Effectiveness of Sitz Bath Versus Infrared Ray Therapy on Level of Episiotomy Pain and Wound Healing Among Post Natal Mothers in Selected Hospital, Puducherry

Background: In normal delivery process, the mother has to experience enormous pain to bring out the baby from their womb. The rate of episiotomy among the postnatal mothers in Nigeria is around 35.6% and in PrimiGravida mothers the rate was around 88.5% and in Enugu, the rate of episiotomy was around 40.4% for women including Primi Para and in multipara. There are some of the pharmacological, non-pharmacological and complementary therapies for episiotomy pain and wound healing. Sitz Bath is warm water, shallow bath that cleans the perineum, which is the space in between the rectum and the vulva or scrotum. Infrared ray therapy increases the level of nitric oxide and thereby it leads to vasodilation of vessels which helps in healing the episiotomy wound and reduces the pain level.


Introduction
"Giving birth is a powerful and life changing event with a lasting impact on women and their families". All women who are pregnant will undergo the process of delivery [1]. The process of delivery may be normal delivery, vacuum delivery, forceps delivery or caesarean section. During normal delivery process, the baby from the mother's womb is delivered through the vagina, and the episiotomy is performed to enlarge the birth canal by the health care provider [2]. During delivery, the mother has to experience enormous pain to bring out the baby from their womb. After delivery, the mother may experience perineal discomfort due to the episiotomy incision.
A surgical incision which is made in the perineum to enlarge the birth canal at the time of crowing to deliver the baby without any complications is considered as episiotomy [3].
A Sitz Bath is a bath, in which a person is asked to sit in a water tub up to the hip level. A sitz bath is otherwise called as hip bath. The term "sitz bath" is derived from "the German word sitz bad", which means "A bath in which one sitz". Sitz bath is given by warm water or by cool water. Warm water sitz bath is recommended to reduce the pain, itching and discomfort [4,5]. Sitz Bath is warm water, shallow bath that cleans the perineum, which is the space in between the rectum and the vulva or scrotum. A sitz bath can also provide relief from pain or itching in the genital area. The befits or advantages of providing sitz bath includes relieving from perineal irritation, pain, swelling and it prevents from soreness, burning sensation around the perineum. Sitz bath is indicated for hemorrhoids, Ano-rectal infections and surgeries and for the vaginally delivered mother during postnatal period [6].
The infrared ray was the dry heat therapy which increases the level of nitric oxide and thereby it leads to vasodilation of vessels.
It keeps the wound dry and reduces the pain level [7,8]. The rate of episiotomy among the postnatal mothers in Nigeria is around 35.6% and in PrimiGravida mothers the rate was around 88.5% and in Enugu, the rate of episiotomy was around 40.4% for women including Primi Para and in multipara. Nigeria is showing the lower rate of episiotomy wound among the postnatal mothers [9][10][11].

Methodology
The present study was aimed to evaluate the effectiveness of Sitz bath versus Infrared ray therapy on level of episiotomy pain and wound healing among the postnatal mothers. In order to achieve the study objectives, a quantitative research approach and the Quasi experimental of pretest posttest with control group research design was used in this study [12]. The independent variable of this study was Sitz Bath and Infrared ray therapy and   Data was collected from each mother after obtaining individual consent.
Mothers were introduced about the study and researcher was collected the information by interview schedule and observation method. The pretest was done on day 1 and sitz bath was given to experimental group I, Infrared ray therapy was given to experimental group II and routine care was provided to the control group. The intervention was provided for five days twice a day and the posttest was done on day 5.

Discussion
The result of the present study showed that, the Pre-test Level of

Conclusion
From this study the researcher concluded that, both the sitz bath and infrared ray therapy was effective in reducing the level of pain and wound healing of episiotomy wound among the postnatal mothers. In that, the sitz bath is more effective in reducing the level of episiotomy pain and wound healing among the postnatal mothers. So, this method of intervention was routinely carried by the staff nursing and to teach the mothers to perform the sitz bath in their home itself.

Recommendation
Based on the result of the study and the experience of the researcher the following recommendations are made a) Replication of the study may be done with the large samples in different settings to generalize the study findings.
b) This study can be conducted by using probability sampling technique to generalize the result findings more effectively.

c)
This study can be conducted in community setting.