Episiotomy Rates Vary Widely Worldwide

Labour is a wondrous act of nature and unique to every childbearing women. It is a transformative and special event in a women’s life. It is the magic of creation. The very process of giving birth is the most beautiful one on earth and the mother attains unique capacities and true nobility through childbirth. The onset of motherhood present a unique set of physical, emotional and psychological challenges.

Episiotomy is a common surgical procedure performed during second stage of labour. The first performance of episiotomy was done in 1742, when perineal incision was made to facilitate difficult deliveries (Grass, Dunn and stys 1986). It is made both to prevent tearing of the perineum and to release pressure on the fetal head with birth (Lawsan and Bienstock, 2007). It is the only procedure in obstetrics is performed without the patient’s specific consent. The advantage of an episiotomy is that it substitutes a clean cut for a ragged tear, minimize pressure on the fetal head, and may shorten the last portion of the second stage of labour (Incerpi,2007).

Episiotomy rates vary widely worldwide, depending on whether the procedure is used restricvely / routinely. The worldwide episiotomy rate was 27%, 54% are nulliparous and 6% are multiparous women (WHO 2003).Rates vary from 8% in the Netherlands,13% in England to 25% in the USA. Among English speaking countries, the US had the highest episiotomy rate, varying greatly from region to region. One in three mothers who delivered vaginally in the U.S from 1995 to 2003 had episiotomies.

In India the birth rate is very high 56% of women had an episiotomy compared to the 46% of white women. The difference between these percentage (10%) is measure of the excess frequency of episiotomy in Indian women.

According to the American college of Obstetrics and Gyenaecology, approximately one in three women having a vaginal delivery also have an episiotomy.

Approximately 70% of women with a vaginal birth experienced some degree of damage to the perineum due to tear (or) episiotomy and needed stitches. Like any other surgical incision, episiotomy results in some discomforts for most of postpartum patients (Hill,2000). Although relatively small in size, episiotomy sutures can cause considerable discomfort, because the perineum is an extremely tender area and the muscles of the perineum are involved in so many activities such as sitting, squatting ,bending ,urinating and defecating. Even without episiotomy women may experience bruising / tearing in the perineum. This is the most common source of infection in the days after giving birth.

Various interventions are found to reduce episiotomy wound infection and enhance the healing process which include administration of antibiotics, cleanliness, topical application of ointments, infra red therapy, sitz bath, performance of kegal’s exercise and perineal care (Helen et.al 2009). In addition complementary therapy is another great aid to perineal healing.

In recent years it has been seen that there has been a shift people from allopathy medicine to complementary medicine. The shift may be because people are becoming more conscious of their health and realize the need of holistic health. Quality of life is felt more important. In 2007 National health interview survey of complementary medicine use by Americans, showed that approximately 38% adults use complementary medicine. A survey by NPS medicine wise in 2008 revealed that 65% of Australians had used one (or) more complementary medicine in the previous 12 months.

The term complementary medicine is primarily used to describe practices employed in conjunction with (or) to complement conventional medical treatment. Complementary medicine is sometimes called mind – body medicine because it is an approach to healing that uses the power of thought and emotions positively influence physical health ( USA Drug, 2005). Complementary therapies can help to boost the immune system, help eliminate toxins, help relieve pain, improve sleep pattern, increase energy levels, induce sleep relaxation, reduce stress and tension, restore balance to body systems.

Lavender oil is one of the complementary medicine. It has a light fresh aroma, is clear in color and watery in viscosity. Lavender has been use continuously for thousands of years, either in the form with lavender water of essential oil / dried flowers. In the 1800’s the yardly company in England, realizing the healing properties of lavender , began adding it to their soaps and perfumes. Lavender oil promotes rapid healing and helps to prevent scarring. These remarkable healing properties of lavender were accidently discovered by French chemist Dr. Rene Maurice Gattefosse when he burnt his hand in a laboratory experiment. He instantly plunged it into a nearby bowl of lavender oil and discovered that it stopped throbbing pain and allowed the burn to heal quickly.

The therapeutic properties of lavender oil are antiseptic, analgesic,anticonvulsant,antidepressant,antirheumatic,antispasmodic,antiinflammatory,antiviral,bactericidal,sedative,carminative,soothing,hypotensive,decongestant and diuretic. The main effects of lavender are calming, soothing, balancing and normalizing. Lavender can be used to a state of mental and physical imbalances to a state balance in which healing can take place. On the skin, lavender oil tones, revitalizes and it is useful for all types of skin problems such as abscesses, acne, oily skin, boils, burns, sunburns, wound, psoriasis, insect bites, injuries and also acts as an insect repellant. Lavender oil can be used in a sitz bath and it would also have the added benefit of decreasing anxiety in the new mother which povidine iodine does not.

Research carried out at Huntington’s Hinchinbrooke Hospital has found that the use of lavender oil in the sitz bath led to greater comfort and improved healing of the perineum between the third and fifth days after delivery.

Adding lavender oil to a sitz bath aids in the healing of torn vaginal tissue. It also prevents the formation of excessive scar tissue, according to Margaret Fawcett of Aroma therapist and author of “Aromatherapy for pregnancy and childbirth”. It is one of the safest essential oil and can be used in full strength on the skin – also referred to as “neat”.

The use of lavender oil can be effective in reducing perineal discomfort and promote wound healing following episiotomy. It is being used due to its antiseptic and healing properties. Lavender oil is found as a good choice in treating episiotomy wound healing because of its cell regenerating properties.

Need for the Study

The postnatal period refers to 6 weeks period after childbirth. The period is popularly termed the fourth trimester of pregnancy. It comprises an amazing variety of complex physiologic and psychological adaptations. Protecting a womená¾½s health as these changes occur is important for preserving the future childbearing function and for ensuring that she is physically well enough to incorporate her new child into her family.

The physical care a women receives during the postnatal period can influence her health for the rest of her life. The nurses role is vital as she assists the mothers through these adjustments and supports them as they make a fresh start as a new family. Postnatal women are more prone for puerperal infection as a result of episiotomy which can be prevented by proper postnatal care.

Approximately 33% of women with vaginal delivery had episiotomy in 2000 (American College of Obstetricians – Gynaecologist, 2008). However the prevalence of episiotomy is not the same in different countries, Asian race are presumed to have smaller and tighter perineum so, the routine episiotomy may reduce the risk of Perineal tearing during delivery (lam et.al 2008).

Studies about the episiotomy rates around the world showed that this surgery ranged from 9.7% (western Europe-Sweden) to 96.2% (South Africa-Ecuador) with lowest episiotomy rates in English speaking countries (North America Canada & united states) and it remained high in many countries (centered south -America like brazil-94.2%, south Africa-63.3% and Asia like China-82%).

One study revealed that episiotomy was performed in 97.3% of 510 primiparous women who had vaginal delivery in Tehran (Shojariet.al.2009).

Barnabas (July 2012) conducted a study to determine the rate and risk factors for episiotomy at Baptist medical centre, Nigeria. Out of 280 subjects who had vaginal delivery, 96 (34.3%) subjects had episiotomy .The rate of episiotomy decreased with parity. The nulliparous had the highest rate (62.2%). The episiotomy rate among assisted vaginal delivery was 80.0% among those who had spontaneous delivery.

Law kw, wong Hs, Pan Tc (2006) were reviewed the use of episiotomy during vaginal delivery in Hongkong puplic hospitals. A prospective observational survey was carried out in total 6222. Women who underwent normal vaginal delivery of a singleton fetus with cephalic presentation of the 6167 women in whom the status of the perineum was known. Episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs. 71.4%).

Several studies suggest that using episiotomy in normal delivery results in fewer perineal laceration and trauma. The episiotomy discomfort and its consequences can affect maternal quality of life as well as the mothers and baby relationship. Like any other surgical procedure episiotomy carries number of risks: excessive blood loss, hematoma formation and infection ( Roberts and Chalmers 1989)

S.T Sule and S.D. Shittu ( July 2003) conducted a prospective cohort study to establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu bedlo university teaching hospital Zaria. The result findings suggest that the episiotomy rate was 35.6% of all vaginal deliveries . Episiotomies were significantly associated with primi gravida. The most common puerperal complications of episiotomies was asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), hemorrhage (5.3%) and extension of the incision (1.3%).

Nahid Arianpour 2009 (June) conducted a descriptive study to determine the bacterial species in postpartum infections at khanevadeh hospital. Postpartum infections among 6077 patients from 2003 till 2008 was studied in this study. In this study out of there different kinds of postpartum infections (i,e genital, breast and urinary tract ). Only genital infection is considered. Postpartum infections among 6077 patients from 2003 till 2008 was studied in this study. In result findings revealed that 7.59% (461 ) patients had postpartum infection, out of which 1.03%(63) patients were re hospitalized. The commonest infection was infection at the site of episiotomy.

Kathelin Karla (2005) stated that the routine use of episiotomy harmful to the pelvic floor that creates greater extent of surgical incision and delayed perineal wound healing, compared with no episiotomy group.

Continues improvement in quality of care after episiotomy could helps to control the infection and improves episiotomy wound healing. Nurse midwife plays on important role to promote postnatal care , to prevent complication of episiotomy wound earlier and hence force to bring a healthy mother. A well integrated postnatal care has an important role in assessing the transition to physical and psychological well being of the mother and baby . Episiotomy wound care is important for comfort and cleanliness and to prevent infection.

Attention should be afforded to episiotomy wound care since it parallels any other wound. One of the suggested method is a regular antiseptic sitz bath. Nowadays using complementary therapies such as essential oils have been recognized in Obstetrics. Mechanism of action of each essential oils is related to its complex active substances .One of the main action of these oils are easy absorption through the skin. The molecule of essential oils are small enough to permeate through the skin barrier. The molecule will be absorbed easily into the skin within 20-40 minutes depending on the chemical nature of the oil.

Lavender oil is one of the frequently prescribed essential oil due to its antibacterial, antifungal, sedative, anti depressant and healing properties.

Research has been done to evaluate the effect of lavender oil sitz bath on episiotomy wound healing (Katayan Vakilan 2012). This randomized control trial was conducted on 120 primiparous women with singleton pregnancy who had received mediolateral episiotomy during spontaneous delivery. Redness in lavender oil group was significantly less than control group (p<0.001).The result shows that 13 control group subjects and 31 lavender oil group subjects had no redness and 28 subjects in the control group and 8 in the lavender oil group showed redness greater than 7 mm. This study suggests application of lavender essential oil instead of povidone iodine for episiotomy wound care.

Fatemeh Sheikhan (Feb 2012) conducted a study on use of lavender oil essence in primiparous women in Iran. This clinical trial was involved 60 primiparous women. In result the REEDA score was significantly lower in experimental group (lavender group) 3 days after episiotomy (p=0.000). It is suggested that lavender oil essence may be preferably to the use of betadine for episiotomy wound care.

Though there are many studies done in various methods of episiotomy healing, only a very few studies are conducted to assess the effectiveness of lavender oil sitz bath on episiotomy wound healing. So the researcher felt the need to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers with episiotomy.

Statement of the Problem

A study to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among post natal mothers in government head quarters hospital at kanchipuram.

Objectives

To assess the level of episiotomy wound healing among postnatal mothers in experimental and control group.

To evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers in experimental group.

To determine the association between the level of episiotomy wound healing among postnatal mothers with their selected demographic and obstetric variables in experimental and control group.

Hypothesis

H1-There will be a significant difference between the mean post test level of episiotomy wound healing between experimental and control group.

H2- There will be a significant association between the level of episiotomy wound healing with their selected demographic variables among postnatal mothers in experimental and control group.

Operational Definition

Effectiveness

In this study effectiveness refers to the extend to which the lavender oil has produced desirable effect on episiotomy wound healing.

Lavender Oil Sitz Bath

It is a clean procedure in which the perineal area is immersed in 4 liter of warm water with a temperature of 100 – 105ËšF added with 5 drops of lavender oil for 10-15 minutes thrice a day for 3 days is used.

Episiotomy

It refers to the surgical incision on the median or right/ left medio lateral aspect of the perineum during second stage of labour to enlarge the vaginal introitus, to facilitate easy and safe delivery.

Postnatal Mothers

It refers to mothers who have undergone normal vaginal delivery and instrumental delivery with episiotomy.

Episiotomy Wound Healing

It refers to absence of redness ,edema, ecchymosis , discharge and presence of well approximation of wound as measured by using REEDA scale.

Assumption

Presence of episiotomy wound may predispose to wound infection.

Lavender oil aids in improving the healing of episiotomy wound.

Delimitation

The study is limited to the postnatal mothers who had normal vaginal and instrumental delivery with episiotomy.

The data collection period is limited for six weeks.

Projected Outcomes

This study will help in assessment of episiotomy wound healing among postnatal mothers.

This study will help to evaluate the effectiveness of lavender oil sitz bath on episiotomy wound healing among postnatal mothers.

This study enables nurses to practice lavender oil sitz bath during postnatal period.