A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF

BETADINE SITZ BATH VERSUS NEEM EXTRACT SITZBATH ON

EPISIOTOMY WOUND HEALING AMONG POST NATAL MOTHERS IN
KASTURBA HOSPITAL AT DINDUGAL.

MRS. MUTHUMARI.C
REG.NO.301220853
M.SC., NURSING II YEAR

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M. G. R.

MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
OCTOBER 2012 – 2014
EFFECTIVENESS OF BETADINE VERSUS NEEM EXTRACT SITZ
BATH ON EPISIOTOMY WOUND HEALING AMONG
POSTNATAL MOTHERS IN KASTURBA
HOSPITAL AT DINDUGAL.
(2012--2014)

BY
MRS.MUTHUMARI.C
Reg.No.301220853

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M. G.

R.
MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
 OCTOBER 2012 – 2014
EFFECTIVENESS OF BETADINE VERSUS NEEM EXTRACT SITZ
BATH ON EPISIOTOMY WOUND HEALING AMONG
POSTNATAL MOTHERS IN KASTURBA
HOSPITAL AT DINDUGAL.
(2012--2014)

APPROVED BY THE DISSERTATION COMMITTEE ON : …..…………

RESEARCH GUIDE
Prof. Mrs. Indhirani M.Sc(N) :…………………………………..
Principal,
Sara College of Nursing,
Dharapuram – 638656,
Tamil Nadu.

CLINICAL GUIDE
Prof. Mrs. Glory Suramanjary M.Sc (N).,: …………………………
Vice Principal,
Department of Obstetrics and Gynecology,
Sara College of Nursing,
Dharapuram – 638656.
Tamil Nadu.

MEDICAL EXPERT
Dr. Deivamathi, M.B.B.S., D.G.O., :…………………………
Obstetrician and Gynecologist,
Nevathetha Hospital,
Dharapuram – 638656
Tamil Nadu.

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M. G.

R.
MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
 MASTER OF SCIENCE IN NURSING
OCTOBER 2012 – 2014
A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF
BETADINE VERSUS NEEM EXTRACT SITZ BATH ON
EPISIOTOMY WOUND HEALING AMONG POSTNATAL
MOTHERS IN KASTURBA HOSPITAL AT DINDUGAL.
(2012--2014)

CERTIFICATE

Certified bonafide project work

Done by
C.MUTHUMARI
M.Sc., Nursing II Year
Sara College of Nursing
Dharapuram

__________________________ ___________________________
INTERNAL EXAMINER EXTERNAL EXAMINER

College Seal:

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M. G.

R.
MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT
 OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
OCTOBER 2012-2014
ACKNOWLEDGEMENT

Glory to God Almighty who is the source of strength, foundation

of knowledge, source of inspiration in every walk of my life and
sustaining me in the completion of this study.

I extend my heart full of thanks and gratitude to the

Management, Sara College of Nursing for providing me an
opportunity to undergo to uplift my professional life.

With deep sense of gratitude, I express my sincere thanks to our

beloved Principal, Prof.Mrs. Ihdhirani M.Sc(N) Sara college of
Nursing for her expert guidance, thoughts, comments, valuable
suggestions, constant encouragement and support throughout the
period of study.

I express my heart felt thanks to Mrs. Marium ul asia, M.A Ex

MLA, Administrator, Sara College of Nursing, Dharapuram for having
given me an opportunity to undergo the study in this esteemed
institution.

I owe my profound gratitude to Head of Department, and my

Research Guide, Prof. Mrs. Glory Suramanjary M.Sc(N)., Department
of Obstetrics and Gynecology for her patience and excellent guidance,
motherly love, affection, concern, moral support and valuable
suggestion, encouragement, direction, pensive correction, personal
interest and prayers till the completion of the study.
 I extend my gratitude to my class coordinator Mrs. Gomathi,
M.Sc.,(N), Mphil(psy), PGDHM, who had been my constant source of
support and guidance.
I extend my gratitude to Mrs. Usha,Msc.,(N), Mrs.Nisha,Msc,
(N)., Mrs.Tamilarasi,Msc.,(N), Ms.Kalaivani,Msc.,(N), and Mr.
Dhinesh, Msc.,(N), for their guidance and constant encouragement
throughout the course.

I acknowledge my genuine gratitude to the Medical Officer of

Kasturba Hospital--Dindugal for granting permission to conduct the
study, treasured help for completion of the study.

I express my genuine gratitude to Dr. Sivaprakasam M.Sc., M.

Phil., Ph.D., ,Reader in Statistics, Gandhigram Rural university
Dindigul District, for his constructive suggestions regarding statistical
analysis.

I extend my gratitude to Mr. A.K. AYYARAJENDRAN. M.A.,

M.ED., (English) for his valuable English Editing.

I extend my sincere thanks to the Librarians, Sara College of

Nursing for rendering their support and help during the time of my
study.

I extend my thanks to Tamlinadu Dr. M.G.R.Medical University

for co-operation and giving permission for utilizing the university
library.

I also would like to thank the mothers who participated in this

study and gave full support and amicable cooperation.
 I extend my special gratitude to Mr.C. VIJAYAKUMAR and staff
members of Vijay Xerox for their patience, co-operation, understanding
the needs to be incorporated in the study and timely completion of the
manuscript.

I extend my special soulful gratitude and thanks to my beloved

Mr.V.Rajaraman.Bsc,D.Pharm.,M.A(Hindi)., for their support and
constant encouragement throughout the course and this research work.

My deep gratitude to my seniors, my friends ,and classmates for

their kind co-operation and support to complete this study.

Last but not the least, I extend my soulful gratitude and thanks to
my husband Mr. R. Selvakumar, my daughter Baby. Chaarudharshini,
and also I could thank my beloved sisters Mrs.Padmavathi
Vijayakumar.B.M.L.T., and Mrs. Karthika Selvakumar.M.E for their
prayers, blessings and constant encouragement throughout the course
and this research work.

C.MUTHUMARI
 TABLE OF CONTENTS

CHAPTE
TITLE PAGE NO
R
I (i) INTRODUCTION
• Background of the Study 1
• Need for the Study 5
• Statement of the Problem 9
• Objectives of the Study 9
• Operational Definitions 10
• Hypotheses 10
• Assumptions 13
• Delimitations 13
• Projected Outcome 13
(ii) Conceptual Framework 14
II REVIEW OF LITERATURE
PART-I
An Overview of Episiotomy 20
PART-II
• Studies related to Prevalence of
episiotomy 24
• Studies related to Betadine sitz bath on
wound healing. 31
• Studies related to Neem extract sitz bath
on episiotomy wound healing . 36
METHODOLOGY
• Research Approach 43
• Research Design 43
 • Settings of the Study 43

CHAPTE PAGE
TITLE
R NO
III • Population 44
• Sample 44
• Criteria for Sample Selection 45
• Inclusion Criteria 45
• Exclusion Criteria 45
• Sample Size 45
• Sampling Technique 45
• Instrument and scoring procedure 48
• Validity of the tool 48
• Pilot Study 47
• Procedure for Data Collection 48
• Plan for Data Analysis 49
• Protection of Human subjects 50
IV DATA ANALYSIS AND 51
INTERPRETATION
V DISCUSSION 69
VI SUMMARY, CONCLUSION 75
IMPLICATIONS OF NURSING
• Nursing Service 78
• Nursing Education 79
• Nursing Administration 79
• Nursing Research 80
RECOMMENDATIONS 80
LIMITATIONS 80
BIBLIOGRAPHY 81
ANNEXURE i-xiii
 LIST OF TABLES

Table Page
Title
No No
1.1 Frequency and Percentage Distribution of Demographic 52
Variable of Samples among postnatal mothers in
experimental group I and II.
2.1 Frequency and Percentage Distribution of Pre-test & post 58
test level of wound healing in Experimental group I
2.2 Comparison of Mean, Standard Deviation and paired ‘t’ 60
value of wound healing-REEDA scale. (group I) .
3.1 Frequency and Percentage Distribution of Pre test & 61
Post-test level of wound healing in Experimental group II
3.2 Comparison of Mean, Standard Deviation and paired ‘t’ 63
value of wound healing -REEDA scale (group II) .
4.1 Comparison of Means, Standard Deviation, independent 64
‘t’ value of post test level of wound healing between
experimental group I & II
5.1 Association between the post test level of episiotomy 65
wound healing and the selected demographic variables
in experimental group I (betadine sitz bath)
5.2 Association between the post test level of episiotomy 67
wound healing and the selected demographic variables
in experimental group II (neem extract sitz bath)

LIST OF FIGURES
TABLE PAGE
TITLE
NO NO
1.1 Conceptual Framework based on Kings Goal 19
Attainment Nursing Theory (1971)

2.1 Frequency and Percentage Distribution Age in years

of experimental group I and II 55

2.2 Frequency and Percentage Distribution in Religion

of experimental group I and II 56

2.3 Frequency and Percentage Distribution in Income

per month of experimental group I and II 57

2.4 Percentage distribution of the Pre-test & post test

level of wound healing in Experimental group I. 59
(REEDA scale)

2.5 Percentage distribution of the Pre test & Post-test

level of wound healing in Experimental group II. 62
(REEDA scale)

LIST OF ANNEXURE
 PAGE
ANNEXURE CONTENT
NO
I Letter seeking permission for conducting the I
study
II Description of Tool II
III Intervention (a) preparations of betadine sitz III
bath (b) preparation neem extract sitz bath
IV Letter requesting opinion and suggesting of IX
experts for content validity of the research tool
V Content validity certificate X
VI List of experts of validation of the tool XI
VII Certificate for English Editing XII
VIII Photos XIII

ABSTRACT

Postpartum period is a period when the mother experiences

intense physical and emotional stress due to exhaustion anxiety and
excitement, each mother has to adjust to physical changes in her own
body due to involution and lactation as well as cope up with new
demands in her time and emotions made by the newborn baby.
Postpartum period is distinct in to three phases. The third phase is the
postpartum period which can last up to 6 weeks. Some changes to the
genitourinary system are much longer in resolving and some may never
fully revert to the prepregnant state.

A comparative study to assess the effectiveness of betadine sitz

bath versus neem extract sitz bath on episiotomy wound healing among
primi postnatal mothers, in kasturba hospital at Dindugal.

The data was collected at kasturba hospital – Dindugal for a

period of four weeks . The investigator has obtained written permission
from the hospital medical officer and nursing superindent. 0ral
permission was obtained from the each participants prior to the study.
The purpose of the study was explained to the subjects prior to the
study..

The investigator selected 60 samples on the basis of inclusion

criteria,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 , who met the inclusion criteria were selected by
purposive sampling technique.

The first two weeks the samples for experimental group I were
selected from the postnatal ward I and demographic variables were
collected and pretest was conducted on the first day morning, the
wound healing was assessed by REEDA scale. Then the interventation
of betadine sitz bath was given for 10-15 minutes , twice a day daily
(Morning & Evening) and for three days to experimental group I.
 Next two weeks of period ,the experimental group II was selected
from the postnatal ward II and demographic variables were collected
and pretest was done on the first day morning, the wound healing was
assessed by REEDA scale. Then the intervention of neem extract
sitzbath was given for 10-15 minutes, twice a day
daily(morning&evening) for three days to experimental group II. Then
the post test level of wound healing was assessed by REEDA scale. The
data were analyzed and tabulated using descrptive and inferential
statistics.

The findings shows that the mean wound healing score in

experimental group I in before betadine sitzbath is 9.3 (SD±1.104) and
after Betadine sitzhbath is 0.56 (SD±0.670 ) respectively. The paired t-
test value is 38.870 ,which is significant at P<0.05 level . And the mean
wound healing score in experimental group II , before Neem extract
sitzbath is 9.2 (SD±0.959) and after Neem extract sitzhbath is 0.23
(SD±0.424 ) respectively. The paired t-test value is 53.926 ,which is
significant at P<0.05 level .

The mean post test wound healing score in group I is about 0.56
(SD±0.670 ) and group II is about 0.23 (SD±0.424) respectively. The
independent t-test value 2.537 which is significant at p<0.05. The
results shows that there is a significant difference between the mean
post test score of betadine sitzbath and mean post test score of neem
extract sitzbath on episiotomy wound healing among postnatal mothers
.Therefore it is clearly proved by this study that Neem Extract Sitzbath
is effective more than betadine sitz bath on episiotomy wound healing.
 CHAPTER - I
INTRODUCTION

" Women because of their closure

affinity to their children
suffer more keenly than do men ."
Elizebath backston.

BACKGROUND OF THE STUDY

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.
MS.JessicaRowe.,(2011)

Post partum period lasts from delivery to six weeks afterward, it

is also known as fourth trimester. The post natal mothers experience
various physiological and psychological changes when she makes the
transition from the pregnant woman to a mother. The needs of the client
and the family during the post partum period can be met through
coordinated multi disciplinary care of the mother, child and the family.
Paultte D.,(1996)

Early discharge plan for the post natal mother can be confirmed
by the evaluation of the mother’s health status and comfort level, self
care education. Assessment at the time of discharge includes vital signs,
fundus, breast, uterus, bladder, bowel, lochia, episiotomy, Homan’s

1
sign and emotional status of the women. The routine hospital stays after
uncomplicated vaginal delivery had ranged from 12 hours to one week.
The current hospital stay for mothers having normal vaginal delivery is
24 to 48 hours. The attending provider is permitted to discharge the
client earlier if the client agrees.
Littleton Y.L.,(2007)

The first performance of episiotomy was done in 1974, when

perineal incision was used to facilitate deliveries. Episiotomy is the
surgical incision made to enlarge the vaginal opening for delivery of
baby’s head. Depending on the client preference, situation and provider
preference and judgement, some women experience delivery with an
episiotomy. This is an incision through the perineal tissues that is
designed to enlarge the vaginal outlet during the delivery. The rationale
for its use depends largely on the need to minimize the risk of severe,
spontaneous, maternal trauma and to expedite the birth when there is
evidence of foetal compromise.
Fraser.M.,(2007)

Episiotomy infection can be observed by persistent redness and

swelling, separation of wound edges, purulent discharge and persistent
pain. The immediate complications related to episiotomy are extension
of the incision, vulval haematoma, infection, wound dehiscence, injury
to the anal muscles and necrotizing fasciitis. The remote complications
related to episiotomy are dyspareunia, chance of perineal lacerations
and scar endometriosis.
Dutta.D.C.,(2004)

2
 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 from 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. Relieving pain and
promoting comfort to the mother is important basic need. It can also
establish and improves mother and child relationship
Lacrent.C., (1992)

Episiotomy wound can cause a considerable discomfort and pain

the perineum is extremely tender area and the muscles of perineum are
involved in many activities. e.g sitting, walking, controlling urination
and defecation. 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. A cortisone based cream or a sitz bath
helps to decrease inflammation to relieve tension in that area.

Specific measures to control infection and promote wound

healing are use of soap and water to wash vulva and perineum, change
the perineal pad every 2 to 3hours, place ice packs against the
episiotomy for 1 hour period every 2 hours during the first 24 hours
following birth, sit in warm sitz bath for 15 to 20 minutes, apply a
topical anesthetic to the episiotomy at every pad change.
Pillitteri A.,(2007)

In pharmacological treatment on episiotomy wound healing,

the pramoxonine hydrocholoride 1% and hydrocartizone acetate 1% in
a meso adhesive foam, were relieving episiotomy discomfort and

3
wound healing for postnatal mothers. Meso adhesive foam were more
effective with regard wound healing and episiotomy discomfort as
measured by analgesic consumption. Pramoxine and hydrocartizone
foam offers no advantage over meso adhesive foam in the treatment of
postpartum episiotomy wound healing.
Greer IA ,Cameron AD.,(1984)

Sitzbath is one of the oldest, cheapest,and safest treatments for

curing many common aliements. The technique exploits the reaction of
the body to hot stimulus. It is seen that heat soothes the body hence
increasing the internal activity. Cold water shunts the blood to internal
organs whereas hot water removes the waste from the body tissues.
Joseph M., (2009)

Povidine - Iodine is an antiseptic solution that is usually used in

Iran for episiotomy wound healing ( Valiklian , et ., al , 2011). Tork
and valei (2002) demonstrated that there was no significant difference
between the povidine- iodine and water on episiotomy wound
healing. Povidine- iodine suppresess the function of fibroblasts and
lymphocytes . Previous research suggested that povidine - iodine has
anti-inflammatory effects and anti-septic effects and pre- wound
healing effects , by increasing the mRNA transcripts of growth factor -
beta I and fibrocetein , so povidine- iodine solutions are very effective
for episiotomy wound healing
Fahimeh., Sehat; shafai .,( 2012)

The sanskrit name of the neem tree is " Arishitha " means
"reliever of sickness" and hence is considered as " Sarnaroganibarini ".
Neem (or) Azadirachta Indica , popularly known as magosa is a

4
large, evergreen tree. Neem extracts is a powerful insects repellent, anti-
bacterial, anti- fungal, anti- viral, anti- inflammatory, anti- diabetic and
also strengthens the bodys over all immune responses. Neem oil
contains fatty acids which build collagen, promote wound healing and
maintain skin elasticity. This keeps any wound (or) leison free from
secondary infection by micro organisms.
Dahanukar et.al.,(2000)

NEED FOR THE STUDY

In worldwide there is considerable international variation in the
rate of episiotomy. The rate is of 15% in England, 13% in Scotland, 10%
in Wales and 22% in Northern Ireland, it is 8% in Holland, 14% in
England, 50% in the USA and 99% in Eastern Europe.
Royal C.,(2004)

In United States, percentage of episiotomies performed out of all

vaginal deliveries is 19.4%. Episiotomy rates were higher among white
women (32.1%) than African American women (11.2)
(HENRIKSEN.,(1992)

In Ireland the rate of episiotomy for operational deliveries was

37.5 %. Over all episiotomy rate at Denmark was 19.8%in 2000.
Jeffery L.,(2000)

In Australia episiotomy rate is currently around 35%. In Taiwan,

it is accepted practice to do an episiotomy on all first time mothers, here
the rates are close to 90%. China, Spain, South Africa and Turkey also
report extremely high episiotomy rates ranging from 60% to almost
90%. The rate of episiotomy in Sweden is 9.7%.
Rhode and Bargar.,(1990)

5
 In Canada, There was an overall episiotomy incidence of 48%;
obstetricians performed episiotomy in 54% and family physicians in
33% women. In Russia, episiotomy rates varied from 9–80%.
Justin .P.,(2007)

An Asian survey done by the WHO in 2007-2008 compared the

percentage of episiotomies performed out of all vaginal deliveries rate
among nine Asian countries. The highest numbers were seen in china
with a episiotomy rate of 46% and the lowest rates were found in
combodia and in India where the rates ranged from 15%-18%. In
Europe the episiotomy rates ranged from 14%, in Netherlands to 38% in
Italy.
. Anh T.Trinh.,(2001)

In India the overall rate of episiotomy is 40.6%. Among that

midwives performed episiotomy was lower rate 21.4% than faculty
33.3% and private providers 55.6%.
Robinson.,(2000)

In New Delhi, Episiotomy rates differ according to care provider.

The episiotomy rate among midwives was 25% and 40% among
medical doctors. Younger doctors are also less likely to perform an
episiotomy than older doctors; one study found the rate of episiotomies
performed by residents to be 17%, while the rate among doctors in
private practice was 66%.
J.Rank.,(2008)

In Madhya Pradesh, routine episiotomy was done in 72.7% of

women. While the rate of restrictive episiotomy group is 27.65 % and

6
has concluded that there was an increases risk of anterior perineal
trauma with restrictive episiotomy.
T.Santha.;(2009)

In Karnataka,SNR hospitals, kolar district, in the year 2007 there

was 1531normal vaginal deliveries were conducted, out of this 100%
incidence of episiotomy among primigravida women and 50%
incidence of episiotomy among multigravida women during the second
stage of labour.
Marshall.,(2007)

In Chennai, the incidence of episiotomy was 96 percent for first

pregnancies, they were 100 percent in private hospital, it fell to about
7% in primary health centre and to 0% at the sub centre.
Narindas.H.,(2008)

In Pondicherry , thiruvallur district, in the year 2013 there was

1061 normal vaginal deliveries were conducted, out of this 100%
incidence of episiotomy among primigravida women and 60%
incidence of episiotomy among multigravida women during the second
stage of labour.
(Ms . Bhavani . P ., 2013)

The complication of episiotomy includes asymmetry (32.9%),

infection (23.7%), partial dehiscence (14.5%), skin tags (7.9%),
haemorrhage (5.3%) and extension of the incision (1.3%). 85% women
experienced some form of trauma. Tears to the rectum and vaginal
vault were more common with episiotomy.82% of the women with
large episiotomy, delay in starting to have sexual relations. The

7
suturing of the episiotomy was found to be painful by 40% women. 20%
woman had pain in the perineum for more than one month. 10%
woman had infections in the episiotomy, half of these required
treatment. Wound infections from episiotomy amounted to 3% of
women of this 27% of maternal deaths occurs.2.6% of women need
further surgeries to fix episiotomy complications.
Katherine.H.et.al.,(2007)

The episiotomy wound has some risk which includes blood loss,
pain, infections, delayed healing, dyspareunia and may contribute to
maternal blues. (occur in 60% women. Pain and edema may inhibit
urination and defecation after delivery. Therefore it is necessary to
reduce episiotomy pain
Reading.et. al., (1990)

OF all deliveries in 2006, 39% were conducted in an institutional

and 48% of the total number of deliveries were attended by health
personnel. The number of institutional deliveries only 18% of the
illiterate mother , and compared to 86% of the mother with twelve (or)
more years of education. In India 2007-2008 institutional deliveries is
seen in the range from about 35% in chhattigarh to 76% in Madhya
Pradesh ,284 districts are high focus on institutional deliveries and less
than 60% in 70 districts in 2011.
Amina Khambalia.,, (2006)

A comparative study was done to assess the effectiveness of neem

extract sitzbath and the betadine sitz bath on the perineum after
episiotomy in selected hospitals at dhasarally- bangalore.. In this study
quasi experimental design was adopted. 60 samples were randomly

8
assigned to treatment conditions. The REEDA score for betadine and
neem extract sitz bath are 0.2, 0.866 respectively. The‘t’ test value is
2.8263, the calculated value is more than the table value (1.701). There is
improvement wound healing to mothers who had undergone the
treatment of betadine sitz bath and neem extract sitzbath.
Mrs . Jeyanthi ., (2008)

The investigator from her personal experience during her clinical

postings at postnatal wards identified many complications like
resuturing, purulent discharge and mothers felt more discomfort due to
episiotomy among postnatal mothers with episiotomy.

The researcher felt that, when postnatal mothers are cared with
definite nursing measures during postpartum period, the severity of
infections are reduced. So the researcher intended to do a study on
postnatal mothers with episiotomy using two specific nursing
procedures, in a view to reduce the complicating of episiotomy.

STATEMENT OF THE PROBLEM

A comparative study to assess the effectiveness of betadine sitz
bath versus neem extract sitzbath on episiotomy wound healing
among post natal mothers in Kasturba hospital at Dindugal.

OBJECTIVES:
1 To compare the pre and post test level of wound healing
scores among post natal mothers in experimental group I
(Betadine sitzbath)
2 To compare the pre and post test level of wound healing
scores among post natal mothers in experimental group II
(Neem extract sitzbath).

9
 3 To compare the effectiveness of post test level of wound
healing scores among postnatal mothers between
experimental group I&II.
4 To find out the association between the post test level of
episiotomy wound healing scores with their selected
demographic variables in experimental group I. (betadine
sitzbath)
5 To find out the association between the post test level of
episiotomy wound healing scores with their selected
demographic variables in experimental group II.(neem
extract sitzbath).
HYPOTHESIS;
H1: There is a significant difference between the mean pretest and
post score on episiotomy wound healing among post natal
mothers in experimental group I.
H2: There is a significant difference between the mean pretest and
posttest score on episiotomy wound healing among post natal
mothers in experimental group II.
H3: There is a significant difference between the mean post test
scores on episiotomy wound healing among post natal mothers
between experimental group I and experimental group II
H4: There will be a significant association between the mean post
testscore on episiotomy wound healing among post natal
mothers with their selected demographic variables in
experimental group I.
H5: There will be a significant association between mean post test
score on episiotomy wound healing among post natal mothers
with their selected demographic variables in experimental
group II.

10
OPERATIONAL DEFNITIONS:
COMPARATIVE STUDY:
It refers to the statistical comparison of episiotomy wound
healing between two groups.

EFFECTIVENESS:
Effectiveness means producing an intended result.
(Kiderley ., 2003)

In this study it refers to the significant difference brought

between the betadine sitzbath and neem extract sitzbath and it is
measured in terms of wound healing process by using statistical
measurements and its scores .

EPISIOTOMY:
Episiotomy is defined as surgical enlargement of the vulval
orifice for obstetrical purposes during parturition.
(Maureen . A. Hickman"s Midwifery .,1967)

In this study episiotomy is refers to a surgical incision made on

perineum to facilitate the birth of the baby and it is measured by
REEDA scale and its scores.

POSTNATAL MOTHERS :-
Postnatal mothers belongs to the period of beginning
immediately after the child birth of a child and extending for about six
weeks.
Whales J .,(2008 )

11
 In this study, it refers to primi mothers who have undergone
normal vaginal delivery with episiotomy after a period of six hours to 5
days.

SITZ BATH:-
Sitzbath is a form of hydrotherapy given by using hot (or) cold
water, steam (or) ice to restore and maintain health. It increases blood
flow to the pelvic and abdominal areas and alleviates a variety of
problems.
Linda., (2007)

In this study it refers to immersing the perineum in a basin of

warm water at a temperature of 105o F for 10 minutes every morning
and evening for 3 days.

WOUND HEALING
Restoration of integrity to injured tissue by replacement of dead
tissue with viable tissue
Bailliere’s (2009)

In this study it refers to absence of symptoms such as redness

edema, echymosis, discharge, approximation as measured by REEDA
scale and its scores .

NEEM EXTRACT
In this study it refers to a solution in which 30gms of neem paste
is added in 5litre of water then the boiled solution is filtered and called
as Neem Extract.

12
BETADINE SOLUTION
It is the pharmacologically available 10% povidine - iodine topical
antiseptic solution.

ASSUMPTIONS
• Improper care of episiotomy may lead to infection
• Postnatal mothers with episiotomy may prone to develop
complications
• Nurses have an important role in reducing episiotomy pain
and promotion of wound healing

DELIMITATIONS:-
• The study is delimited to 60 samples
• Four weeks of data collection
• The mother who are willing to participate

ETHICAL CONSIDERATION:
The study was conducted after the approval of the dissertation
committee of Sara Nursing College, Dharapuram. A written permission
was obtained from the concerned authority of the selected hospital. The
purpose and nature of the study were explained to each subject and oral
consent was obtained. Patients are also informed that they can
withdraw themselves from the study whenever they feel difficulty or
any inconvenience.

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.

13
 KING’S GOAL ATTAINMENT THEORY

The purpose of the conceptual framework is to make the students

and researchers to identify and analyze events in specific nursing
situation. This framework suggests the essential characteristics of
nursing and those properties that have persisted in spite of
environmental changes. This theory was related to the means of
analyzing the interactions.

King derived the following seven hypotheses in goal attainment

theory:
• Perceptual congruence in nurse patient interaction
increases the mutual goal setting.
• Communication increases mutual goal setting between
nurse and patient and leads to satisfaction
• Satisfaction of the patient increase goal attainment
• Goal attainment decrease stress and anxiety in nursing
situation
• Goal attainment increase patient learning and coping
ability in nursing situation
• Role conflict experienced by the patient, nurses or both
decreases transaction in nurse patient interaction

The elements of interaction are

• Action
• Reaction
• Disturbance
• Mutual goal setting
• Explore means to achieve goal

14
 • Transactions
• Goal achieved
This theory combines some factors from the classification system
and the process of human interaction.

THEORY OF GOAL ATTAINMENT

Major components of theories of goal attainment are stated in her
interpersonal system in which two people who are the strangers come
together in health care organization to help and to be helped to
maintain a state of health that permits functioning in roles.

Percep on  
Nurse 
Judgement 

Ac on – Reac on 
Interac on – 
Transac on  
Ac on – Reac on 

Judgement 
Client 

PERCEPTION
According to theorist, Perception is each person’s representation
of ‘reality’. The elements of perception are the imparting of energy from
the environment and organizing it by information transforming energy,
information, storing information and exploring information in the form
of overt behaviour.

15
 In this study perception reveals the pain perceived by the patient
and condition of the wound by the nurse. The researcher collected the
demographic variables such as age, education, occupation, religion,
monthly income, type of family and type of delivery. Pretest was done
by using REEDA scale in both experimental group I & II.

JUDGEMENT
According to theorist, Judgement is a mental action that decides
to act, it focus on as the intervention that is going to be in action.

In this study nurse decides to promote wound healing. The

mother needs a fast in episiotomy wound healing and recovery.

ACTION
According to theorist, Action is defined as a sequence of
behaviour, involving mental and physical action. First the mental action
helps to recognize the presenting condition and physical action helps to
begin activities related to those condition and finally mental action in
effort to exact control over the situation combined with physical action
seeking to achieve the goals. It means taking some actions to promote
wound healing.

In this study, the action represents deciding to provide betadine

sitz bath in experimental group I and neem extract sitzbath on
episiotomy wound site by the nurse to the patient in the experimental
group in II. The client decides to take some measures to promote
wound healing .

16
REACTION:
According to theorist, Reaction is the sequence of behaviour
described in action.

In this study, it includes the efforts taken by the nurse by means

of intervention for both groups. The nurse explains the procedure to
experimental group I & II and gets the consents from the samples. In
experimental group I & II the client decides to cooperate and accept
betadine sitzbath and neem extract sitz bath for 3 days.

INTERACTION
According to theorist, Interaction is defined as the process of
perception and communicated between person and environment and
between person and person represented by verbal and non verbal
behaviour that are goal directed. Hence each individual involved in an
interaction brings different ideas, attitudes and perception to exchange.
It includes the perception, judgment, action and reaction. Interactions
are the observable behaviour of two or more person in mutual presence.

In this study interaction represents the procedure done by the

nurse for the experimental group I & II. Betadine sitzbath was given for
10 minutes twice a day (morning & evening) and Neem extract sitz bath
was given for 10 minutes twice a day (morning & evening) for 3 days. .

TRANSACTION
According to theorist, Transaction is defined as the observable
behaviour of human beings interacting with that environment.
Transactions represent the valuation component of human Interactions
and involved bargaining, negotiating and social exchange. When

17
Transaction occurs between nurses and clients goals are attained. It is a
purposeful interaction that leads to goal attainment. Transactions for
this conceptual framework are derived from cognitions and
perceptions.

In this study, the post test was done in experimental group I and
II by using REEDA Scale to assess the wound healing. . The wound
healing was graded as no infection, mild infection, moderate infection
and severe infection.

Thus King’s states that, a professional nurse with special

knowledge, skills and perception of personal problems meets the
strangers in natural environment. They interact mutually to identify
problems and achieve goals.

18
 Precep on Ac on : Reac on Interac on :
    Collected the  Experimental Experimental Experimental group I:‐
demographic variables,  group I :‐ group I & II:‐ Betadine sitz bath was 
age, educa on,     Decides to  Nurse :‐ given for 10‐15 min two 
Nurses  occupa on, religion,  provide betadine      Explain the  mes a day (mor & eve) 
income, type of family  sitz bath on  procedure, get  for 3 days. 
and  pre test was done.  episiotomy wound  consent from  Group II :‐
The level of episiotomy  site.  samples and taking       Neem extract sitz 
wound healing was  the efforts  bath was given for 10‐15      The post test 
assessed by using REEDA  Experimental toprovide betadine  minutes at 1050F temp  level of wound 
scale in both  group II:‐ and neem extract  of water or two  mes a  healing scores 
experimental group I & II.    Decides to   sitz bath on  day (mor & eve) for 3  was evalua oed 
Judgment :‐ provided the neem  episiotomy site. das  by REEDA scale  Transac on REEDA
Judgment
   Promo:‐on of  extract sitz bath on  in both  scale :
   Promo on of 
episiotomy wound  episiotomy site.  experimental 
episiotomy wound 
healing.  group I & II. 
healing. 

 Percep on :‐  Ac on :‐ Client : Client :

   Percep on of pain and     Taking some     Under standing the      Under going the 
the need for wound  measures to promote  procedure and giving  procedure of betadine site 
Client  healing .  wound healing.  acceptance decides  bath and neem extract site 
to co operate for  bath for 3 days at two 
Judgement :‐
betadine sitz bath  mes a day (mor & eve). 
Mother need for wound  and neen extract size 
and neem extract 
healing and recovery.  bath  
size bath  

CONCEPTUAL FRAME
CONCEPTUAL WORK
FRAME (MODIFIED
WORK KINGS GOAL
(MODIFIED ATTAINMENT
KINGS MODEL) (1980)
GOAL ATTAINMENT MODEL) (1980)
 CHAPTER-II
REVIEW OF LITERATURE

Review of literature is an essential component of research

process. Review of literature is a critical examination of publication
related to a topic of interest. Review should be comprehensive and
evaluative.

The review of literature in this study was organized as follows:

PART--I
• Overview of episiotomy

PART-II
• Studies related to prevalence of episiotomy.
• Studies related to complications of episiotomy.
• Studies related to betadine sitz bath on wound healing
• Studies related to Neem extract sitz bath on wound
healing.

PART--I
OVERVIEW OF EPISIOTOMY

DEFINITION OF EPISIOTOMY:
A surgically planned incision on the perineum and the posterior
vaginal wall during the second stage of labour is called episiotomy
(periniotomy)
D.C Dutta.,(2010)

An episiotomy is a surgical cut in the perineum which is the

muscular area between the vagina and rectum.
Baby Centre India., (2010)
TIMING OF INCISION:-
If the episiotomy was given too early it will fail to release the
presenting part and haemorrhage. From blood vessels may ensure .the
incision is best made on a contraction when the tissues are stretched. So
that there is a clear view of area and bleeding is less likely to be severe.
Diana. S.,(2003)

TYPES OF INCISION:-
Median: incision is made in the middle of the perineum and
directed towards the rectum and easy to repair and more comfortable
for the patient during the healing process.

Medio lateral: incision laterally begins at the fourchette and is

directed at a 45 degree angle to the midline towards a point midway
between the ischial tuberosity and the anus. It could be enlarged when
needed. Mother feels uncomfortable during healing process.

Lateral: the incision starts from about 1 cm away from the centre
of fourchette and extents laterally.

‘J’ shaped :the incision begins in centre of fourchette and is

directed posteriorly along the midline for about 1.5 cm and then
directed downwards and out wards along 5 and7 ‘o clock position to
avoid analsphincter.
D.C.Dutta., (2010)

INDICATIONS OF EPISIOTOMY:
FETAL:-
 • Reduction of trauma to the fetal head.
• When the baby is very large.
• Fetal bradycardia.
• Prolonged late decelerations
• Shoulder dystocia

MATERNAL :-
• When instrumental delivery is indicated.
• When women has undergone female genital mutation.
• Prolonged labour
• Premature delivery .
• Shortening of the second stage of labour .
• Subsequent disorder of pelvic floor anatomy and function .
Book shelf.,(2005)

USES OF EPISIOTOMY:-
Episiotomy was said to produce following benefits:
• Speed up the birth
• Prevent tearing and laceration
• Protect against incontinence
• Promote pelvic floor relaxation
• Heals easier than tear
Robin .E.,(2008)
COMPLICATIONS OF EPISIOTOMY:-
• Infection
• Increased pain
• Increase in third and second degree vaginal laceration
• Longer healing times
• Increased discomfort when intercourse is resumed
 Robert. J.,(1995)
NURSING INTERVENTION IN EPISIOTOMY WOUND CARE
• Dressing: the wound is to be cleaned after defecation to
keep the area clean and dry. It is done by swabbing with
cotton soaked in antiseptic lotion
• Comfort: to relieve pain magnesium compress or
application of infra red radiation may be used. Analgesic
drug may be given.
• Removal of stitches: when the wound is sutured by catgut
which will be absorbed. But if non Absorbable material is
used the nylons has to be removed by 6th day.
• Ambulance: the patient is allowed to move out of bed after
24 hours.
D C. Dutta .,(2010)

• Clean the perineum from front to back after every voiding

and defecation
• Focus infra red ray on the perineum for 15 minutes 2 or 3
times in first 24 hours of delivery to promote fast healing.
• Practice proper hand washing after perineal care.
• Use fruit juices that are rich in vitamin c to increase
resistance against infection.
• External antiseptic applied to the episiotomy wound after
every perineal care or 2 times a day.
Trained Nurses Association., (2008)
Sitz bath can be beneficial. Medications can range from over the
counter products depending on the extent of pain. Tropical sprays are
used to cool and make the area numb. Perineum is kept dry.
 Care of wound:-to reduce stringing effect of the wound pour cool
water on the area as they pass urine. Soak the perineum in cool salt
water 5 to 10 minutes once or twice daily for quick healing. Feminine
sprays or powders should not be used as they interfere with healing
process. Lift heavy items only after 6-8 weeks after delivery.
Robin .D.,(2000)

To keep the episiotomy wound clean by oneself:-

• Place a cool gel pad, ice pack on your stitches.
• Have a warm bath
• Try to expose the stitches in air.
• Walk around as much as possible and practice pelvic floor
exercise to stimulate wound healing.
• Drink plenty of water and wholesome diet to avoid
constipation.
• Use mild laxatives if it is difficult to pass stools for first few
days.
• Keep the stitches clean and dry.
• Apply an antiseptic cream on the wound for a few days.
• Sitz bath helps in cleaning as well as reducing pain and
swelling.
Baby centre India.,(2010)

PART- II
STUDIES RELATED TO EPISIOTOMY
Vehvil – Ninen – Julkunen K. Heinonen S. (2008), conducted a
study on need for and consequences of episiotomy in vaginal birth. The
study was to describe and explain the short – term effects of lateral
episiotomy, and determine the factors associated with more / less
common use of episiotomy. The study was conducted between October
and December 206. Episiotomies were more common among
primiparous than multiparous women (55% Vs 12%, P<0.001). The
maternity hospital was the most significant determinant of the
episiotomy rate. It was concluded that episiotomy rates can be reduced
without causing harm to women or newborn babies.

Sooklim R, Thinkamrop J. (2007) conducted a study on the

outcome of midline versus mediolateral episiotomy for complication
such as extended perineal tears, pain scores, wound infection and other
complications. All women included had low risk pregnancies and
delivered at term. The outcome measures included deep perineal tears
(including perineal tears with anal sphincter and / or rectum tears),
other complications and women’s satisfaction at 48 hours and 6 weeks
postpartum. Results in women with midline episiotomy, deep perineal
tear occurred in 14.8% which is statistically higher compare to 7% in
women who underwent a medio-lateral episiotomy (p<0.05). there was
difference between the group for other outcome (such as blood loss,
vaginal hematoma infection, pain, dyspareunia, and women satisfaction
with the method). The risk factors for the perineal tears were: midline
episiotomy, primi parity, maternal height less than 145cm, fetal birth
weight>3500gm and forceps extraction. The conclusion was midline
episiotomy compare to mediolateral episiotomy resulted in more deep
perineal tears. It is more likely deep perineal tears would occur in case
with additional risk factors.

Dimitrov A, tsenov D, ganeva G. (2000) conducted a study on

cause for healing complications in episiotomy. The aim of the study is
to look for the most probable causes of disturbed healing of episiotomy.
The study is prospective and includes 33 early puerperal women
without data of infection disease or risk factor like PPROM,
vulvovaginitis, chorioamnionitis, diabetes, obesity and others. The cases
are divided in two groups; the first group are 12 women with normal
healing of episiotomy; the second group 21 cases with wound healing
complications, divided in three subgroups: 13 with edematous and
erythematous edges; 5 with superficial dehiscence in introitus vaginae;3
with entirely open episiotomies. The results were for a period of 5 years
the mean rate of entirely open episiotomy is 1.07%. According to data
the process of episiotomy healing is not influence by age of women
parity, duration of labor, the weight of the neonate. For the episiotomy
outcome, the experience of the obstetrician is important. The shorter
time between ROM during labor and delivery and use of cat-gut
stitches on the skin of the perineum show tendency of poor healing of
the episiotomy.

Graczyk S, Limanowski M, Wyduba M, (1998) conducted a

study on comparison of healing and patient comfort parameters
between interrupted and subcutis polyglycolic acid suture used for
episiotomy repair after delivery was done. Patients had follow up
during hospital stay, and two months after delivery a self administered
questionnaire was sent to all women who participated, enquiring about
perineal pain, and resumption of sexual intercourse and cosmetics of
suture line. Of 52 patients who had repair with interrupted suture, 21
were lost to follow up. Of 65 gravida who had repair with sub cutis
suture, 23were lost to follow up. At the 3rd day postpartum
examination, patients with sub cutis sutures had significantly better
healing. An inflammatory process was present in 2 of 52 patients with
interrupted sutures comparable with 1 of 65 in the sub cutis group, and
a gaping wound in 0 of 52 and 1 of 65, respectively. Recovery of
function, measured by resumption of sexual activity by 8 weeks, was
demonstrated in 5 of 31 patients with interrupted sutures versus 24 of
42 patients who had sub cutis sutures. Episiotomy repair with sub cutis
polyglycolic acid (Dexon) offers significant advantages over traditional
interrupted suture, both in terms of wound healing and resumption of
sexual activity..

Lancet (1993) conducted a study on routine Vs selective

episiotomy: a randomized controlled trial. It compares the selective
with routine use of a mediolateral episiotomy for women having first
and second deliveries in 8 public maternity units in Argentine.
Episiotomy was done in 30.1% of deliveries in the selected and 82.6% in
the routine group. The main outcome measure was severe perineal
trauma. Severe perineal trauma was uncommon in both group but was
slightly frequent in the selective group (1.2% Vs 1.5%). Anterior
perineal trauma was more common in the selection group but posterior
perineal surgical repair, perineal pain, healing complications and
dehiscence were all less frequent in the selective group .

FYNEFACE – OGAN S, MATO CN, ENYINDAH CE, 2006 were

conducted a comparative study to assess the effect of two local
anesthetic agent on post partum perineal pain in university of port
Harcourt teaching hospital, Nigena. By using a random sampling
technique, the study was conducted in primi parous women who had
spontaneous vaginal delivery, comparing with 1% plain lidocaine and
0.25 % plain bupivacaine infiltration for the repair of selective
episiotomy. Results showed that within 2 to 4 hours, women who had
perineorraphy under lidocaine had significantly higher pain scores on
the visual Analogue scale (VAS) than those who had the repair under
bupivacaine. The P value was P< 0.0000 ( students ‘t’ test ) and
statistically significant. The study suggested that bupivacaine had a
prolonged analgesia and need a fewer doses of oral analgesics in the
immediate postpartum perineal repair period26

Nam HK, Park YS (1991) conducted a study on comparison of ice

bag and heat lamp for the relief of perineal discomfort. The purpose of
the study were to compare the effect of ice bag and heat lamp for the
relief of perineal discomfort and to identify the sustaining time of each
effects. Forty women took ice bag and heat lamp with random
assignment of initial therapy. Women rated the degree of perineal
discomfort before and after each therapy and at half hour, two hour and
four hour intervals after each therapy. A discomfort scale, 18cm graphic
rating scale was used. The results of the study were as follows: 1. The
ice bag group showed (p=0.000) significantly lower discomfort score
than the heat lamp group (p=0.002) at the half hour and two hour
intervals after therapy. 2. The ice bag group showed significantly lower
discomfort score for 5 hour after than before therapy (p=o.ooo), but the
heat lamp group did not show significantly lower discomfort score. 3.
Neither the type of episiotomy nor the previous experience of heat
therapy influenced on the effect of ice bag relieving the perineal
discomfort. Therefore ice bag was significantly more effective in
relieving the perineal discomfort than heat lamp

Hill PD (1989) conducted a study on effect of heat and hold on

the perineum after episiotomy / laceration. The Redness Edema
Ecchymosis Discharge Approximation (REEDA) tool, devised to
evaluate postpartum healing of the perineum following an episiotomy/
laceration, was used to evaluate the effect of heat and cold on the
perineum during the first 24 hours after delivery. Ninety patients were
randomly assigned to one of three treatment groups. Treatment
consisted of 30 subjects applying a warm perineal pack, 30applying a
cold perineal pack, and 30 taking a warm sitz bath. Analysis of variance
indicated no difference in the REEDA score before or two hours after
treatment. A Pearson correlation indicated the REEDA score was
(p=0.009), ( p=0.003) associated with a laceration and not with infant
weight. Although these findings do not support assumptions from the
literature, this study provides baseline data and trends for future study.

Culhane.J.,(2002) conducted descriptive study was conducted to

assess the prevalence of episiotomy among primi postnatal mothers at
child birth clinic, United States. Simple random sampling was used.
Episiotomy is the most common during postnatal period. It occurs in
20% to 73% of primi women in hospital deliveries. 4% to 13% had
fourth degree perineal laceration where (r=0.07,p<0.01).80% of
episiotomy is because of prolonged labour, obstructed deliveries and
infant weighing 2800 to 4000g. The study reveals that most of the primi
postnatal mothers (73%) have complaints due to episiotomy during the
postnatal period.

Krone.m.et.al.,(2008) conducted a study to assess whether the

episiotomy at first vaginal delivery increase the risk of spontaneous
obstetric lacerations in subsequent deliveries in Magee women’s
hospital at Pennyslavia, USA. 6052 patients were included in the study.
Data was collected by Magee obstetric maternal and infant data base.
Multivariable polytomous logistic regression was used for data
analysis. The study result reveals that 47.8% of them had episiotomy in
first delivery. Spontaneous second degree laceration at the time of
second delivery occurred in 51.3%who has the history of episiotomy
compared with 26.7% without having the history of episiotomy
(p<.001). Only 1.7% has laceration without the history of episiotomy.
The study concludes that episiotomy at first vaginal delivery increases
the risk of spontaneous obstetric laceration in subsequent delivery.

STUDIES RELATED TO COMPLICATIONS OF EPISIOTOMY

Hilger.S.et.al.,(2000) conducted a cross sectional study for 101
samples selected randomly in NHS hospital, Pune. The objective of the
study was to determine the rate and describe the complications for
episiotomy and perineal tear in low risk primi gravida. Check list was
used to assess the rate of episiotomy and their causes. Inferential
statistics was used for data analysis. The study result reveals that, 83%
of women explain some sort of perineal trauma. 40% of mothers had
episiotomy only, while 65 % had episiotomy and perineal tears. 37%
had perineal and other tears without episiotomy. The main reason for
episiotomy is fetal distress 27% and impending tears 25% and delay of
the second stage labour 21%. The distribution of having episiotomy is
increased with the second stage of labour irrespective of the time of
delivery.

Fenner D.,(2003) conducted a study to estimate the incidence of

urinary and bowel incontinence, and the factors associated with anal
sphincter laceration in university of Michigan Medical center.
Questionnaire was prepared separately for urinary function and bowel
function and sent to women who delivered vaginally with episiotomy
along with demographic variables. 943 women completed urinary
function questionnaire and 831 women completed bowel function
questionnaire. Univariate analysis was performed in all covariates;
multiple logistic regressions were used for analysis of presence of
laceration. The study results shows that, 19% of the women sustained
third and fourth degree laceration during child birth, 23% women had
sphincter laceration p>.05. About 70% of midline episiotomy women
had anal sphincter laceration and 50% of women had urinary
incontinence after delivery.

Choa.et.al.,(2010) conducted a study to find the effect of

episiotomy on pain, urinary incontinence and sexual function up to 3
months postpartum, in a medical centre at Taiwan. A prospective
follow up study was used. The tool consist of short form Mc Gill pain
questionnaire, international consultation on incontinence questionnaire,
female sexual function index and demographic variables. Data analysis
was done by ANOVA and chi square test. Validity and reliability were
assessed using Cronbach’s alpha coefficient and factor analysis. The
study result shows that the women who delivered without episiotomy
had significantly lower perineal pain scores on 1, 2, 6th day compared
to women who had episiotomy (p=0.006, 0.039, 0.0497) groups. The
mean urinary incontinence score was significantly higher in the
episiotomy group 3 months postpartum (p=0.0065). No degree of
sexual dysfunction was found between the group.

STUDY RELATED TO BETADINE SITZ BATH ON EPISIOTOMY

WOUND HEALING
Sheikhan F, Jahdi F, Khoei EM, (2012 AUG) was conducted a
clinical trial involved 60 qualified primiparous women , they were
randomly categorized in to two groups participants discomfort were
recorded using a REEDA scale, 12hours and 5days following
episiotomy. Collected data was analyzed in SPSS 14 using an
independent t-test and chi-square. There was a statistical difference in
pain intensity scores between the 2groups after 4hours (p=0.002) and
5days (p=0.000) after episiotomy. However differences in pain intensity
between the two groups, at 12hours post-surgery were not significant
(p=0.066). The REEDA scale was significantly lower in the experimental
group 5days after episiotomy (p=0.000).

HURMH, HanSH, The study was designed to verify the effect of

betadine sitzbath on a postpartum mothers perineal healing. The
subjects of this experimental were postpatum mother who are delivered
vaginally with an episiotomy. The betadine sitzbath to evaluate the
effect of the perineal healing status was measured by using the REEDA
scale and smear of episiotomy wound were obtained. The data were
analyzed by repeated measures of ANOVA,ANCOVA, chi-2test and
multiple response analysis via SPSS program. The REEDA scale was
significantly low in the experimental group at postpartum 5and 7 days
(p=0.009), (p=0.003) respectively.

KASHYAP ANUPAMA, Marwaha R.K,(Mar-2013)Chandigrah,

Episiotomy is the most common perineal surgical in obstetric and
midwifery. Application betadine sitzbath is a new approach in
episiotomy wound healing. The clinical trial involved 30 qualified
primiparous women admitted for labour in kamali hospital in Karaj
Iran, they were randomly allocated. The participants wound healing
was recorded on the REEDA scale respectively. The obtained data were
analyzed in using independent T- test (t=4.006) at p<0.000 and paired T-
test and chi-square test. They were statistically difference in REEDA
score was significantly at 5 days after episiotomy (p=0.000).
 A study( Harrision .RF, 2006 ) was done to find the effect of
betadine sitzbath on episiotomy wound healing in postnatal mother
admitted in Pune hospital. 30 postnatal mothers were given betadine
sitzbath according to the REEDA scale assessment score maximum
(53.3%) postnatal mothers were having moderate infection before
giving betadine sitzbath (9.3 (SD=1.106) ) and the difference was
statistically significant according to assessment of REEDA score,
maximun (63.3%)after giving betadine sitzbath (0.54 (SD=O.657) ), the
study analysis shows that betadine sitzbath is reducing infection.

Taehan.C.,(2004) designed a study to verify the effectiveness of

betadine sitzbath on the postpartum mothers episiotomy in Eulji
university Hospital, Korean. The research design used for the study was
clinical trial. The methods of betadine sitzbath were applied for 90
postnatal mothers who delivered with episiotomy were included in the
study. The tool used for measuring the wound healing was by REEDA
Scale and smears of episiotomy. Data was analyzed by ANOVA,
ANCOVA, Chi square test and multiple response regression by SPSS
programmed. The result shows that REEDA Scale was significantly low
in the experimental group at postpartum 5th and 7th days (p=.009,
p=.003). These findings indicate that betadine sitzbath would be
effective in healing episiotomy.

Frank.J.,(2006) conducted a study of betadine sitz baths in

relieving perineal wound healing after episiotomy in postpartum
period in Gandhi memorial hospital, Hyderabad. True experimental
research design was used and the patients are assigned randomly. 40
patients were assigned for betadine sitz bath. A REEDA scale using 0
-15, o representing no infection and 15 representing severe infection
was used. Data analysis was done by using two -way analysis of
variance. The study result shows that betadine sitz bath were
significantly more effective in reducing infection at (p=.005) level of
significance.

Hamid Highani., (2004) A comparative study to evaluate the

effectiveness of dry heat application & betadine sitzbath on episiotomy
wound healing in postnatal mothers admitted in MAN hospitals, hydra
bad. True experimental research design was used. 40 postnatal mothers
were taken for the study. 20 postnatal mothers were given betadine
sitzbath, 20 postnatal mothers were given dry heat application. At the
end of the study it was evident that betadine sitzbath was effective in
episiotomy wound healing process with the difference mean score of
0.75 with standard deviation of 0.579 at p<0.05 level.

Vakilian.K.et.al.,(2010) conducted a study to know the healing

advantage of povidine-iodine sitzbath on episiotomy wound healing,
at Essence Pharmaceuticals, Shah rood University of Medical Sciences
in Iran. Random controlled clinical trial was selected for the study. The
researchers enrolled 120 subjects, including primiparous women with
singleton pregnancies who had episiotomies during spontaneous
vaginal deliveries. The researchers used computerized block
randomization to divide the subjects into 2 groups: lavender oil (n=60)
and povidine-iodine (n=60). The1&2- group received lavender oil &
povidine-iodine antiseptic sitzbath. The lavender oil group and
povidine-iodine group took sitz baths with 5-7 drops in 4 L of water
twice daily for 10 days. The evaluation was done based on 6 criteria:
pain (visual analogue scale), edema (cm), redness (mm), dehiscence
(wound opening), number of sutures, and infection. Retest (r=0.8) was
used to assess reliability. The post test was done on the 10th day.
Inferential statistics was used for data analysis. Incision site was
assessed and there was no significant difference between two groups
but the redness in povidine-iodine group was significantly less than the
lavender group where P=0.001

Higgens.M.et.al.,(2010) conducted a comparative study to

evaluate the postpartum healing of perineum following episiotomy
wound healing in Bay view Medical Center, USA. True experimental
research design with random sampling technique was used. 60 patients
were assigned to one of the treatment groups namely, 30 applying cold
perineal pack and 30 subjects taking povidine-iodine sitz bath. REEDA
scale was devised to evaluate postpartum healing. Post test was done 24
hours after delivery. ANOVA and Pearson r correlation are used for
data analysis. Study result shows that there is povidine - iodine sitzbath
were significantly more effective with the mean score of 0.75 with
standard deviation of 0.579 at p< 0.05 level.

ANNIE. K . JACOB .,(2008) conducted a study to evaluate the

episiotomy wound healing in primi postnatal mothers in RIMS ,
hospital at Manipur. Pre experimental two group pretest , posttest
design was used. The mothers were selected by using purposive
sampling technique. Group I was given warm water sitzbath and group
II was given betadine sitzbath for three days. Then both the groups
were post tested after intervention. Data were analyzed using
descriptive and inferential statistics. In paired "t' test value of group I
was about (mean score on REEDA scale =7.10 and1.93, t=23.469 ), group
II was about (mean score on REEDA scale=5.77 and 0.80, t=30.569 ) at
p<0.05 level of significance. Independent "t" test value was (t=4.606)
significant at p<0.05. The studies results show that is betadine sitzbath
were significantly more effective than warm water sitzbath.

STUDY RELATED TO NEEM EXTRACT SITZBATH ON

EPISIOTOMY WOUND HEALING
AMJTher, (2007-Aug), Mbah Ali, udeinya IJ., The safety and
effect of an acetone/ water neemleaf extract for care of episiotomy
wound after normal delivery was conducted in 50 women. The results
were on healing scores on a REEDA scale was highest (score=2.5) on
day of the delivery. By the 5th day all the woman’s wound were healed
well. It was noted that all the women maintained a high standard of
perineal hygiene with a mean of 5 washes a day. It concludes that in a
woman with normal vaginal delivery, application of neem extract
sitzbath is effective in the care of a routine episiotomy wound.

Hamid Highani., (2004) to evaluate the effectiveness of neem

extract sitzbath & betadine sitzbath on episiotomy wound healing in
postnatal mothers admitted in MAN hospitals, Hyderabad. 40 postnatal
mothers were taken for the study 20 postnatal mothers were given
betadine sitzbath, 20 postnatal mothers were given neem extract
sitzbath. At the end of the study it was evident that neem extract
sitzbath was effective in episiotomy wound healing process with the
difference mean score of 0.75 with standard deviation of 0.579 at p<0.05
level.

Dhanalakshmi.V.,(2004) conducted a study to assess the

effectiveness of the neem extract sitz bath and infra red therapy on the
perineum after episiotomy at selected hospitals at bangalore. In this
study matched group experimental design was adopted. 30 samples
were randomly assigned to treatment conditions. The instrument used
for data collection includes socio demographic data, Modified
Southampton Scale and wound status was assessed by modified Bates
Jensen Wound Assessment Scale, pain was assessed by a verbal
descriptor scale. Unpaired ‘t’ test was done. The average wound score
for infra red radiation and sitz bath are 0.2, 0.866 respectively. The ‘t’
test value is 2.8263, the calculated value is more than the table
value(1.701) the above results indicates mothers who had undergone
the treatment of neam extract sitzbath expressed decreased pain
intensity and wound healing on perineum after episiotomy compared
to mothers who had undergone the treatment of infra red therapy.

Sandhiya.B.D., (2007) conducted a comparative study to assess

the episiotomy wound healing and comfort of primipara mothers with
and without neam leaf extract in a selected hospital, Mangalore. A quasi
experimental design was used for the present study. The sample
consists of 40 primipara mothers who are assigned randomly to
experimental and control group as with and without neem leaf extract
sitzbath. Tool used were base line proforma, wound assessment scale,
that REEDA scale. Data were analyzed using descriptive and inferential
statistics i.e. paired‘t’ test and chi-square test. There is no significant
difference in comparison of wound healing in both groups, (p=0.05). In
the area of comfort there was a significant difference of comfort score in
experimental group (0.64, (SD=0.771)) and control group (9.2,
(SD=1.10)) at p <0.01. The findings of the study suggest that application
of neemleaf extract sitzbath helps in wound healing, and increasing
comfort.
 Esther .J.et.al.,(2007) conducted a study to evaluate the
effectiveness of neem extract sitzbath on episiotomy wound among post
natal mothers in a selected hospital, iran, kajari for 40 samples. Quasi
experimental research design was adopted for the study. Tools REEDA
scale used, that modified episiotomy wound assessment scale.
Episiotomy wound healing was assessed in both, control and
experimental group, twice a day for three days. After the treatment of
three days with neem extract sitzbath, 75% of women showed adequate
wound healing and 25% of them showed poor wound healing. In
control group 70% of them showed poor wound healing. While
analyzing the association by Chi-square test there was no association
between healing of episiotomy wound with selected demographical
and obstetrical variable. While analyzing the area of significance of
mean ‘t’ test,(0.26, (SD=0.482)) it was found that there was a significant
difference between healing scores of experimental and control group
after neemleaf extract sitzbath by three days at p =0.05 level of
significance.

Venkadalaxmy.V.et al;(2009) conducted a study to find the effect

of neem extract sitz bath on episiotomy wound healing in post natal
mothers in selected Hospitals, dhsharally,bangalore. It was
experimental study of pretest post test design with 60 postnatal mothers
were selected. Systemic random sampling technique was used. 30
mothers were randomly assigned to control and experimental group.
REEDA scale, structured interview schedule was used to assess the
episiotomy post partum healing of episiotomy. On the third day,it was
found that 10% of the participant in control group developed mild
infection, where as none of them had any infection in the experimental
group on the third day after the administration of neem extract sitzbath.
The mean and standard deviation (9.6 (SD=1.14) ) of episiotomy
REEDA score were high in control group in comparison with the
experimental group (0.45, (SD=0.629) ). The difference was statistically
significant at p<0.001 level.

Padma.P.R.,(2009) conducted a study on effectiveness of neem

extract sitz bath versus aseptic perineal care upon episiotomy wound
healing among postnatal mothers in selected hospital at Chennai.
Experimental approach was used with quasi experimental design. 60
postnatal mothers with episiotomy were selected. 30 postnatal mothers
were assigned to neemextract Sitz bath and 30 postnatal mothers for
Aseptic Perineal Care by probability sampling technique. Demographic
& Obstetric variable proforma, REEDA scale, Check list were used to
assess -nursing time and materials used for the Aseptic perineal care.
Pretest was conducted on first day before giving neem extract Sitz bath
and Aseptic perineal care using REEDA scale. Aseptic perineal care was
given by the researcher twice a day in the morning and evening. The
paired "t" test value for aseptic perineal care was in 25.48 (table
value=2.57) and for neem extract sitz bath was in 55.66(table
value=2.57) at p<0.05. Independent "t" test, calculated value was 4.84
(table value=2.22) at p<0.05. Mean cost of materials used for neem
extract sitz bath was less than that of Aseptic Perineal Care. The
difference were found statistically significant at p<0.05. The findings of
the study showed that the neemextract Sitz bath was effective when
compared to Aseptic Perineal Care.

BASWA,et.,al,. (40) assessed the antimicrobial activity of

KARANJ and neem (Azadirachta indica) in vitro against fourteen
strains of pathogenic bacteria.Using the tube dilution technique, it was
observed that 57.14 and 21.42% of the pathogens were inhibited at
500micro/ml; 14.28 and 71.42% at 125micro/ml; and 28.57 and 7.14% at
250micro/ml of neem respectively. The activity with neem was
bactericidal and independent of temparature and energy . Most of the
pathogens were killed more rapidly at 4 degrees C than 37 degree C.
The activity was mainly due to the inhibition of cell membrane
synthesis in the bacteria.

THAKURTA,P.,Bhoomik Mukeherjees., (2007-May) Indigenous

uses of Azadirahta indica.A. Juss (locally known as neem) leaves in
different parts of India for curing episiotomy wound healing is wide
spread. The objective of the present study was to evaluate the
antibacterial and anti-secretary activity of neem extract against
infection. Azadidrchta indica extract had significant antibacterial
activity against wound infection of 01,0139 and non-01, non-0139,. The
minimum inhibitory concentration reached by 50% and minimum
bacterial concentration for the extract were 2.5, >5 and 10mg/ml
respectively. Application of neem extract involved wound healing. The
results obtained in this study give some scientific support to the uses of
neem extract sitzbath employed by the indigenous people in India
employed for the treatment of episiotomy wound healing.

HSUKF,Jaosw.,(2009) July ., Neem extract sitz bath is advised

for episiotomy wound healing. A randomized controlled study was
conducted to determine if the neem extract sitzbath was effect in the
episiotomy wound healing in postnatal period and its easy to carry out.
A total of 120 patients were randomly assigned to warm sitzbath (or)
neem extract sitzbath. Clinical parameters including pain, and
evaluated by REEDAscale. They were no significant difference in scores
for postnatal pain (p=0.23) irritation (p=0.48) between groups, over all
satisfaction (p<0.005) compared with the neem extract sitzbath group.
At the end of the 5 th day of postnatal day followup period, 90% of
patients in the warm water sitzbath group (2.82and SD of 2.41 ) and
93%of patients in the neemextarct sitzbath group(7.42 and SD of 3.01)
showed complete wound healing. There were no significant differences
in episiotomy wound healing between groups.

Ms. Bhavani . P. (2009) ., March ., Neem extract sitzbath and

luke warm water sitzbath on episiotomy wound healing in selected area
of Thiruvallur District at Pondicherry. 30 samples were in each group
was selected by randomization as sample for the study. Pre and post
test was done using clinical features scale and Ph colour fast indicator
stick and was compared. The organisms found predominantly during
pretest was 19 (63.3%) in group A and 21 (70%) in group B . After neem
extract sitzbath the over all mean difference was 8.90 and SD of 3.58
.After luke warm water sitzbath the over all mean difference was 2.27
and SD of 2.12 .Comparing the clinical features between group Aand B
showed that neem extract sitzbath was more effective than luke warm
water sitz bath was highly significant at the level of P<0.001.

ELIZEBATH. K . JONES.,,(2009) conducted a study to evaluate

the episiotomy wound healing in primi postnatal mothers in KJK,
hospital at Manipal. Pre experimental two group pretest, posttest
design was used. The mothers were selected by using purposive
sampling technique. Group I was given hot water sitzbath and group II
was given neem extract sitzbath for three days. Then both the groups
were post tested by using REEDA scale after intervention. Data were
analyzed using descriptive and inferential statistics. In paired "t' test
value of group I was about (mean score 9.10 and 2.63, t=21.469), group
II was about (mean score 6.51 and 1.20, t=30.569) at p<0.05 level of
significance. Independent "t" test value was (t=4.824) significant at
p<0.05. The study results shows that is neem extract sitzbath was more
effective than hot water sitzbath.
 CHAPTER III
RESEARCH METHODOLOGY

Research methodology includes research approach, design,

variables, description of setting criteria for sample selection. It further
deals with description of tool, sampling technique, sample size,
collection of data, method of data collection.

RESARCH 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:
SCHEMATIC PRESENTATION:

Group Pre test Intervention Post

test
Experimental Group – I E1O1 X1 O2
Experimental Group – II E2O1 X2 O2

E1:- Experimental group one

E2:- Experimental group two
O1- Pre test
O2- Post test
X 1– Betadine sitz bath
X2--Neem extract sitzbath
Quasi-Experimental design, two groups pre-test, post-test only
design.
VARIABLE:-
Independent variable : Neem extract sitz bath, beta dine sitz bath.
Dependent variable : Episiotomy wound healing

SETTINGS:-
The study was conducted in Kasturba Hospital at Dindugal. It is
a 450 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 outpatients
department monthly. On an average 300-400 deliveries are conducted in
a month among this 250 were normal deliveries and 100-150 were
caesarean and forceps deliveries. The post natal ward I&II was situated
near to labour room. There were 30 beds are in each postnatal ward.
About 6-8 forceps deliveries were conducted in a month.

POPULATION:
The population selected for this study was postnatal mothers
admitted in postnatal ward.

SAMPLING:-
Sample Size:-
Total sample composed of 60 primi postnatal mothers who had
undergone episiotomy, fulfilling the selection criteria from Kasturba
hospitals at Dindugal. 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.

CRITERIA FOR SAMPLE SELECTION:

The sample was 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.

DESCRIPTION OF TOOL
The tool was designed in to two parts.

SECTION --A
To assess the demographic profile, the structured interview
schedule was used. It comprised of demographic data of episiotomy
wound healing such as age, educational status, occupation, family
income, religion, gravida, mode of delivery, 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 blood
flow), discharge, and approximation (closeness of the skin edges). This
tool is used to assess healing based on a 3 point scale; a score of 3
signifies an assessment of very poor wound healing.

SCORING INTERPRETATION
The scoring from 0-3 and it is used to assess the signs of infection.
0 - None
1 - Mild
2 - Moderate
3 - Severe

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.
VALIDITY
The content validity of the tool was corrected by five experts
(4 nursing experts and 1 medical expert). There was no change made in
the standardized tool.

RELIABILITY
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).

PILOT STUDY
The pilot study was conducted in Nivetha hospital- Dharapuram
for a period of seven days. The investigator obtained written permission
from medical officer and oral permission was obtained from each
participant prior to the study. The purpose of the study was explained
to the subjects prior to the study. The pilot study was conducted with
12 samples among this 6 samples for experimental group I and 6
samples for experimental group II. The samples who met the inclusive
criteria were selected by purposive sampling method. Pretest was done
by REEDA scale to assess the episiotomy wound healing for
experimental group I& II. Then the intervention of betadine sitzbath
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 sitzbath 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 collected data was analyzed by using descriptive and

inferential statistics. The paired " t " test value for experimental group I
was is 27.61 (table value= 2.57) at P<0.05 level of significance and for
experimental group II was about 57.88 ( table value =2.57 ) at P<0.05
level of significance should that there is a wound healing in neem
extract sitzbath.

Independent ‘t' test calculated value was 5.66 (table value =2.228)
at p<0.05 level of wound healing among neem extract sitz bath &
betadine sitzbath. After the pilot study it was found that it is feasible &
practicable to conduct the main study.

DATA COLLECTION PROCEDURE

The main study was conducted at Kasturba hospital – Dindugal
for a period of four weeks. The investigator obtained written
permission from the hospital medical officer and nursing
superintendent. 0ral permission was obtained from the each participant
prior to the study. The purpose of the study was explained to the
subjects prior to the study.

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. The experimental Group I from the postnatal ward I, and the
experimental group II from their postnatal ward II. In this study 3-4
samples were selected per day.

The first two weeks the experimental group I was selected from
the postnatal ward I and demographic variables were collected on the
basis of inclusion criteria and pretest was conducted on the first day
morning, the wound healing was assessed by REEDA scale. Then the
intervention of betadine sitz bath was given for 10-15 minutes, twice a
day daily (Morning & Evening) for three days to experimental group I.
Then the post test was done with the same scale on 3rd day evening in
postnatal ward I.

Next two weeks of period, the experimental group II was

selected from the postnatal ward II and demographic variables were
collected on the basis of inclusion criteria and pretest was done on the
first day morning, the wound healing was assessed by REEDA scale.
Then the intervention of neem extract sitzbath was given for 10-15
minutes, twice a day daily (morning& evening) for three days to
experimental group II. Then the post test level of wound healing was
assessed with the same scale. The data were analyzed and tabulated
using descriptive and inferential statistics.

PLANFOR DATA ANALYSIS

Data were analyzed by using descriptive and inferential statistics.
The statistical methods will be used as follows:
DATA
METHODS OBJECTIVES
ANALYSIS
Descriptive Frequency To describe the demographic variables
statistics percentage
Inferential Mean, SD To assess the pre and posttest score
Statistics Frequency
percentage

Paired T Test To compare the pre and posttest level

of wound healing scores among
postnatal mothers in exp – group I
(Betadine sitzbath)
 DATA
METHODS OBJECTIVES
ANALYSIS
To compare the pre and posttest level
of wound healing scores among
postnatal mothers in exp – group II
(Neem extract sitzbath)
Independent T To compare the effectiveness of mean
test posttest level of wound healing
scores among postnatal mothers
between experimental group I & II.
Chi – square test To find the association between mean
posttest level of wound healing scores
among postnatal mothers with their
demographic variables in
experimental group I& II.

PROTECTION OF HUMAN SUBJECTS

The proposed study was conducted after the approval of
dissertation committee. Written permission was obtained from medical
officer and nursing superintendent of Kasturba hospital, Dindugal. Oral
consent was obtained from each selected sample by explaining the
purpose of the study before collecting the data and assessing the wound
healing. Assurance was given to them that confidentiality was
maintained throughout the study.

CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
 This chapter deals with the analysis and interpretations of the
data collected to evaluate the effectiveness of neem extract sitz bath and
betadine sitzbath in promoting wound healing among primi post natal
mothers who were admitted in postnatal ward I&II in a Kasturba
hospital at Dindugal. Data was collected from 60 primi postnatal
mothers, were 30 mothers under experimental group I and 30 mothers
under experimental group II by using REEDA scales. The data obtained
were analyzed and presented under following headings.

ORGANIZATION OF DATA:
The data has been tabulated and organized as follows:
SECTION A Assessment of the demographic variables in primi postnatal
mothers.
SECTION B Comparison of the pre test and post test level of wound
healing scores among primi postnatal mothers in
experimental group. I
SECTION C Comparison of the pre test and post test level of wound
healing scores among primi postnatal mothers in
experimental group II.
SECTION D Comparison of the post test level of wound healing scores
among primi postnatal mothers between experimental group
I and experimental group II
SECTION E Association between post test level of wound healing scores
among mothers in experimental group I &II with their
selected demographic variables.

SECTION - A
TABLE : 1 Frequency percentage distribution of demographic
variables
 Group –I Group –II Total
SI.
Demographic Variables N=30 N=30 N=60
No
F % F % F %
1 Age in years
a) 15-25 20 67 20 67 40 67
b) 26-35 10 33 10 33 20 33
c) 36 & Above 0 0 0 0 0 0
2 Educational Status
a) No Formal 1 3 4 13 5 8
b) Primary 8 27 6 20 14 23
c) High School 2 7 8 27 10 17
d) High Secondary 10 33 6 20 16 27
e) Graduate and Post Graduate 9 30 6 20 15 25
3 Occupation
a) Housewife 21 70 17 56 38 64
b) Farmer 0 0 0 0 0 0
c) Office Worker 1 3 8 26 9 15
d) Others 8 26 5 16 13 21
4 Income per Month
a) Rs. 3000&below 22 73 21 70 43 72
b) Rs. 3001-5000 1 3 5 17 6 10
c) Rs. 5001 & above 7 24 4 13 11 18

Group –I Group –II Total

SI.
Demographic Variables N=30 N=30 N=60
No
F % F % F %
5 Religion
Hindu 20 67 22 74 42 70
 Christain 8 26 4 13 12 20
Muslim 2 6 4 13 6 10
6 Type of family
Nuclear 14 46 16 53 30 50
Joint family 16 53 14 46 30 50

Table 1 shows the demographic variables among primi postnatal

mothers in both experimental group I&II such as age, education,
occupation, religion, income¸ type of family , mode of delivery, and
gravida .

Regarding age in experimental group I, majority 20(67%) of primi

mothers belonged to the age group of 15-25 years and 10(33%) belonged
to age group of 26-35 Years. In experimental group II majority of
mothers 20(67%) belonged to the age group of 15-25 years and 10(33%)
belonged to the age group of 26-35 years.

With regard to education in experimental group I, majority of the

mothers 10(33%) had higher secondary school. In experimental group II
majority of the mothers 8(27%) had high school education.

Regarding occupation in experimental group I, majority of the

mothers 21(70%) were house wives and least 1(3%) were office workers.
In experimental group II majority of the mothers 17(56%) were house
wives and least 5(16%) were coolie workers.

Regarding religion in experimental group I, majority of primi

mothers 20(66%) were Hindu, and the least 2 (6%) were Muslims and
8(26%) were Christians. In experimental group II, majority of primi
mothers 22(73%) were Hindu, and 4(13%) were Muslims and 4(13%)
were Christians.

In regard to income, in experimental group I majority of mothers

22(73%) had income Rs 3000&below, and least 1(3%) had income Rs
3001-5000. In experimental group II majority of mothers 21(70%) had
income Rs 3000 & below .

Regarding type of family, in experimental group I majority of the

primi mothers 14(47%) were from nuclear family and 16(53%) were
from joint family. In experimental group II majority of the primi
mothers 16(53%) were from nuclear family and 14(47%) were from joint
family .
Fig:1.Frequency & Percentage distribution age in years of experimental group I &experimental group II
Fig:2. Frequency & Percentage distribution in religion of experimental group I &experimental group II
Fig: 3. Frequency & Percentage distribution in income per month of experimental group I & experimental Group II
 SECTION B

COMPARISION OF PRETEST AND POSTTEST SCORE ON

WOUND HEALING IN EXPERIMENTAL GROUP I

TABLE 2.1: Frequency and percentage distribution of pre test and post
test level of wound healing in experimental group I
N=30
PRE TEST POST TEST
Level of infection
NO % NO %

No infection (0) 2 7 21 70
Mild infection(1-5) 27 90 9 30
Moderate infection(6-10) 1 3 - -
Severe infection ( 11-15) - - - -

Table 2.1 Depicts that in experimental group in pretest 27(90%)

primi mothers had mild infection. In the post test 21(70%) primi
mothers had no infection and 9(30%) primi mothers had mild infection.
Fig:4 Comparison of frequency & Percentage distribution of pre and post test in experimental group I
TABLE: 2.2 Comparison of Mean, Standard deviation, Mean
difference and Paired "t" value between pretest and
posttest score on wound healing in Group- I.
n
=30

SI. Wound Mean Paired Table

Group N Mean SD
No healing difference ‘t’ Value

3 Pre test 9.3 1.104 2.060

1 I 8.74 38.870
0 Post test 0.56 0.670

df =29 P< 0.05***

The table 2.2 indicates that the pretest mean score is 9.3 ( SD=1.104 )
and post test mean score is 0.56 ( SD=0.670 ) and the Paired " t " value is
38.870 which is significant at P<0.05 level.

From the mean scores it is clear that the patients in group I have a
lower level of wound healing score in post test score than the pretest
score and this indicates that there is an improvement of wound healing
after betadine sitzbath.
SECTION C : COMPARISON OF PRETEST AND POSTTEST
SCORE ON WOUND HEALING IN
EXPERIMENTAL GROUP II

TABLE 3.1: Frequency and percentage distribution of pre test

and post test level of wound healing in experimental
Group-II
N=30
PRE TEST POST TEST
Level of infection
NO % NO %
No infection (0) 3 10 25 83.3
Mild infection(1-5) 24 80 5 16.7
Moderate infection(6-10) 3 10 - -
Severe infection ( 11-15) - - - -

Table 3.1 depicts that in experimental group in pretest 24(80%)

primi mothers had mild infection. In the post test majority 25(83.3%)
primi mothers had no infection and 5(16.7%) primi mothers had mild
infection.
Fig .5. Comparison of frequency &percentage distribution of pretest &post test level of wound healing in
experimental group II
TABLE 3.2 : Comparison of Mean, Standard deviation , Mean
difference and Paired "t" value between pretest and
posttest score on wound healing in group- II.
n=30
SI. Wound Mean Paire
Grou Table
N N healing Mean SD differenc dt
p Value
o Score e value

0.95
3 Pre test 9.2 9
1. II 8.97 53.926 2.060
0
Post test 0.23 0.42
4

df = 29 P<0.05***

Table 3.2 indicates that the pretest mean score is 9.2 (SD=0.959)
and post test mean score is 0.23 ( SD=0.424) and the Paired " t " value is
53.926, which is significant at P<0.05 level.

From the mean scores it is clear that the mothers in group I have a
lower level of wound healing score in post test score than the pretest
score and this indicates that there is an improvement of wound healing
after neem extract sitzbath.
SECTION: D COMPARISION OF POST TEST SCORE ON
WOUND HEALING IN EXPERIMENTAL GROUP
I & II.
Table 4.1 Comparison of Mean, standard deviation, Mean
difference and Independent "t" value between
betadine sitzbath and Neem extract sitzbath on
wound healing score in group I&II.
n=60

Wound Mean
SI. Grou independent Table
N healing Mean SD differenc
No p "t" value Value
score e

After
1. I 30 betadine 0.56 0.670
sitzbath
After 0.33 2.537 2.001
Neem
2. II 30 0.23 0.424
Extract
sitzbath

df = 58 P<0.05***

This table 4.1 indicates that mean score of wound healing after
betadine sitztbath is 0.56 ( SD=0.670 ) and mean score of wound healing
after neem extract sitzbath is 0.23 ( SD=0.424 ) respectively.

The Independent ‘t’ value obtained for wound healing score is

2.537. This is significant at P< 0.05 level. From the mean scores it is clear
that the mothers in group II have a lower level of wound healing score
than group I
 SECTION-E: ASSOCIATION BETWEEN POST TEST LEVEL OF
WOUND HEALING SCORE AMONG MOTHERS IN
EXPERIMENTAL GROUP I & II WITH THEIR SELECTED
DEMOGRAPHIC VARIABLES .

TABLE ; 5.1 Association between post test score level of wound

healing score among mothers in experimental group I with their
selected demographic variables. ( Betadine sitzbath )

S. Episiotomy Wound Healing

Demographic No Mild Moderate Infer
No Table
Variables infection infection infection X2 ence
Value
N F N F N F
1 Age in years
15-25 3 10 7 23 2 7 12.59
4.17 NS
26-35 8 27 7 23 1 3 (df=6)
36 & Above - - 2 7 - -
2 Educational Status
No Formal 2 7 - - - -
Primary - - 2 7 1 3
High School 5 17 12 40 2 7 10.02 2.178 S
High Secondary 1 3 1 3 - - (df=12)
Graduate &
Post Graduate 3 10 1 3 - -
3 Occupation
Housewife 7 23 12 40 3 10
Farmer - - 3 10 - - 2.262
7.8 S
Office worker 2 7 - - - - (df=9)
Others 2 7 1 3 - -

S. Demographic Episiotomy Wound Healing

No No Mild Moderate Infer
Table
Variables infection infection infection X2 ence
Value
N F N F N F
4 Income per Month
Rs.3000&below 4 13 10 33 2 7
3.51 12.59 NS
Rs. 3001-5000 4 13 5 17 1 3
(df=6)
Rs. 5001 & above 3 10 1 - - -
5 Religion
Hindu 4 13 9 30 3 10 12.59
NS
Christian 4 13 2 7 - - 5.3 (df=6)
Muslim 3 10 5 17 - -
6 Type of family
3.182
Nuclear 11 37 4 13 5 17 2.01 NS
(df=3)
Joint family 3 10 4 13 3 10

Chi square test was done to find the association between the post
test levels of episiotomy wound healing in group I with their selected
demographic variables.

TABLE 5.1 shows the association between the post test level of wound
healing in experimental group I with their selected demographic
variable of age, educational status, Occupation, Income, Religion, type
of family. The findings revealed that there was no significant
association between the level of wound healing and their selected
demographic variables in experimental group-I
 TABLE 5.2 Association between post test e level of wound healing
score among mothers in experimental group II with their selected
demographic variables. ( Neem extract sitzbath )

Episiotomy Wound Healing

SI. Demographic No Mild Table Infer
Moderate X2
No Variables infection infection Value ence
No F No F No. F
1 Age in years
15-25 13 43 4 14 - - 12.59
1.424 NS
26-35 10 33 1 3 - - (df=6)
36& Above 2 7 - - - -
2 Educational
Status
No Formal 2 7 - - - -
Primary 3 10 - - - - 2.178
5.97 S
High School 13 43 2 7 - - (df=12)
High Secondary 4 13 3 10 - -
Graduate &
Post Graduate 3 10 - - - -
3 Occupation
Housewife 9 30 3 10 - -
Farmer 10 33 - - - - 3.151 2.262 S
Office Worker 2 7 - - - - (df=9)
Others 4 13 2 7 - -

SI. Demographic Episiotomy Wound Healing X2 Table Infer

No Mild Moderate
 infection infection
No Variables No F No F No. F Value ence
4 Income per
Month
Rs.3000&below 16 53 4 14 - - 0.67 12.59 NS
Rs. 3001-5000 7 23 1 3 - - (df=6)
Rs.5001 & above 2 7 - - - -

5 Religion
Hindu 16 53 4 14 - - 5.291 12.59 NS
Christian 7 23 1 3 - - (df=6)
Muslim 2 7 - - - -
6 Type of family
Nuclear 13 43 3 10 - - 0.119 3.182 NS
Joint family 12 40 2 7 - - (df=3)

Chi square test was done to find the association between the post
test level of episiotomy wound healing in experimental group II with
their selected demographic variables.

Table 5.2 ; shows the association between the post test level of
wound healing in experimental group II with their selected
demographic variable of age, educational status, Occupation, Income,
Religion, type of family. The findings revealed that there was no
significant association between the level of wound healing and their
selected demographic variables in experimental group-II

CHAPTER – V
RESULTS AND DISCUSSION
 The study was undertaken to compare the effectiveness of
Betadine sitzbath and Neem extract sitzbath on episiotomy wound
healing among postnatal mothers. Before and after intervention,
episiotomy wound healing of group I ( Betadine sitzbath) and group II
(Neem Extract Sitzbath) was measured by using REEDA Scale for
assessment of perineal wound area. The results and discussion of the
study are based on the findings obtained from the statistical analysis.
To compare the scores of pretest and post test of the same group, paired
t-test was used whereas to compare the post test results of group I and
group II, independent t-test was used and chi-square was used to find
the association between selected demographic variables and final post
test results in Betadine sitzbath and Neem Extract sitzbath on
episiotomy wound healing.

FINDINGS OF THE STUDY:-

DEMOGRAPHIC CHARATERISTICS;.
Fig;1. Regarding age in experimental group I, majority 20(67%) of
primi mothers belonged to the age group of 15-25 years and 10(33%)
belonged to age group of 26-35 Years. In experimental group II majority
of mothers 20(67%) belonged to the age group of 15-25 years and
10(33%) belonged to the age group of 26-35 years.

With regard to education in experimental group I, majority of the

mothers 10(33%) had higher secondary school education. In
experimental group II majority of the mothers 8(27%) had high school
education.
Regarding occupation in experimental group I, majority of the
mothers 21(70%) were house wives and least 1(3%) was office worker.
In experimental group II majority of the mothers 17(56%) were house
wives and least 5(16%) were coolie workers.

Fig;.2 Regarding religion in experimental group I, majority of

primi mothers 20(66%) were Hindus, and the least 2 (6%) were Muslims
and 8(26%) were Christians. In experimental group II, majority of primi
mothers 22(73%) were Hindus, and 4(13%) were Muslims and 4(13%)
were Christians.

Fig;.3 In regard to income, in experimental group I majority of

mothers 22(73%) had income Rs 3000&below, and least 1(3%) had
income Rs 3001-5000. In experimental group II majority of mothers
21(70%) had income Rs 3000&below .

Regarding type of family, in experimental group I majority of the

primi mothers 14(47%) were from nuclear family and 16(53%) were
from joint family. In experimental group II majority of the primi
mothers 16(53%) were from nuclear family and 14(47%) were from joint
family .

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 sitzbath ) .
The mean wound healing score in experimental group I before
betadine sitzbath is 9.3 (SD±1.104) and after Betadine sitzhbath is 0.56
(SD±0.670 ) respectively. The paired t-test value is 38.870 ,which is
significant at P<0.05 level .
The study findings were consistent with the findings of
Fernandez. R. Griffiths.R (2 008) performed to investigate the
effectiveness of Povidine -Iodine sitzbath for episiotomy wound healing
in primi postnatal mothers. The findings shows that the mean post test
score is 0.27 (SD±0.514) ,the mother had adequate wound healing and
the pre test score is 0.83 (SD±0.728) shows poor wound
healing.Analysis reveales that there was significant difference between
the mean wound healing score of the post natal mothers in the pretest
&post test scores. Therefore povidine – Iodine (10%) can be used as
wound healing agent. Hence the research hypothesis H1; There is a
significant difference between the mean pretest & posttest scores of
betadine sitzbath on episiotomy wound healng among postnatal
mothers in experimental group I was accepted.

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 sitzbath)
The mean wound healing score in experimental group II before
Neem extract sitzbath is 9.2 (SD±0.959) and after Neem extract
sitzhbath is 0.23 (SD±0.424 ) respectively. The paired t-test value is
53.926, which is significant at P<0.05 level .

The study findings were consistent with the findings of Gouin. S.

Patel.H (2001) performed to investigate the effectiveness of neem
extract sitzbath for episiotomy wound healing in primi postnatal
mothers. The findings shows that in paired "t" test the calculated value
is 2.82 is more than the table value is 1.701. .Analysis revealed that there
was significant difference between mean wound healing score of the
post natal mothers in the pretest &posttest scores. Therefore neem
extract sitzbath can be used as wound healing agent. Hence the
research hypothesis H2 ; There is a significant difference between the
mean pretest & posttest scores of neem extract sitzbath on episiotomy
wound healng among postnatal mothers in experimental group II was
accepted.

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 0.56
(SD±0.670 ) and group II is about 0.23 (SD±0.424) respectively. The
independent t-test value 2.537 (p<0.05). The calculated value is more
than the table value.

The study findings were consistent with the findings of Seena.M.,

(2008) performed to investigate the effectiveness of Betadine sitzbath &
Neem extract sitzbath in wound healing in postnatal mothers. After
intervention, 10% of them from experimental group I developed mild
infection and none of participants from experimental group II had
infection in observation . The result shows that there is a significant
wound healing after Neem extract sitzbath in experimental group II
than after betadine sitzbath in experimental group I that the mean post
test score is7.10 (SD±1.768). The calculated Independent ‘t’ value (2.647)
was greater than the expected value of ‘t’(2.0). Hence the hypothesis H3:
There is a significant difference between the mean post test score of
betadine sitzbath and mean post test score of neem extract sitzbath on
episiotomy wound healing among postnatal mothers in experimental
group I & II was accepted .
Therefore it is clearly proved by this study that Neem Extract
Sitzbath is effective more than betadine sitz bath on episiotomy wound
healing.
 The fourth objective of the study was to find out the association
between the post test score of Betadine Sitzbath on episiotomy
wound healing with their selected demographic variables.
Chi-square values were calculated and the results shows that there
was no significant association found between the post test level of
wound healing among primi postnatal mothers with their selected
demographic variables in experimental group – 1

The study findings were consistent with the findings of

ROMERGER M., (2008), in which age of mother, education, occupation,
family income, has no significant association with demographic
variables and wound healing in experimental group. Hence the
hypothesis.

H4: There will be a significant association between the mean

post score on wound healing among mothers in experimental group 1
with their selected demographic variable was rejected.

The fifth objective of the study was to find out the association
between the post test scores of neem extract Sitzbath on episiotomy
wound healing with their selected demographic variables.
Chi-square values were calculated and the results showed
that there was no significant association found between the post test
level of wound healing among primi postnatal mothers with their
selected demographic variables in experimental group – II
The study findings were consistent with the findings of HSUKF,
CHIASJS, JAOSW, GANEVA., (2000) in which age of mother,
education, occupation, family income, has no significant association
with their selected demographic variables and would healing in
experimental group. Hence the hypothesis

H5: there is a significant association between post test score of

wound healing among primi postnatal mothers in experimental group
11with their selected demographic variables was rejected.

From the above discussion it is concluded that Neem Extract

Sitzbath has better effect on episiotomy wound healing than Betadine
sitzbath.

CHAPTER VI
SUMMARY, CONCLUSION, IMPLICATIONS,
RECOMMENDATIONS AND LIMITATION
This chapter deals with:
• Summary of the study
• Conclusion
• Implications for nursing
• Recommendations
• Limitations

SUMMARY OF THE STUDY

The study was done to evaluate the effectiveness betadine
sitzbath and Neem Extract Sitzbath on episiotomy wound healing,
among primi postnatal mothers.

The research approach used for the study was evaluative

approach. The research design used for this study was quasi
experimental research design. The study was conducted at Kasturba
Hospital at Dindugul. Conceptual frame work adopted for the present
study was modified “Kings Goal Attainment Model“. The sample size
was sixty primi postnatal mothers undergone episiotomy, thirty in
experimental group I and thirty in Experimental group II. The
samples were selected by purposive sampling technique and were
assessed for the level of episiotomy wound healing during postnatal
period using the following REEDA scales.

The “REEDA Scale” was used to measure the level of wound

healing. The investigator selected the mothers who met inclusion
criteria by using purposive sampling and pre test was done for both
experimental group I and Experimental group II. Then the intervention
of betadine sitzbath and neem extract sitzbath was given twice a day
every morning and Evening for 10 minutes for three days. Then the
post test level of wound healing was assessed third day evening by
using REEDA scale for both groups. The data was analyzed and
tabulated using descriptive and inferential statistics.

MAJOR FINDINGS OF THE STUDY

Distribution of demographic characteristics of the primi postnatal
Mother’s in experimental group.
• Among 60 postnatal mothers with episiotomy wound
incision, most of the mothers 20 (67%) under the age group
15-25 years in group I and 20(67%) were under the age
group of 15-25 years in group II.
• With regard to educational status, 10 (33%) of the postnatal
mothers having higher secondary education in group I and
8(27%) were high school education in group II.
• Majority of the postnatal mothers were housewives
21(70%) in group I and 17 (56%) in group II.
• In group I, the 22 (73%) the postnatal mothers were having
the family income of Rs.3000 and below and group II , the
21 (70%) were having the family income of Rs. 3000 and
below .
• Regarding gravida 100% of the postnatal mothers were
primi gravid woman in group I and group II.
• 100% (60) of postnatal mother had normal vaginal delivery.
• 100% (60) of postnatal mothers used absorbable suture
materials.
• Regarding Religion majority 20 (67%) postnatal mothers
belongs to Hindu religion in group I and 22(73%) were in
group II.
 • Regarding type of family the majority 16(53%)of the
postnatal mothers belongs to joint family in group I and
the majority 16(53%) of the postnatal mothers were from
Nuclear family in group II.

In experimental group I the post test level of wound healing

mean score, 0.56(SD±0.670) is lower than the pre test mean scoring
9.3(SD±1.104). The paired‘t’ value for experimental group I was 38.870
(table value= 2.060) is significant at P< 0.05 level. In experimental group
II , the post test mean score 0.23(SD±0.424) which is lower than the pre
test mean score 9.2(SD±0.959). The paired‘t’ value for experimental
group II was 53.926 (table value= 2.060) which is significant at P< 0.05
level.

Independent "t" value was 2.537 (table value=2.001) which is

significant at P<0.05 level. It indicates that there is a significant
difference between the post test level of wound healing between
experimental group I& II.

No significant association was found between post test level of

wound healing in relation to age, income, gravida, mode of delivery,
religion, type of family (P<0.05) in experimental group I & II.

The study revealed that Neem extract sitzbath was highly

effective in improvement of episiotomy wound healing among primi
post natal mothers.
CONCLUSION
• The present study was done to assess the effectiveness of
Betadine sitz bath and Neem Extract sitzbath among primi
 postnatal mothers with episiotomy wound healing during
postnatal period in Kasturba hospital at Dindugal. Based
on statistical findings, the mean post test score of
experimental group II ( 0.23 (SD±0.424) ) was significantly
lower than the mean post test score of experimental score
of group I ( 0.56 (SD±0.670) ). Independent ‘t’ value was
2.537 (table value= 2.001) which is significant at P< 0.05.
Therefore the investigator felt that there is a significant
difference on episiotomy wound healing between Neem
extract sitzbath and Betadine sitzbath.

• Statistically proved that neem extract sitzbath is more

effective in episiotomy wound healing than betadine
sitzbath among postnatal mothers

IMPLICATIONS:
IMPLICATION FOR NURSING SERVICE
• The nurses can practice betadine and neem extract sitz bath
along with routine perineal care is improving the wound
healing on postnatal mothers with episiotomy.
• Nurses as the change agent can introduce various
preventive measures to prevent infection on postnatal
mothers with episiotomy.

IMPLICATIONS FOR NURSING EDUCATION

 • The nurse educator can orient the students with alternative
therapies and promoting wound healing in betadine
sitzbath and Neem Extract sitzbath.
• The nurse educator can include information on Neem
Extract and betadine and sitz bath in the clinical rounds
and clinical presentation.
• Nurse educator can conduct workshops on alternative
therapies to update the knowledge and help students to
provide effective care.

IMPLICATIONS FOR NURSING ADMINISTRATION:

• 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 sitzbath and Beatine sitzbath and episiotomy
wound can be made available to nursing staff in wards and
nurse 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 post natal
wards.
• The nurse educator can provide in-service education to
nursing students to update their knowledge and practice
using Neem Extract sitzbath and Betadine sitz bath among
women in postnatal period with episiotomy wound.

IMPLICATIONS FOR NURSING RESEARCH

 • 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 in
nursing science.

RECOMMENDATIONS
• Similar study can be conducted for a large group.
• A comparative study can also be done between the
effectiveness of various alternative therapies for episiotomy
wound healing.
• A comparative study can be done among primi mothers
and multi mothers.
• Similar study can be conducted for the women who are
suffering with vaginal injuries.

Similar study can be conducted for who are suffering with ano-
rectal injuries

LIMITATIONS
• Since it is a new procedure to most of the mothers the
researcher found difficulty in making them to understand
the merits.
• More privacy was needed to do the procedure.
 BIBLIOGRAPHY
BOOKS:
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 14. Pillitteri adele .(2003).” Maternal and child health
Nursing”, (8th ed.). Philadelphia: Lippincott Williams &
Wilkims. Pp 512-514.
15. Polit. D.F.,(2008).” Introduction to Nursing Research”, (8th
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(3rd ed.). New Delhi: Vora Medical Publication. Pp 94,100.

JOURNALS
18. Beger.D (1998) Postpartum teaching priorities the view
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bearing women. Journal of advanced nursing ,32 (2) 407
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mediolateral episiotomies. British Journals of obstetrics and
gynaecology, 87, 407.
21. Dimitrov A., et.al (2000) Causes for healing complications
in episiotomy , article in Bulgarian, 40 (4), 17-21
22. Rhode M.A. and Barger M.K. (1996), Perineal care then
and now . Journal of nurse midwifery, 35 (4), 220-230 .
23. Sally I.L. (1986), Episiotomy repair - immediate and long
term sequlae. A prospective randomized study of three
different methods of repair. British journals of obstetrics
and gynaecology , 93 , 1920.
24. Judith Noronha (2003) Effectiveness of self perineal care
on episiotomy wound healing. The Indian journal of
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wound care following childbirth. British Journal of
nursing, 6(10), 584-8.
26. Hill, P.D. (1989). Effects of medicated and non-
medicated sitzbath on perineum after episiotomy /
laceration . Journal of Obstetrics & Gynaecology Neonatal
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healing ”, Nightingale Nursing times,11(4),60-67.
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WEBSITES
37. www.therapy/health pages.org
38. www.research/reports
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44. www. research report.com
 ANNEXURE-I
LETTER SEEKING PERMISSION TO CONDUCT A
RESEARCH STUDY

TO WHOM SO EVER IT MAY CONCERN

1
 ANNEXURE-II
DESCRIPTION OF TOOL

SECTION – A
DEMOGRAPHIC CHARACTERISTICS
A structured interview schedule was used to assess the
demographic data of the post natal mothers such as age, educational
status, Occupation, income, religion.

SECTION – B
It consist of REEDA – scale for assessment of episiotomy wound
healing. The scoring from 0 – 3 and it used to assess the signs of
infection.

According to this scoring the mothers were classified into various

catogories of wound healing.

SCORE INTERPRETATION

0 No Infection

1–5 Mild Infection

6 – 10 Moderate Infection

11 - 15 Severe Infection

PART- I

2
 DEMOGRAPHIC CHARACTERISTICS
Instruction: Tick ( ) the correct answer:
1. Age
a) 15-25 years
b) 26-35 years
c) 36 and above
2. Educational Status
a) No formal
b) Primary
c) High School
d) Higher Secondary
e) Graduate and post Graduate
3. Occupation
a) House wife
b) Farmer
c) Office worker
d) Others
4. Income
a) 3000 and below
b) 3001 – Rs.5,000
c) Rs.5,001 and above
5. Religion
a) Hindu
b) Christian
c) Muslim
6. Type of family
a) Nuclear
b) Joint
PART-II

3
 REEDA SCALE ASSESMENT FOR PERINEAL WOUND AREA

1. Redness of the perineal area ------------------------------------------

Score --------
0 - None
1 - Within .25cm of Incision bilaterally
2 - within .5cm of Incision bilaterally
3 - Beyone .5cm of Incision bilaterally

2. Edema of the perineal area -------------

Score ---------
0 - None
1 - Perineal,lessthan1cm from incision
2 - Perineal,and /or vulvar, between 1-2cm from
incision
3 - Perineal,and /or vulvar, greaerthan 2cm from
incision

3. Ecchymosis of the perinealy area__________________

score ________
0 - None
1 - within 0.25cm bilaterally or .5cm unilaterlly
2 - between .25cm -1cm bilaterlly or between 0.5- 2cm
unilaterally
3 - greaterthan 1cm bilaterally or 2cm unilaterally
4. Discharge from the wound ________
score _______
0 - None
1 - Serum

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 2 - Serosanguinous
3 - Bloody, purulent
5. Approximation of skin edges ____________
Score ________
0 - closed
1 - Skin seperation 3mm or less
2 - Skin and subcutaneous fatseperation
3 - Skin and subcutaneous fat and facial layer seperation

Total REEDA Score = 15 Total Score______

Scoring
0 : No infection
1-5 : Mild Infection
6-10 : Moderate infection
11-15 : Severe infection

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 ANNEXURE-III
INTERVENTION
SITZ BATH

Definition: It is also known as a hip bath, a sitz bath involves

immersion of the pelvic area in warm or hot water.

Purposes:
• To relieve discomfort
• To promote wound healing by cleansing the perineum
• To increase the circulation
• To reduce inflammation
• It helps to relax local muscles

Equipments:
• Sitz bath/Stainless Steel basin
• Rubber mat
• Lotion thermometer
• Two bath blankets
• Towels
• Hospital gown
• Gloves
• Povidine-Iodine solution 10%
• Neem paste with bowl
• Clean Perineal Pads

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 (A) PREPARATIONS OF BETADINE SITZ BATH

Take a clean sitz tub/stainless steel basin containing 5 litres of

water or one-third to one-half full, add 10ml of povidine-Iodine 10%
solution.

Procedure:
• Explain the procedure to the patient
• Provide screens for privacy
• Ask the mother to wear the hospital gown and thoroughly
wash the Perineal area.
• Spread the rubber mat, kept the stainless basin (Betadine
solution)
• Check the water temperature with lotion thermometer is
about 105o F
• Allow the mother to immerse the perineum for fifteen to
twenty minutes
• Repeat this application for two times a day

After Care:
• Dry the area thoroughly
• Keep the clean perineal pads

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 (B) PREPARATION NEEM EXTRACT SITZ BATH

Take fresh neem leaves, grind it well till it becomes paste; then
take 30gms neem paste and add 5 liters of water, mix it well and boil,
filter and pour into the basin.

Procedure:
• Explain the procedure to the patient
• Provide screens for privacy
• Ask the mother to wear the hospital gown and thoroughly
wash the Perineal area.
• Spread the rubber mat, kept the stainless basin (Neem
extract solution)
• Check the water temperature with lotion thermometer is
about 105o F
• Allow the mother to immerse the perineum for fifteen to
twenty minutes
• Repeat this intervention for two times a day

After Care:
• Dry the area thoroughly
• Keep the clean Perineal pads

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 ANNEXURE – IV
LETTER REQUESTING OPINION AND SUGGESTING OF
EXPERTS FOR CONTENT VALIDITY OF THE RESEARCH TOOL
From:
C.Muthumari
1st Year M.Sc(Nursing)
Sara Nursing College,
Dharapuram.

To:

Through: The Principal

Sara Nursing College,
Dharapuram.

Respected Sir / Madam

Sub : Request letter to gather opinion and suggestion of expert for
establishing content validity of the research tool.

I am C.Muthumari, M.Sc(Nursing), student of Sara Nursing college,

dharapuram, as a partial fulfillment of master degree in nursing, I have
undertaken the following research study which has to be submitted to the
Tamil Nadu Dr.M.G.R.Medical University, Chennai.

Respected Study: “A Study to evaluate the effectiveness of

Betadine Sitz Bath versus Neem extract Sitz Bath on episiotomy wound
healing among post natal mothers”

Herewith I have enclosed

ƒ Statement of the problem
ƒ Objectives of the study
ƒ Tool - I - Structured interview schedule
ƒ Tool – II - REEDA – Scale assessment for episiotomy wound
healing
ƒ Intervention – Betadine Sitz Bath and Neem extract Sitz Bath
ƒ Content Validity Certificate

9
 I request you to kindly validate the tool and give expert opinion for
necessary modification.
Thanking you
Yours obediently
Place :
Date :
ANNEXURE – V
CONTENT VALIDITY CERTIFICATE

I hereby certify that, I have validated the tool of Mrs

C.MUTHUMARI first year MSc Nursing Student of Sara Nursing
College –Dharapuram, Who undertaken dissertaion work on A
COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF
NEEM EXTRACT SITZBATH VERSUS BETADINE SITZ BATH
ON EPISIOTOMY WOUND HEALING AMONG POSTNATAL
MOTHERS AT DINDUGAL HOSPITAL.

Signature of expert :

Name :

Designation :

Date :
Place :

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 ANNEXURE – VI
LIST OF EXPERTS VALIDATED THE TOOLS

Dr. Deivamathi, M.B.B.S., D.G.O.

Obstetrician and Gynecologist,
Nevathetha Hospital,
Dharapuram – 638656
Tamil Nadu.

Prof.A.Meena, M.Sc.(Nursing)
Head, Department of OBG
Annapoorna College of Nursing
Salem

Mrs.R.Aarthy Sodi, M.Sc.(Nursing), Ph.D.,

Asst. Professor
Department of OBG
Sacred Heart Nursing College
Madurai

Mrs.P.L.Murugalakshmi, M.Sc.(Nursing)
Asst. Professor.
Department of OBG
Shri K.Ramachandra Naidu College of Nursing
Sankaran Koil.

Prof. Murugeswari, M.Sc.(Nursing)

Asst. Professor.
Department of OBG

11
Shri K.Ramachandra Naidu College of Nursing
Sankaran Koil.

ANNEXURE – VII

ENGLISH EDITING CERTIFICATE

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ANNEXURE – VII
PHOTOS

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