Six days. It was conducted with 12 samples among these 6 samples for experimental
group I and 6 samples for experimental group II.
Pre-test was done by REEDA scale to assess the episiotomy wound healing for
experimental group I & II. Then the intervention of betadine sitz bath was given 10-15
minutes, twice a day (morning & evening) for 3 days to experimental group I and
posttest was done with the same scale on 3rd day. Then the intervention of neem
extract sitz bath was given 10-15 minutes, twice a day (morning & evening) for 3 days
to experimental group II and the Post -test was done with the same scale on 3rd day.
The paired " t " test value for experimental group I = 2.73 (Table value = 2.4)
experimental group II = was about 4.5 (Table value = 2.45). So, there is a wound
healing in Neem extract sitz bath. Independent ‘t' test = 4.2(Table value = 2.18) .
After the pilot study it was found that it is feasible & practicable to conduct the main
study.
18. DATA COLLECTION PROCEDURE
Techniques of Data collection: The main study was conducted at GMERS Hospital
of Junagadh, for a period of 20 days. Screening was done among postnatal mothers
who undergone vaginal delivery with episiotomy. Consent obtained from the postnatal
mothers who met the inclusion criteria were selected by using purposive sampling
technique for the study. Main study was conducted from 4th April to 23rd April for 20
days at GMERS Hospital Junagadh. Demographic data collected by structured
Questionaries and obstetrical data was obtained from medical records and through one-
to-one interview. Episiotomy wound healing level was assessed after vaginal delivery
followed by post-test assessed after 3 days and its outcome was measured with REEDA
scale by investigator.
19. Intervention: The main study was conducted with 60 samples, and the samples
were divided in to two groups (I&II). Among that 30 samples were experimental group
I and other 30 samples were experimental group II, and who met the inclusion criteria
were selected by purposive sampling technique. Pre-test was done by REEDA scale to
assess the episiotomy wound healing for experimental group I & II. Then the
intervention of betadine sitz bath was given 10-15 minutes, twice a day (morning &
evening) for 3 days to experimental group I and post-test was done with the same scale
on 3rd day. Then the intervention of neem extract sitz bath was given 10-15 minutes,
twice a day (morning & evening) for 3 days to experimental group II and the post-test
was done with the same scale on 3rd day. In this study 8 -9 samples were selected per
day.
20. PLAN OF DATAANALYSIS
DATA
ANALYSIS
METHODS OBJECTIVES
Descriptive
statistics
Frequency
percentage
To describe the demographic variables
InferentialStatistics Mean, SD Frequency
percentage
To assess the pre and Post -test score
Paired T Test To compare the pre and posttest level of wound
healing scores among postnatal mothers in exp
– group I(Betadine sitz bath)
To compare the pre and posttest levelof wound
healing scores among postnatal mothers in exp –
group II (Neem extract sitz bath)
Independent Ttest To compare the effectiveness of mean Post -test
level of wound healingscores among postnatal
mothers between experimental group I & II.
21. COMPARISION OF PRE-TEST AND POSTTEST SCORE ON
WOUND HEALING IN EXPERIMENTAL GROUP I
Table of Frequency and percentage distribution of Pre-test and Post -test level of wound
healing in experimental group I:
Level of infection PRE-TEST POST -TEST
NO % NO %
No infection (0)
Mild Infection (1-5)
Moderate Infection (6-10)
Severe Infection (11-15)
3
24
3
-
10
80
10
10
20
-
-
33.3
66.6
-
-
22. Percentage distribution of the Pre-test & post-test level of wound healing in
Experimental group I. (REEDA scale)
10
80
10
0
33.3
66.6
0
0
NO INFECTION MILD INFWCTION MODERATE
INFECTION
SEVERE INFECTION
PRE-TEST
POST -TEST
POST-TEST
PRE -TEST
23. Table of Comparison of Mean, Standard deviation, Meandifference and Paired "t"
value between Pre-test andposttest score on wound healing in Group- I
Sr.
No
Group N Wound healing Mean SD Mean difference Paired ‘t’ Table Value
1 I 30 Pre-test
Post -test
3.9
2.2
2.15
1.7
1.7 9.05 2.04
25. COMPERISION OF PRE-TEST AND POST-TEST SCORE ON
WOUND HEALING IN EXPERIMENTAL GROUP II
Table of frequency and percentage distribution of Pre-test and Post -test level of wound
healing in experimentalGroup-II
Level of infection PRE-TEST POST-TEST
NO % NO %
No infection (0)
Mild Infection (1-5)
Moderate Infection (6 – 10)
Severe Infection (11-15)
2
27
1
-
6.6
90
3.3
-
21
9
-
-
70
30
-
-
27. Table of Comparison of Mean, Standard deviation, Mean difference and Paired "t"
value between Pre-test andposttest score on wound healing in group- II.
Sr. No Group N Wound Healing
Score
Mean SD Mean
Difference
Paired
t value
TableValue
1. II 30 Pre-test
Post -test
2.8
0.6
1.3
0.98
2.2 14.4 2.04
28. Comparison of Mean, Standard deviation, between Pre-test andpost-test score on
wound healing in group- II.
Mean , 2.8
SD, 0.6
Mean , 1.3
SD, 0.98
0
0.5
1
1.5
2
2.5
3
Mean SD
GROUP II
PRETEST
POST TEST
29. COMPARISION OF POST -TEST SCORE ON WOUND
HEALING IN EXPERIMENTAL GROUPI & II.
Table of Comparison of Mean, standard deviation, Mean difference and Independent
"t" value between betadine sitz bath and Neem extract sitz bath on wound healing score
in group I&II.
Sr.
No
Group N Wound
Healing score
Mean SD Mean
difference
Independent
"t" value
Table
Value
1. I 30 After betadine
sitz bath
2.2 1.7
0.72 4.7 2.00
2. II 30
After Neem
Extract
Sitz bath
0.6 0.98
30. Comparison of Mean, standard deviation, Mean difference and paired "t" value
between betadine sitz bath and Neem extract sitz bath on wound healing score in
group I&II.
Mean, 2.2
SD, 1.7
t value, 9.05
Mean, 0.6
SD, 0.98
t value, 14.4
0
2
4
6
8
10
12
14
16
Mean SD t value
GROUP I
GROUP II
31. FINDINGS OF THE STUDY
1. The first objective of the study was to compare the pre and post - test level of
wound healing among mothers in experimental group I(Betadine sitz bath).
The mean wound healing score in experimental group I before betadine sitz bath is 3.9
(SD=2.15) and after Betadine sitz bath is 2.2 (SD=1.7) respectively. The paired t-test
value is 9.05, which is significant at P<0.05 level.
2. The Second objective of the study was to compare the pre and post-test level of
wound healing among mothers in experimental group II (Neem extract sitz bath)
The mean wound healing score in experimental group II before Neem extract sitz bath
is 2.8 (SD=1.3) and after Neem extract sitz bath is 0.6 (SD=0.98) respectively. The
paired t-test value is 14.4, which is significant at P<0.05 level.
32. 3. The third objective of the study was to compare the effectiveness of Post -test score
of wound healing among mothers between experimental group I & II.
The mean post- test wound healing score in group I is about 2.2 (SD=1.7) and group II
is about 0.6 (SD=0.98) respectively. The independent t-test value 4.7 (p<0.05). The
calculated value is more than the table value.
Therefore, it is clearly proved by this study that Neem Extract Sitz bath is effective
more than betadine sitz bath on episiotomy wound healing.
33. LIMITATIONS
• Since it is a new procedure to most of the mothers the researcher found difficulty in
making them to understand the merits.
• The More privacy was needed to do the procedure.
• The study is limited for 60 samples.
• The obstetrical variables are not included.
34. IMPLICATIONS
The nurses can practice betadine and neem extract sitz bathalong with routine perineal
care. Its improving the wound healing on postnatal mothers with episiotomy.
The nurse educator can orient the students with alternative therapies and promoting
wound healing in betadine sitz bath and Neem Extract sitz bath.
Nurse educator can conduct workshops on alternative therapies to update the
knowledge and help students to provide effective care.
The nurse educator can provide in-service education tonursing students to update their
knowledge and practice using Neem Extract sitz bath and Betadine sitz bath among
women in postnatal period with episiotomy wound.
35. The nurse administrator should conduct in-service education to nursing personnel
regarding other measures used for wound healing. Workshops, seminars about the
effectiveness of Neem Extract sitz bath and Betadine sitz bath and episiotomy wound
can be made available to nursing staff in wards andnurse education in institute
Nurse administrators have the responsibility as creating awareness among primi
postnatal mothers regarding the effectiveness of Neem Extract & Betadine sitz bath by
facilitating free distribution of pamphlet to the postnatal wards.
The finding of this study can be effectively utilized by the emerging researchers for
their reference purpose.
The research study enhances the body of knowledge innursing science.
