RESEARCH PAPERS

EFFECTIVENESS OF HONEY VERSUS BETADINE

ON EPISIOTOMY WOUND HEALING
By
MANJULA P * ANITHA C. RAO ** RANJANI P ***
* Student, Canara College of Nursing, Kundapur.
** Associate Professor, Canara College of Nursing, Kundapur.
*** Assistant Professor, Manipal College of Nursing, Mangalore, Manipal University.

ABSTRACT
An experimental study was conducted to compare the effect of honey versus betadine on episiotomy wound healing
among 60 postnatal women (30 - honey group, 30 - betadine group) in Government Taluk Hospital, Kundapura between
23rd October 2011 and 23rd November 2011. Data was collected using episiotomy wound assessment scale. Findings
revealed that in the honey group on day 1 the episiotomy wound assessment score mean is 8.03, on day 5 mean score
reduced to 0.27. In betadine group day 1 mean is 8.23 and on day 5 mean score reduced to 1.4. There was a mean
difference of 7.8 in the honey group and 6.83 in the betadine group. The obtained 't' value on day 2 (3.818), day 3
(2.967), day 4 (4.2), day 5 (4.02) found to be significant (p< 0.05) at 0.01 and 0.05 level of significance. This reveals that as
the day progresses episiotomy wound healing was good in both the groups but it was faster in honey group than in
betadine group. Study results denoted that application of honey has significant influence on episiotomy wound healing.
Keywords: Effectiveness, Episiotomy wound healing, Honey, Betadine.

INTRODUCTION United Kingdom to assess the wound healing properties of

Midwives have an important role in the care of perineal
wound following childbirth. Today when the cost of medical
treatment and care is increasing, economical care of
patients with episiotomy can be provided if the nurses and
midwives realize the relevance of their care and practical
impact of the advocated procedure in wound healing
(Grundy,1993). The use of honey as a wound dressing
material is becoming increasing interest as more reports of
its effectiveness are published. The clinical observations
recorded are that infection is rapidly cleared,
inflammation, swelling and pain are quickly reduced,
odour is reduced, sloughing of necrotic tissue is induced,
granulation and epithelialization are hastened, and
healing occurs rapidly with minimal scarring. The
antimicrobial properties of honey prevent microbial growth
in the moist healing environment created. Unlike other
topical antiseptics, honey causes no tissue damage
(Molan, 1998).
A nonrandomized prospective study was conducted in
honey. Eight males and nine females with 20 ulcers (3
bilateral) were included and manuka honey was applied on
the wound regularly for 2 weeks. The use of Manuka honey
dressings was associated with a statistically significant
decrease in wound pH and a reduction in wound size (Wood,
Rademaker, Molan, 1997). Raw honey is a great remedy for
first- degree perineal tears. Honey's thick consistency forms a
barrier defending the wound from outside infections. The
moistness allows skin cells to grow without creating a scar.
Honey also acts as an anti-inflammatory and pain killer and
prevents bandages from sticking to wounds. Glucose
converted into hyaluronic acid at the wound surface forms
an extracellular matrix that encourages wound healing,
honey is also considered antimicrobial (Demetria Clark,
2005).
Literature Review
An experimental study was conducted on 33 patients who
underwent laparotomy in Iran to assess the wound healing
properties of honey. In the control and experimental group

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the wound was washed 3 times a day with normal saline. In
the experimental group, the wound was covered with a thin
layer of honey, intervention was continued till the complete
formation of the wound granulation tissue. The study results
proved that mean time of granulation tissue formation
started from 4th day to 27 days in the control group and first
day to 18 days in the experimental group (Askarpour,
Rashidi, Daei, Mahmoodi, 2010).
A n o n r a n d o m i z e d , p r o s p e c t i v e, o p e n - l a b e l
(noncontrolled), side-by-side comparison trial was
conducted on 88 patients in United Kingdom, to determine
the use of honey as an adjunct in the healing of split-
thickness skin graft donor site. In the treatment of split-
thickness skin graft donor sites, honey-impregnated gauzes
showed faster epithelialization time and a low sense of pain
than paraffin gauzes and saline-soaked gauzes. There was
no significant difference between honey impregnated
gauze and hydrocolloid dressings with regard to
epithelialization time and sense of pain. An experimental
study was conducted to determine the effects of honey
and sugar dressings on wound healing at Malawi. Forty
patients with open or infected wounds were randomised to
receive either honey or sugar dressing. Results concluded
that honey appears to be more effective than sugar in
reducing bacterial contamination, promoting wound
healing, and slightly less painful than sugar during wound
dressing and motion (Mphande, Killowe, Phairas, Janes,
2007).
A prospective randomized study on honey dressing versus
boiled potato peel in the treatment of burns was
conducted in India. In the 50 patients treated with honey,
90% of wounds were rendered sterile within 7 days. In the
50 patients treated with boiled potato peel dressings,
persistent infection was noted within 7 days. Of the
wounds treated with honey, 100% healed within 15 days
as against 50% in the wounds treated with boiled potato
peel dressings (Subrahamanyam,1996). A rospective
randomized clinical and histological study of superficial
burn wound healing with honey and silver sulfadiazine
was conducted in India. The study concluded that in
honey dressed ounds, early subsidence of acute
inflammatory changes, better control of infection and
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quicker wound healing was observed while in the silver
sulfadiazine treated wounds sustained inflammatory
reaction as noted even on epithelialization
(Subrahamanyam, 1998).
The Objectives of the Study
Compare the effectiveness of honey with betadine on
episiotomy wound healing as measured by episiotomy
wound assessment scale.
Hypothesis
There will be significant difference in the episiotomy wound
healing between honey and betadine group.
Method
Design
Design selected for this study is Randomized controlled trial
(unblinded).
Population
Population for this study was postnatal women admitted in
Government Taluk Hospital, Kundapura between 23rd
October 2011 and 23rd November 2011.
Sample Size and Sample
The required sample size calculated for 95% confidence
limit with power of 80% was 60. Sample comprised of
postnatal women in the age group above 18 years with
right or left mediolateral episiotomy.
Description of the Tools
Episiotomy wound assessment scale was used to assess
the condition of episiotomy wound healing. The scale
consisted of five domains with 23 sub items. The domains
included in the tool were redness, edema, ecchymosis,
discharge from the episiotomy area and approximation of
the episiotomy wound edges. The measurement was done
with a standard paper centimeter scale which had ten
subdivisions of one millimeter each for redness, edema,
ecchymosis and approximation of the wound edges. For
each postnatal woman separate scale was used. The
minimum score was 0 and maximum score was 18. On the
basis of scoring, wound healing was arbitrarily categorized
and classification of scores were: 0-3 good wound healing,
4-7 mild wound healing, 8-12 moderate wound healing,
13-18 poor wound healing.
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Content Validity of the Tools being affected.

To ensure the content validity, the tools along with the blue Procedure of Data Collection
print and objectives of the study were given to fifteen The investigator obtained written permission from the
experts from the field of Obstetric and Gynecological concerned hospital authority prior to the study. Once the
nursing, Obstetrics medicine, Ayurveda and Statistics. The eligible postnatal women got admitted in the postnatal
experts were requested to give their suggestions and ward, on the first day of delivery the purpose of the study
opinions regarding the relevancy, accuracy and was explained, confidentiality was assured and informed
appropriateness of the items. The items present in the tool written consent was obtained. Subjects were assigned into
were 23. There were100% agreement for the entire items. honey group and betadine group by simple random
Testing of Honey technique using lottery method. Initial assessment of the
Honey was obtained from the S.D.M ayurveda college, episiotomy wound was done by using episiotomy wound
Udyavara, Udupi. Testing of the honey for its purity and assessment scale. Perineal care was given to the postnatal
constituents was done in biochemical laboratory, Manipal women (perineum cleaned with cotton swab soaked in
College of Pharmaceutical sciences, Manipal. Honey as normal saline), then 5ml of honey soaked in gauze piece
tested for its purity and for the presence of added sugar. was applied directly on the episiotomy wound to the honey
Tests indicated that the honey is pure, natural and it has no group and betadine application was followed for the
added sugar. betadine group every 12hrs from the 1st day onwards for 5
days. Episiotomy wound healing was observed on every
Reliability of the tool
day morning for 5 days. Daily assessment of the condition
In order to establish the reliability, the episiotomy wound
of the episiotomy wound was recorded for both the group.
assessment scale was administered on twenty postnatal
Intervention was done by the researcher.
women who got admitted in Manish Maternity Care
Results
Hospital, Government Taluk hospital, Kundapur, Udupi
district from 28/07/2011 to 07/08/2011 Reliability was Data was analyzed using statistical package for social
established by using Inter rater reliability. The calculated sciences (SPSS), version 11.5.
reliability coefficient was 0.89. This indicates that the tool Effectiveness of betadine application on episiotomy
was reliable. wound healing in betadine group
Pilot Study The data presented in the Table 1 shows that, the base line
Pilot study was conducted in the Government Taluk maximum episiotomy wound score for betadine group
Hospital, Kundapur, Udupi from 4/09/2011 to 10/09/2011 was 11 and the minimum score was 5 with mean score
after obtaining written permission from the ethics 8.23 and standard deviation 1.31. During the second
committee and administrators of hospital. Informed written postnatal day the maximum episiotomy wound
consent from the postnatal women was obtained. The pilot assessment score was 10 and the minimum sore was 2 with
study was done on 10 samples. The study design was found the mean score 6.63 and standard deviation 1.94, for the
feasible by the investigator. Hence no modifications were N=30
made in the study. DAYS SCORES
Minimum Maximum Mean Median SD
Ethical Considerations BASELINE 5 11 8.23 8 1.31
Ethical clearance was obtained from Institutional Ethics DAY 2 2 10 6.63 6 1.94
DAY 3 1 7 3.93 4 1.76
Committee (IEC) and informed consent was obtained from DAY 4 0 6 2.37 2 1.59
the postnatal women. During recruitment, the researcher DAY 5 0 5 1.4 1 1.33

emphasized that participation was voluntary and any time Note: Confidence interval = 95%
Table 1. Distribution of episiotomy wound assessment
women can withdraw from the study without their care
score of postnatal woman in betadine group

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third postnatal day the maximum score was 7 and the difference of 7.8. There is significant reduction in the day
minimum score was 1 with the mean score 3.93 and wise episiotomy wound assessment mean score in the
standard deviation 1.76. In the fourth postnatal day the honey group.
maximum episiotomy wound assessment score was 6 and To analyze the variance in the components of episiotomy
the minimum sore was 0 with the mean score 2.37 and wound assessment scale by honey application, repeated
standard deviation 1.59, for the fifth postnatal day the measures ANOVA was used to compute the Maucholy
maximum score was 5 and the minimum score was 0 with sphericity value and Greenhouse Geisser value. The data
the mean score 1.4 and standard deviation 1.33. As days presented in Table 3 shows that, the Mauchlys test is
progresses the maximum score is reduced from 11 to ten significant (P<0.05), so assumption of sphericity is not met,
and the minimum score is reduced from 5 to 0. The mean so p value in Greenhouse- Geisser was considered and it is
score is reduced from 8.23 to 1.4 with the mean difference found to be less than 0.05 for redness, edema, ecchymosis
of 6.83. There is significant reduction in the day wise and approximation of wound edges. This indicates a
episiotomy wound assessment mean score in the significant variance.
betadine group.
To compare the effectiveness between honey
Effectiveness of honey on episiotomy wound healing in (experimental group) and routine episiotomy care (control
honey group group) on episiotomy wound healing data was computed
The data presented in the Table 2 shows that, the base line using independent “t” test. Data in Table 4 shows that, the
maximum episiotomy wound score for experimental group day 1 mean score in experimental group was 8.07 when it
was 12 and the minimum score was 4 with mean score reached day 5 the mean score reduced to 0.27, in control
8.07 and standard deviation 2.27. During the second group the day 1 mean score was 8.23 when it reached day
postnatal day the maximum episiotomy wound 5 the mean score was 0.64. There is a mean difference of
assessment score was 8 and the minimum sore was 1 with 7.8 in experimental group and 6.83 in control group. The
the mean score 4.53 and standard deviation 2.15, for the obtained 't' values are day 2 (3.818), day 3 (2.967), day 4
third postnatal day the maximum score was 6 and the (4.2), day 5 (4.02). For the degree of freedom 58 the table
minimum score was 0 with the mean score 2.50 and value of “t” is 2.6633 at 0.01 level and 2.0017 at 0.05 level.
standard deviation 1.82. In the fourth postnatal day the The calculated values which is compared with the table
maximum episiotomy wound assessment score was 3 and N=30
Measuring Components Maucholy test of Greenhouse Remarks
the minimum score was 0 with the mean score 0.90 and of Episiotomy wound sphericity value Geisser value
standard deviation 0.92, for the fifth postnatal day the assessment scale
Redness 0.000 0.000 S*
maximum score was 3 and the minimum score was 0 with Edema 0.000 0.000 S*
the mean score 0.27 and standard deviation 0.64. As days Ecchymosis 0.000 0.000 S*
Approximation of wound edges 0.000 0.000 S*
progresses the maximum score is reduced from 12 to 3 S*=Significant (p< 0.05) NS=Non significant
and the minimum score is reduced from 4 to 0. The mean Table 3. Variance in the components of episiotomy wound assessment
scale by honey application on the episiotomy wound
score is reduced from 8.07 to 0.27 with the mean
N = (30+30=60)
N=30
DAYS SCORES Days Honey group Betadine group df ‘t’ value p value Remarks
Mean SD Mean SD
Minimum Maximum Mean Median SD
BASELINE 8.07 2.27 8.23 1.31 58 0.321 0.729 NS
BASELINE 4 16 8.07 8 2.27
DAY 2 4.53 2.15 6.63 1.94 58 3.818 0.000 S*
DAY 2 1 8 4.53 4 2.15 DAY 3 2.50 0.82 3.93 1.76 58 2.967 0.003 S*
DAY 3 0 6 2.50 2 1.82 DAY 4 0.90 0.92 2.37 1.57 58 4.2 0.000 S*
DAY 4 0 3 0.90 1 0.92 DAY 5 0.27 0.64 1.40 1.33 58 4.02 0.000 S*

DAY 5 0 3 0.27 0 0.64 Note: Confidence interval: 95% Significant at 0.01 and 0.05 level
df (58) = 2.6633 at 0.01level and 2.0017at 0.05level
Note: Confidence interval = 95%
Table 4. Comparison of effectiveness between honey
Table 2. Distribution of episiotomy wound assessment and betadine application on episiotomy wound
score of postnatal woman in honey group healing in the honey and betadine group

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 RESEARCH PAPERS
value of 't' found to be significant at 0.01 and 0.05 levels.
This reveals that as the day progresses episiotomy wound
healing was good in both the groups but it was faster in
experimental group than in control group.
Discussion
The current study revealed that application of honey has
significant influence on episiotomy wound healing. The
finding of the study is supported by the randomized control
trial done in Malaya on sixty one patients having either post-
perineal repair or post-episiotomy wound infections with the
aim to compare the effectiveness of honey and local
antiseptics. Study concluded that honey is an effective and
inexpensive treatment for perineal wound sepsis. Another
study supports the finding of the current study, conducted
on fifty patients to determine the effect of topical honey on
post-operative wound infection. Results showed that after
using honey, 84.4% of patients showed complete wound
healing without wound disruption or need for re-suturing
and only 4 patients showed mild dehiscence. Study
concluded that topical application of crude undiluted
honey could faster eradicate bacterial infection, reduce
period of antibiotic use and hospital stay, accelerate
wound healing, prevent wound dehiscence and need for
re-suturing and resulted in minimal scar formation (Waili,
Saloomky,1999).
The present study supported by the study done in Bangkok,
Thailand conducted with an objective to evaluate the
usefulness of topical application of honey in treatment of
abdominal wound disruption. Fifteen patients whose
wound disrupted after caesarean section were treated with
honey application and wound approximation was done by
micropore tape instead of the traditional method of wound
dressing with subsequent re-suturing. Results showed
complete healing within 2 weeks in all the cases. Study
concluded that honey application is inexpensive, effective
and avoids the need to re suture which also requires
general naesthesia (Phuapraditn, Saropala, 1992).
Conclusion
Study reveals that episiotomy wound healing was faster in
honey group than in betadine group. This shows that honey
is effective in treating episiotomy wound.
Implications
36
Nursing Practice
This study finding suggest a need for nurses to provide more
thorough and consistent information for all mothers during
pregnancy and after giving birth about perineal hygiene,
what to expect at the episiotomy site, how to care for it and
the effects of honey on episiotomy wound healing.
Nursing Education
Nursing students should be given updated knowledge on
recent practices and trends of episiotomy care.
Nursing Administration
The findings of the study could be made use of by health
personnel both (nursing and non nursing) holding
administrative positions to formulate policies and make
necessary changes in the health care delivery system.
Ward incharge can recommend honey for episiotomy
wound care by making necessary changes in the policies
and procedure. In-service education for nursing personnel
regarding episiotomy care including honey for episiotomy
wound care should be arranged by administrators with up
to date knowledge of nursing personnel, so that they can
implement what they have learned.
Nursing Research
Appropriate utilization of research helps nurses to make
decisions based on evidences for episiotomy care.
Selected care measures to protect the perineum may
reduce maternal morbidity. It is a topic that requires further
evaluation through well designed and implemented
research.
Community
In this social context the findings of the study have a great
impact on community health care delivery system. As this
treatment (honey for episiotomy wound care) is safe, cost
effective, accessible, feasible and affordable to common
people.
Recommendations
Study can be done in large sample to increase validity and
generalization. Similar study can be done in high risk
postnatal women (with medical conditions like diabetes
mellitus, hypertension, gynaecological conditions like wart,
sexually transmitted disease like syphilis) and also postnatal
women who underwent operative vaginal delivery
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(vaccum delivery, forceps delivery). Effect of honey and sugar dressings on wound healing. J
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ABOUT THE AUTHORS

Ms. Manjula P is currently pursuing her final year MSc Nursing from Canara College of Nursing, Kundapur.

Mrs. Anitha C . Rao is working as an Associate Professor and Principal of Canara College of Nursing, Bailur Educational Trust,
Kundapura, India.

Ms. Ranjani P is currently working as a Assistant Professor in the Department of Fundamentals of Nursing, Manipal College of
Nursing, Mangalore.

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