Case Study Into Female Pain During Childbirth

SUMMARY

Delivery is a one of the miracle of every women’s life. The mothers suffer much distress. After child birth due to painful perineum. Perineal pain is most commonly associated with child birth by vaginal delivery. Pain following episiotomy appears to be universal. The mother undergoing episiotomy is characterised by greater blood loss in conjunction with delivery, and there is a risk of improper wound healing and increased pain during early puerperium. Various interventions are found to aid the healing process, which include cleanliness, applying ice pack, topical application by dry heat (infrared therapy), sitz bath performance of kegel’s exercise and perineal care. Any outward incident in the family may cause shees and stain which in turn will affect the psychological well being of the mother.

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Aromatherapy is effective for reducing labor pain, decreasing stress hormones, alleviating depression and anxiety, and increasing interactive behaviors between parent and child. Lavender oil is a great aid to perineal healing. So, the investigator assessed the effectiveness of lavender oil sitz bath on reduction of episiotomy wound healing and psychological wellbeing among postnatal mothers in Gani hospital, Tirunelveli district, Tamil Nadu.

Objectives of the study were

• To assess and compare the pre and post test level of episiotomy wound status and psychological wellbeing among the experimental group of postnatal mothers.
• To assess and compare the pre and post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers.
• To compare the pre test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.
• To compare the post test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.
• To associate the post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers with selected demographic variables

The assumptions of this study were

The assumptions of the study were.

• Unhealing and inadequate care of episiotomy wound may predispose to vulval haematoma, infection, wound dehiscence and scar endometriosis.
• Lavender oil sitz bath may improve the wound healing psychological wellbeing.

Hypotheses of the study were

RH1 – There is a significant difference between pre and post test level of episiotomy wound status and psychological wellbeing among the experimental group of postnatal mothers.

RH2 – There is a significant difference between pre and post test level of episiotomy wound status and psychological wellbeing among the control group of postnatal mothers.

RH3 – There is a significant difference in pre test level of episiotomy wound status and psychological wellbeing between the experimental and the control group of postnatal mothers.

RH4 – There is a significant difference in post test level of episiotomy wound status and psychological wellbeing between the experimental and the control of group of postnatal mothers.

RH5 – There is a significant association of post test level of episiotomy wound status and psychological wellbeing among the experimental and the control group of postnatal mothers with selected demographic variables.

Review of literature collected for the studies related to

The literature gathered from exclusive review is depicted under the following heading.

Section A: Literature related to episiotomy.

Section B: Literature related to episiotomy wound healing.

Section C: Literature related to psychological wellbeing of mother with episiotomy.

Section D: Literature related to lavender oil sitz bath on episiotomy wound healing and psychological wellbeing

The conceptual frame work opted for the study was based Ludwig Von Bertalarffy `s general system theory and it provided a complete framework in order to achieve the objectives of the study.

The research design selected for the study was true experimental pre and post only design was used and the study was conducted in the postnatal ward in Gani Hospital, Tirunelveli Dist, and Tamil Nadu. The tool used for data collection consisting of demographic variables which include age, education status, work pattern, type of the family and parity. The assessment level of episiotomy wound and psychological wellbeing among the experimental group and the control group were measured by using REEDA scale and structured observation check list . The tool was validated by 2 experts in the field of obstetrician and gynecologist and 3 experts in obstetrician and gynecologist nursing personnel and the reliability of the tool was established by interpreter reliability method. The value of the reliability was r=0.9. The tool was highly reliable to conduct the main study.

The pilot study was conducted in Gani Hospital, Tirunelveli district among 6 samples out of which 3 were in the experimental group and 3 were in the control group of postnatal mothers. The experimental group received lavender oil sitz bath but no one had lavender oil sitz bath in control group. The finding revealed the feasibility, reliability and practicability of the tool for conducting main study. No modification was made after pilot study. Pilot study period was 4 consecutive days from28-4-2010 to1-5-2010 from 9am to5pm.

The main study was conducted at Gani Hospital, Tirunelveli district. Tamil Nadu. The 60 postnatal mothers who fulfilled the inclusive and exclusive criteria were selected for the study ,out of which 30 mothers were the experimental group and 30 of them were the control group . Sample was selected by using simple random sampling method by Lottery method. Mothers who came under group A lottery will come under the experimental group of mother and mother who came under group B lottery will come under the control group of mothers. The investigator gave lavender oil sitz bath to the experimental group . Lavender oil sitz bath is Lavender oil is added with warm water in a basin and asked the mother to sit for 15 minutes 2 times per day about 3 days in the experimental group. Hospital routine care was given to the control group. The collected data was analyzed and interpreted based on the objective by using descriptive and inferential statistics.

The findings of the study revealed that the calculated ‘t’ value was 8.75 which showed highly statistical significant difference in post test level of episiotomy wound status and psychological wellbeing among the experimental group and the control group of postnatal mother at p<0.05 level was retained.

Association of post assessment level of episiotomy wound status and psychological wellbeing with selected demographic variables of the experimental group and the control group showed that there was no statistical significance at p<0.05 level was retained.

CONCLUSION

The present study assessed the effectiveness lavender oil sitz bath on episiotomy wound healing and psychological wellbeing among postnatal mothers in Gani Hospital, Tirunelveli. Tamil Nadu. The results of the study concluded that rendering the lavender oil sitz bath was effective for episiotomy wound healing and psychological wellbeing. The lavender oil sitz bath is cost effective, easy to apply, not harmful and can enhance comfort in mothers. So, it could be easy to adopt a regular intervention. Therefore, the investigator felt that more importance should be given to episiotomy wound healing and improve psychological wellbeing following the intervention of lavender oil sitz bath which can be given as a non-pharmacological measure to enhance reduction of episiotomy infection and improve psychological wellbeing.

IMPLICATION:

The investigator has derived from the study, the following implications, which are of vital, concern in the field of nursing practice, nursing education, nursing administration and nursing research.

NURSING PRACTICE

The midwives have a vital role in providing safe and effective nursing care to enhance episiotomy infection and psychological wellbeing.

This can be facilitated by motivating the nurse midwives to

• Have an in depth knowledge on physiological changes during puerperium and management of puerperium for mother with episiotomy
• Have an in depth knowledge regarding episiotomy wound care and its healing process and for improvement of psychological wellbeing of the mother.
• Learn about accurate assessment of episiotomy wound and psychological wellbeing with the use of standard and appropriate scales.
• Develop skill in providing efficient nursing care for effective management episiotomy wound healing and psychological wellbeing of postnatal mothers.
• Teach the mothers during antenatal period about the effectiveness of various non pharmacological measures for episiotomy wound healing and psychological wellbeing.

NURSING EDUCATION

Ensure that the students learn the normal physiological changes during puerperium and its management.

Provide adequate clinical exposure for the students to give effective and safe nursing care in postnatal care with episiotomy.

Make use of available literatures and studies related to non-pharmacological measures for episiotomy wound healing and psychological wellbeing.

Educate the students about various complementary and alternative therapies for episiotomy wound healing and psychological wellbeing.

Encourage the students for effective utilization of research based practices.

NURSING ADMINISTRATION

Collaborative with governing bodies to formulate standard policies and protocols to emphasize nursing care during puerperium and mother with episiotomy.

Conduct in-service programme and continuing education programme for effective management during puerperium and episiotomy wound healing and psychological wellbeing .

Ensure and conduct workshops ,conferences ,seminars on non-pharmacological methods to promote episiotomy wound healing and psychological wellbeing .

NURSING RESEARCH

As a nurse researcher, promote more research on effective management during puerperium regarding episiotomy wound healing and psychological wellbeing.

Disseminate the finding of the research through conferences, seminars and publishing in nursing journal.

Promote effective utilization of research findings on puerperium management especially episiotomy wound healing and psychological wellbeing.

RECOMMENTATION

The study recommends the following future research…

The similar study can be conducted with larger samples for better generalization.

A comparative study can be conducted to compare the episiotomy wound healing and psychological wellbeing between primi and multi mothers.

A study can be conducted to assess the knowledge and practice of nurse midwives with regard lavender oil sitz bath for episiotomy wound healing and psychological wellbeing .

A study can be conducted to assess the knowledge and attitude of nurse midwives on complementary and alternative therapies for episiotomy wound healing and psychological wellbeing .

A study can be conducted to assess the effectiveness of other nursing measures such as music, warm water bath, breathing exercise on episiotomy wound healing and psychological wellbeing .

LIMITATION

Only limited literatures and studies was obtained from the Indian context.

Due to time constraints, the investigator was unable to take samples for the study.