Bagcal, Johann Mark N.

2NUR2

RLE 2.1 Maam Ariel

I.

Reference

Haghani, H., Jahdi, F., Khoei, E.M., Shamsalizadeh, N., Sheikhan, F., & Sheikhan, M. (February 2012). Episiotomy pain relief: use of Lavender oil essence in primiparous Iranian women. Complementary Therapies in Clinical Practice, 18, 1, pp. 66- 70.

II.

Rationale of the Study The reason behind this study was to devise a method on how to ease the

discomfort felt by primiparous mothers who just had an episiotomy surgery through complementary medicine. Moreover, this study compared the effectiveness between povidone- iodine and lavender oil essence on post- episiotomy discomfort pain scale of postpartum mothers.

III.

Background of the Study The most common perineal incision in obstetrical procedure is

episiotomy. In 2000, about 33% of women with normal spontaneous delivery had an episiotomy. This procedure usually results in pain for postpartum mothers especially for the primipara. Studies shown that 10% of women with spontaneous vaginal delivery encountered pain for more than two months with the rate elevating to 30% for those with assistant vaginal birth. Mediolateral episiotomy is more prevalent than midline episiotomy in Iran and prevalence of surgical complications is higher in Iranian mothers than with other Asian counterparts. Since episiotomies are similar with other surgical incisions, care should be given to this type of wounds. In addition, antiseptic sitz bath is one of the methods used for treating episiotomy incisions. In Iran, oral analgesics and regular sitz bath using 10% povidone- iodine for 30 min are regularly used. Another rising intervention is the use of aromatherapy oil essences in promoting healing of

wounds and pain comfort of patients with incisional wounds. Oil essences derived from Lavender flowers affords antibacterial, antifungal, carminative (relaxes smooth muscle), sedative, anti- depressive effects and can be effective for burns and insect bites. Another attributes of Lavender oil are the medical properties such as analgesic, sedative, antispasmic and relaxing. Little research has been conducted to evaluate the effects of sitz baths and the application of Lavender oil essence as an alternative way to treat or reduce perineal discomforts of patients. This study was performed to explore the use of Lavender oil essence in perineal healing and pain relief in a group of postpartum Iranian women.

IV.

Statement of the Problem This study aims to discover innovative safe and effective treatment for

wound healing. It targets to find the efficacy of aromatherapy oil essences such as Lavender oil in reducing perineal discomfort experienced by postpartum women after an episiotomy incision. Thus, it devises a way in promoting faster wound healing of an episiotomy and avoiding further wound complications caused by this type of surgical incisions such as bleeding, infection, pain, urinary incontinence, dyspareunia and the mothers anxiousness. Furthermore, this study compares the effectiveness of routine practical program or protocol of sitz bath with Povidone- iodine vis--vis the use of alternative medicine such as Lavender oil essence in post- episiotomy discomfort and alleviating its drastic effects in maternal quality of life, mental health of women and mother- baby relationship. V. Summary of the Study

This experimental and evaluation study necessitated 60 qualified Iranian primipara admitted for labor in Kamali Hospital in Karaj, Iran who were randomly divided into two significant groups- the case group which used Lavender oil and the control group which used the routine hospital protocol. The client- participants perineal trauma was documented with the use of VAS (Visual Analogue Scale) and REEDA (Redness, Edema, Ecchymosis, Discharge Scale). Pain and discomfort of the participants were

assessed at four hours, twelve hours and five days interval after the episiotomy. All analgesics used by the participants were recorded. Both groups were in the hospital on the first day after labor. To assess analgesic consumption and document pain intensity, subjects in both groups were routinely allowed to take Mefenamic acid capsules 250 mg every 8 h or three times during the first 12 h following episiotomy and to take analgesics at home when pain required them to do so. The two groups were provided with a form on which to record their analgesia use. Gathered data was dissected with the use of SPSS 14 utilizing an independent t- test and chi- square. There was no significant difference between the control and case groups pain score at the pre- interventional phase of this clinical trial. Towards the end of this clinical trial, at 4h post- op, the case group has a lower pain score compared with the control group. At the 12h post-op, there was no significant deviation between the two groups leaving only 0.06 as a difference. After 5 days following the episiotomy, the pain intensity of the case group was lower versus the pain intensity of the control group. In addition, 70% of participants in the case group had not taken analgesia vis--vis the 33% of participants in the control group who had not taken analgesia 4 days after episiotomy. In the 2 nd, 3rd, 4th and 5th day after their delivery, significant level between the mean levels of analgesics was evident. Before the clinical trial, there was no significant difference found on the REEDA (Redness, Edema, Ecchymosis, Discharge and Approximation) between the two groups. At the end of the intervention, five days after the episiotomy, the case group (using Lavender oil essence) was significantly lower in terms of REEDA versus the control group (using the Betadine).

VI.

Conclusion of the Study

As evidenced by the results obtained from this conducted randomized controlled clinical trial, there was no significant difference recorded between the two groups: case group (using Lavender oil essence) and control group (using Betadine as a routine hospital protocol) on demographic data- age, education, economical status, job experience and there was no significant differences between obstetric and neonatal

factors- length of episiotomy wound, duration of each labor stage (1 st- 3rd), numbers of superficial stitches, mothers body mass index 5 days post- episiotomy, neonatal head circumference or commencement of breast feeding or re- commencing daily activities after labor. This study asserts that the treatment of Lavender oil essence on the perineal incision after an episiotomy is an effective way of pain relief and it enhances the incision wound healing process. Based from the REEDA and pain intensity score results, the case group was significantly lower compared to the control group five days after the episiotomy. Also, analysis of analgesic consumption showed that the case group reduced pain relief medication significantly more than the control group which may be attributed to the Lavender oil essences analgesic effects. In the course of this study, Lavender oil essences of the case group enhanced the healing process of surgical incision caused by an episiotomy versus the Povidone- iodine sitz bath of the control group. Furthermore, the use of Lavender oil essence in warm baths affords incisional wound healing of the perineum of a post- partum mother preventing further wound complications indicated by a delayed healing process. Moreover, this intervention is proven effective in alleviating the pain intensity experienced by the patient. Nevertheless, aromatherapy oil essence inclusion in warm bath as an alternative medicine is more efficacious than the usual hospital protocol in Iran.

VII.

Implications to the following:

1. Nursing practice This study suggests the use of alternative medicine in the healing process of a post- partum mother after an episiotomy. It also suggests that the nursing personnel may include alternative medicine besides the use of hospital protocol and pharmacological ways as part of his/ her health teaching upon the assessment- BUBBLESHE and the discharge of a post- partum woman. 2. Nursing education This study considers the addition of complementary medicine in the nursing care of a post-operative or post- partum mother after a delivery as part of

the curriculum. It also provides a way to include herbal medicine or aromatherapy in the surgical incision healing process of the perineum. It proves that the use of aromatherapy oil essences enhanced healing process and relieved the perineal trauma: pain and discomfort of post- partum mothers. It explores to the use of complementary medicine which increases the attention given by nursing, midwifery and medicine. 3. Nursing administration This study recommends an implementation of Lavender oil essences warm bath on the hospital protocols done on a post- partum mother. It suffice post- episiotomy trauma which affects maternal quality and mental health of life and the mother and baby relationship and this study increases the quality nursing care provided to mothers.

4. Nursing research Further studies were recommended by this study to cater in discovering other alternative medicine in treating the physiologic and emotional discomfort of post- partum mothers with spontaneous vaginal delivery, exploring other effects of aromatherapy oil essences and Lavender oil essences on the post- episiotomy mother and specifying how it works on a human body. 5. Nursing theory This study reflects the Nursing as Caring theory of Anne Boykin and Savina Schoenhofer which states that persons are caring by virtue of being human; are caring, moment to moment; whole and complete in the moment; and already complete while growing in completeness. I believe it is so because the researchers focused to the relief of perineal trauma following episiotomy felt by post- partum mothers and to their recovery stage. They became caring persons in the nursing prospect throughout this study. 6. Nursing students This study implies the nursing students to be vigilant and tact in assessing post- partum mothers. It suggests the application of complementary medicine as part of their health teaching and intervention to post- episiotomy patients

especially the primiparous mothers. In addition, it calls them to probe innovative professional nursing treatment and elevate the nurse- client centered approach not only to the post-partum mothers of obstetrics but to other patients as well.