Effects of episiotomy on bonding and mothers' health

The Use of Capacitive and Resistive Energy Transfer in Postpartum Pain Management in Women after Perineal Trauma

Perineal pain occurs in 97% of women with episiotomy or first- and second-degree perineal tears on the first day after delivery. The study aimed to assess the impact of capacitive and resistive energy transfer (TECAR) on perineal pain and discomfort in the first two postpartum days. The prospective randomized double-blind study was performed with the pain and discomfort assessment using the Visual Analogue Scale at baseline and after both TECAR interventions. Characteristics data, delivery information, and the number of painkillers taken were collected. The assumed significance level was α < 0.05. The study included 121 women with a mean age of 30.7 ± 4.2 years and a median BMI of 26.1 kg/m2 (24.1; 28.9). Pain reduction at rest, when walking, and discomfort reduction when walking were significantly higher in the TECAR group compared to the sham group (p < 0.05). After the first TECAR intervention, significant reduction in all measured parameters was observed in the study group (p < 0.03), whereas in the control group, it was observed in pain and discomfort while sitting (p < 0.04). The amount of ibuprofen taken on the second day was significantly reduced in the study group compared to the first day (p = 0.004). TECAR has been shown to provide more immediate and significant reduction in perineal pain and discomfort.

Evaluation of education and counseling using social media tools after discharge in women who underwent episiotomy

In this study, it was aimed to evaluate the effects of post-discharge education and counseling using social media tools on wound healing, pain status, and care and practices for women with episiotomy. The study was conducted experimentally with 60 women (30 experimental, 30 control) who had vaginal delivery with episiotomy in a public hospital in Istanbul. Data were collected using a data entry form and evaluations on the REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) scale, VAS (Visual Analogue Scale), and Diagnostic Form for Episiotomy Care and challenges. In our study, training and counseling were given to the experimental group by making video calls via social media on the 3rd, 5th, 7th, and 14th postnatal days (PP), and the results were evaluated without any training to the control group. SPSS program was used for data analysis. There was no difference between the experimental and control groups in terms of demographic and obstetric data. It was determined that the total scores of the experimental group on the REEDA scale on the 7th postnatal day (x¯ =2.167 ± 0.747) were statistically significantly lower than the total scores of the control group on the REEDA scale on 7th postnatal day (x¯ =3.100 ± 0.923) (p = 0.000 > 0.05). It was determined that the total scores of the experimental group on REEDA scale on the 14th postnatal day (x¯ =0.200 ± 0.407) were also statistically significantly lower than the total scores of the control group on REEDA scale on the 14th postnatal day. (x¯ =1.333 ± 0.844) (p = 0.000 > 0.05). The VAS DS scores of the experimental group on 3rd (x¯ =4.733 ± 0.907) and the 5th (x¯ =3.267 ± 0.691) postnatal day were statistically significantly lower than the VAS DS scores of the control group on 3rd (x¯ =5.267 ± 0.944) and 5th (x¯ =3.933 ± 0.944) (p = 0.003 > 0.05) postnatal day. In the light of this information, it was found that scores on REEDA scale were lower and pain experiences were significantly less in the group that received education and counseling with social media tools after discharge in women who underwent episiotomy.

The Effect of Virtual Reality Glasses Applied During the Episiotomy On Pain and Satisfaction: A Single Blind Randomized Controlled Study

Objective

The research was conducted as a randomized controlled study to determine the effect of virtual reality glasses on the mother's pain and satisfaction during episiotomy.

Methods

The sample consisted of 50 pregnant women determined by randomization among primiparous pregnant women. Data were collected with the Mother Information Form and Visual Analog Scales Pain and Satisfaction Evaluation forms. 5 mL of lidocaine was administered to mothers in the intervention and control groups during episiotomy repair. Only the mothers in the intervention group watched a video with virtual reality glasses for an average of 10 minutes during the episiotomy procedure. SPSS 22.0 was used in the analysis.

Results

In the comparison between the groups, it was found that the mean pain score measured during episiotomy inner and episiotomy skin suturing was statistically significantly lower in the intervention group than in the control group; there was no significant difference between the intervention and control groups in the mean pain scores measured before and after episiotomy repair. It was determined that the mean satisfaction score of the intervention group was higher than that of the control group.

Conclusion

Virtual reality glasses reduced pain during episiotomy and increased satisfaction. According to the results, it is recommended to be used by midwives because it is an easily applicable non-pharmacological method and increases the mother's birth satisfaction.

The effect of music-based interventions on short-term postpartum episiotomy pain: A systematic review and meta-analysis

Episiotomy took over as the most common surgery in the field of midwifery that was performed in the second stage of labor to facilitate delivery, and reduce perineal damage. Music is one of the methods used to combat pain. We applied a meta-analysis to investigate whether music-based interventions can reduce short-term postpartum episiotomy pain. Four main English databases including Embase, PubMed, Web of Science, and Scopus were searched until July 2022. All randomized controlled trials (RCTs) with at least two groups (control and intervention) that aimed to measure the effect of music therapy on episiotomy pain were included in the present review. The Cochrane risk of bias checklist was used to assess study quality. Study heterogeneity was determined using the I² statistic and publication bias using Begg's and Egger's tests. Results of random effect analysis are presented as Standard Mean Difference (SMD) with 95% confidence intervals (CI). Data were analyzed using the STATA software version 16. In total, seven articles with 677 subjects were included in the meta-analysis. Overall, the pool estimates of the meta-analysis demonstrated that music therapy has a positive impact on reducing short-term pain derived from episiotomy in both primiparous and multiparous compared to the control group (pooled SMD = -1.60; CI = -2.18, -1.02, p-value<0.001). The heterogeneity was high among including studies (I² = 95.7%, p < 0.001). Our result showed that music-based interventions can be considered a choice for the management of short-term postpartum episiotomy pain among both primiparous and multiparous women. Future studies with large sample sizes and longer follow-up periods will be required to draw better conclusions about the long-term effects on postpartum pain.

Prevalence and its Associated Factors of Episiotomy Practice Among Mothers Who Gave Birth in Debre Tabor Town Northwest Ethiopia: An Institutional Based -Cross-Sectional Study

BACKGROUND

An episiotomy is a surgical technique that widens the perineum during the second stage of childbirth. Therefore, the goal of this study was to assess the prevalence of episiotomy and the variables that affect it among women who gave birth in the town of Debre Tabor, in 2021.

METHODS

In the Debre Tabor municipality's four designated health center regions, 402 women who gave birth were included in a cross-sectional study. Systematic random selection was used to choose the study subjects. In SPSS version 23, data were entered, cleaned up, and analyzed using descriptive and inferential statistics. The use of binary and multivariable logistic regression models allowed the researchers to identify characteristics related to episiotomy magnitude. Using a 0.05 p value, the level of statistically significant variables was also calculated.

RESULT

Out of a total of 402 deliveries for this inquiry, the magnitude of the episiotomy was calculated to be 35.1% of those deliveries. About 127 women, or the bulk of respondents, were between the ages of 25 and 29 (33.1%). Face presentation was 4.7 times more common among primiparous women than breech and vertex presentation, and midwifery professionals and midwifery students were 5.5 times higher than internship medicine and health officer students. The odds of performing an episiotomy were 3.7 times higher among primiparous women compared to multiparous women (AOR = 3.754 (1.382-15.108)).

CONCLUSION

The magnitude of episiotomy in this study was somewhat larger than the World Health Organization's recommendation of 10% .Instrumental delivery, neonatal presentation, experts allocated to the delivery ward, and the mother's parity were all shown to be strongly linked with the practice of episiotomy.

Obstetric outcomes of 297 women treated for vaginismus

OBJECTIVE

Vaginismus is a disease characterized by vaginal spasms that impede sexual penetration and lead to sexual dysfunction. The association between this disease and infertility is quite well acknowledged. This paper aims to assess the obstetric outcomes and patient characteristics of vaginismus-treated women.

STUDY DESIGN

This cross-sectional research comprised 297 vaginismus patients who were effectively treated.

METHODS

The following information was collected: age, degree of education, occupation, length of marriage, and obstetric history (primigravida, multigravida, and previous abortions). Following pregnancy, the following data were collected: The results of pregnancy, obstetrics, and neonatology, such as maternal age, gestational age, and birth weight. As obstetrical outcomes, miscarriage, early delivery, hypertension, and fetal loss were recorded. In addition, the mode of delivery (cesarean section vs vaginal birth), reasons for selecting it, analgesic techniques, and potential problems during or after delivery were evaluated.

RESULTS

The mean maternal age was 29.2 ± 4.7 years, and the pregnancy rate was 86.86% (n = 258). 258 individuals were reported to have had at least one term pregnancy and delivery. In the feedback for vaginismus, no recurrence was reported 16 weeks after hospital release.

CONCLUSION

Vaginismus patients should be treated prior to being deemed infertile, and other fertility treatments should be attempted. Moreover, the caesarean delivery rates of individuals with treated vaginismus are the same as those of the general population. Vaginal delivery after vaginismus treatment seems to be safe, with no increased perineal morbidity or vaginismus recurrence.

The effect of olive cream on pain and healing of caesarean section wounds: a randomised controlled clinical trial

OBJECTIVE

This study was performed to determine the effect of olive cream on the severity of pain and healing of caesarean section wounds.

METHOD

This study is a parallel randomised clinical trial that was conducted on women who had caesarean sections at Ayatollah Taleghani Hospital in Arak, Iran. Women were assigned to intervention, placebo and control groups by a block randomisation method. Women in the intervention and placebo groups were asked to use olive cream and placebo cream, respectively, twice a day from the second day after surgery to the tenth day. The wound healing score and pain intensity score were assessed using the REEDA and VAS scales, respectively, before and at the end of the intervention.

RESULTS

The intervention group consisted of 34 women, the placebo group of 34 women and the control group of 35 women. We found a statistically significant difference between the intervention and placebo groups, intervention and control groups, and placebo and control groups in terms of the pain intensity (p<0.05 in all three cases). Also, we found a statistically significant difference between the intervention and placebo groups, and intervention and control groups in terms of the scores of wound healing on the tenth day after surgery (p<0.05 in both cases).

CONCLUSION

Olive cream can be effective in relieving pain and enhancing caesarean section wound healing, and since no specific side effects were reported, the use of olive cream is recommended.

Effect of uterine fundal pressure applied in the second stage of labor on birth outcomes and neonatal oxygen saturation

AIM

To examine the effect of fundal pressure applied in the second stage of labor on birth outcomes and neonatal O₂ saturation.

METHODS

The study is of a descriptive and comparative type. Research data were collected in the obstetrics clinic of a Maternity Hospital between August 15, 2019 and February 15, 2020. The study sample consisted of 160 pregnant women who met the research criteria (80 pregnant women who received fundal pressure, 80 pregnant women who did not receive fundal pressure).

RESULTS

The duration of the second and third stages of labor was found to be shorter in the nonfundal pressure group (t = -3.422, p = 0.001; t = 2.195, p = 0.030). When the groups were compared, the formation of perineal trauma and second-degree laceration, episiotomy requirement, elongation of the episiotomy incision and cervical laceration rate were found to be significantly higher in the fundal pressure group χ²  = 10.794 p = 0.001; χ²  = 8.403 p = 0.004; χ²  = 10.014, p = 0.002; χ²  = 16.579 p = 0.000; χ²  = 16.276 p = 0.000). The 1st and 5th min Apgar scores of the newborns were lower in the fundal pressure group (t = -6.377, p = 0.000; t = -3.581, p = 0.001). The 1st, 5th, 10th, and 15th min oxygen saturation of the newborns were determined to be significantly lower in the fundal pressure group (t = -4.753, p = 0.000; t = -2.427, p = 0.016; t = -2.604, p = 0.010; t = -2.492, p = 0.014).

CONCLUSION

According to the study results, it was determined that the uterine fundal pressure has a negative effect on birth outcomes and neonatal oxygen saturation. Adverse effects of fundal pressure application should be revealed in different aspects.

Effects of Herbal Medicines on Nipple Fissures: A Systematic Review

Context: As a prevalent problem on the first days of childbirth, nipple fissures can cause pain and discomfort and lead to the early cessation of breastfeeding. Effectively treating this complication is therefore crucial. This systematic review investigated the effects of herbal medicines on the treatment of nipple fissures. Data Sources: Keywords such as “treatment”, “nipple fissure”, “fissure”, “medicinal plants”, “sore nipple” and “herbal ingredients” were used individually and in combination to extract relevant articles published by March 2020 from English databases, i.e., Science Direct, PubMed, Scopus and Google Scholar. The Persian equivalents of these keywords were used for extracting articles from Google Scholar, SID and Magiran. The selected articles were qualitatively evaluated using the checklist issued by Consolidated Standard of Reporting Trials (CONSORT) in 2017. Results: Out of 132 articles retrieved, 10 eligible ones were included in this study. Investigating the full text of the articles found herbal medicines such as purslane, Aloe vera, olive oil, frankincense, Pistacia atlantica, curcumin and Ziziphus jujuba effective in treating nipple fissures. Conclusions: Given the effects of herbal medicines on treating nipple fissures, it is recommended that comprehensive studies be conducted on different forms and doses of these compounds.

Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia

BACKGROUND

Episiotomy is a surgical incision of the perineum to hasten the delivery. There is a scarce of information related to episiotomy practice, and its associated factors, in developing countries, including Ethiopia. Thus, this study was aimed to determine the level of episiotomy practice and to identify its determinants at public health facilities of Metema district, northwest, Ethiopia.

METHODS

Institutional-based cross sectional study was conducted among 410 delivered mothers from March 1 to April 30, 2020. We recruited study participants using systematic random sampling technique. Data were entered to Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Stepwise backward elimination was applied for variable selection and model fitness was checked using Hosmer and Lemshows statistics test. Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.

RESULTS

In this study, the magnitude of episiotomy practice was found 44.15% (95% CI 39.32-48.97). Vaginal instrumental delivery (AOR 3.04, 95% CI 1.36-6.78), perineal tear (AOR 3.56, 95% CI 1.68-7.55), age between 25 and 35 (AOR 0.11, 95% CI 0.05-0.25), birth spacing less than 2 years (AOR 4.76, 95% CI 2.31-9.83) and use of oxytocin (AOR 2.73, 95% CI 1.19-6.25) were factors significantly associated with episiotomy practice.

CONCLUSIONS

Magnitude of episiotomy practice in this study is higher than the recommended value of World Health Organization (WHO). Instrumental delivery, age, oxytocin, birth spacing and perineal tear were significant factors for episiotomy practice. Thus, specific interventions should be designed to reduce the rate of episiotomy practice. Plain English summary The routine use of episiotomy practice is not recommended by WHO. A study that compares routine episiotomy with restrictive episiotomy suggests that the latter is associated with less posterior perineal trauma, less need for suturing, and fewer complications related to healing. In addition, though, the rate of episiotomy has been declined in developed countries, still it remains high in less industrialized countries. The data for this study were taken at public health facilities of Metema district, northwest, Ethiopia. We included a total of 410 delivered mothers. The magnitude of episiotomy practice was found 44%. This result was higher than the recommended value of WHO. The WHO recommends an episiotomy rate of 10% for all normal deliveries. The result of this study showed that episiotomy practice is common among mothers whose age group are 18-24. In addition, mothers whose labor were assisted by instrumental vaginal delivery are more likely to have episiotomy as compared to those delivered by normal vaginal delivery. Laboring mothers who had used oxytocin were about three times more likely to be exposed for episiotomy than laboring mothers who did not use oxytocin drug. Moreover, episiotomy practice was nearly five times more likely among mothers who had birth spacing of 2 years and less as compared to mothers who had birth spacing of more than 2 years.

Anti-Inflammatory and Restorative Effects of Olives in Topical Application

METHODS

A literature search was conducted (1990-2021) in Medline, Embase, CINAHL, Google Scholar, Science Direct, SID, IranDoc, and Magiran databases. From the 102 reviewed articles, 17 articles were selected to be included in the current article.

RESULTS

Various forms of olive have long been used to accelerate the healing of various wounds and skin damage such as diabetic foot ulcers, atopic dermatitis, diaper dermatitis, episiotomy wound, and nipple ulcer but there are still no credible documents or articles that provide reliable evidence of topical use.

CONCLUSION

According to the information obtained from the articles reviewed, olive oil appears to be an effective, safe, and available treatment. This study suggests that olive oil is an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of olive oil in similar or different injuries in different populations.

Is mediolateral episiotomy angle associated with postpartum perineal pain in primiparous women?

OBJECTIVE:

Our aim is to elucidate the relationship between mediolateral episiotomy (MLE) angle and postpartum perineal pain.

METHODS:

This study was designed prospectively. Primiparous women with MLE in the postpartum period were included in the study and divided into three groups according to episiotomy angle ranges (Group 1: <40°, Group 2: 40°–60°, and Group 3: >60°). Postpartum perineal pain was quantified with the short-form McGill Pain questionnaire (SF-MPQ) consisting of the following three parts: Sensory-affective-verbal descriptions, visual pain scale (VPS), and present pain intensity scale (PPI). Postpartum perineal pain scores on days 1 and 7 were compared among the angle group.

RESULTS:

Overall, 86 eligible women were enrolled in this study. Seventy-three women (85%) scored the perineal pain between 0 and 3 on the VPS and 13 women (15%) rated the pain from 4 to 6 on the 1^st postpartum day. No significant differences were noted among the three groups regarding the total pain scores on SF-MPQ and on the each part of form at the 1^st postpartum day. At 7 days postpartum, total pain score was found significantly high in Group 1 [Med; IQR (min-max)=0; 4 (0–5)] compared with Group 2 [Med; IQR (min-max)=0; 0(0–5)]. The pain scores obtained from the sensory, affective, VPS, and PPI parts of the questionnaire were [Med; IQR (min-max)=0; 1 (0–2)], [Med; IQR (min-max)=0; 1 (0–1)], [Med; IQR (min-max)=0; 2 (0–2)], and [Med; IQR (min-max)=0; 0.25 (0–1)], respectively, in Group 1. For Group 2, pain scores obtained from the sensory, affective, and PPI were [Med; IQR (min-max)=0; 0(0-1)]; and VPS was [Med; IQR (min-max)=0; 0(0-2)]. No significant differences were observed between Groups 1 and 2 for each part of the questionnaire on day 7. Percentage of need for analgesics on day 7 was found significantly higher in Group 1 (42.9%) than Group 2 (31.2%)

CONCLUSION:

MLE at an angle <40° to the midline is associated with a higher score of perineal pain and an increase need for analgesics during the early postpartum days.

The effect of music and skin contact with the newborn on pain and anxiety during episiotomy repair in primiparous women: A double-blind randomized controlled study

OBJECTIVE

To show that music medicine and skin contact with the newborns can reduce pain and anxiety during episiotomy repair.

DESIGN

Double-blind randomized controlled trial SETTING: The study was conducted between April and July 2020 at the private Medipol Nisa Hospital.

PARTICIPANTS

A total of 150 primiparous pregnant women over 20 years of age who underwent vaginal delivery with episiotomy INTERVENTIONS: Participants were randomized into the music medicine, skin contact with the newborn, and control groups (with no treatment). After episiotomy repair (with the designated treatment or no treatment), the State Trait Anxiety Inventory and Visual Analog Scale were used to assess anxiety and pain, respectively.

MAIN OUTCOME MEASURES

Pain and anxiety experienced after episiotomy repair in the treatment and control groups.

RESULTS

Women in both treatment groups (music medicine and skin-to-skin contact) had significantly lower anxiety and pain levels than those in the control group. In particular, music medicine significantly reduced pain in comparison to skin contact with the newborn (VAS 2 3.92 ± 1.46 vs. 5.42 ± 1.73, respectively, VAS 3 2.64 ± 1.63 vs. 5.14 ± 1.77, respectively, VAS 4 1.38 ± 1.46 vs. 4.14 ± 2.04, respectively, p < 0.05). Thus, music medicine is more effective than skin-to-skin contact in reducing the pain experienced during episiotomy repair, but both treatments were equally effective in reducing anxiety (35.30 ± 6.47 vs. 36.82 ± 9.71 vs. 49.22 ± 16.95, respectively, p < 0.05).

CONCLUSION

Both of these nonpharmacological treatments can be used along with analgesics and anxiolytics for the treatment of pain and anxiety during episiotomy repair.

The effect of acupressure applied to points LV4 and LI4 on perceived acute postpartum perineal pain after vaginal birth with episiotomy: a randomized controlled study

PURPOSE

Acupressure can be used for alleviating perineal pain sustained after a vaginal birth with episiotomy. To evaluate if a 10-min acupressure application relieved perineal pain after vaginal birth with episiotomy and if the analgesic effect was maintained for up to 120 min.

METHODS

A randomized controlled trial was conducted from January to May 2019 with 120 women. The participants were over 18 years old, had an episiotomy and experienced perineal pain ≥ 4, had not received anti-inflammatory medication or analgesics after childbirth, and were randomized to receive acupressure or ice-pack application on the perineum for 10 min or standard care.

RESULTS

Immediately post-intervention, the women in the experimental groups had a significantly higher decrease in perineal pain. Within 120 min, there was a significant difference in the pain levels between the three groups. Each method (acupressure, ice package and control group) is evaluated for 30 min (VAS 3), 60 min (VAS 4) and 120 min (VAS 5). Comparing these 3 methods the acupressure has significantly reduced pain after the application (VAS 3 3.20 ± 1.28 vs. 3.77 ± 1.27 vs. 4.82 ± 0.93, respectively, VAS 4 2.65 ± 1.33 vs. 3.5 ± 1.37 vs. 4.62 ± 0.97, respectively, VAS 5 2.02 ± 1.44 vs. 3.5 ± 1.37 vs. 4.57 ± 0.93, respectively, p < 0.05) CONCLUSION: Effective pain relief is achieved by applying acupressure for 10 min to the perineum and is maintained between 30, 60, and 120 min.

The development and validation of a new postpartum sexual function and dyspareunia assessment tool: The Carol Scale

OBJECTIVE

The aim is to develop a new tool to evaluate postpartum sexual function and dyspareunia which will facilitate better evaluation of perineal pain in woman after vaginal delivery.

DESIGN

The development and validation of the Carol Postpartum Sexual Function and Dyspareunia Assessment Scale.

SETTING

The Obstetrics and Gynecology Service of a University Hospital in central Spain.

PARTICIPANTS

102 women after being attended for vaginal birth, and 5 midwife assessors.

FINDINGS

81women reinitiated sexual activity (with vaginal intercourse) during the first three months postpartum. The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale (Carol Scale) was internally reliable with a Cronbach-α value of 0.79 (95%CI0.72-0.85). Cronbach-α coefficients for Carol Scale domains were: preparation for the sexual activity 0.69 (95%CI0.55-0.79), pain or discomfort on caressing the vulval area 0.86 (95%CI0.79-0.91), pain or discomfort related to vaginal intercourse 0.93 (95%CI0.90-0.95) and pain or discomfort after vaginal intercourse 0.86 (95%CI0.78-0.91).

CONCLUSIONS

The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale is valid and reliable for measuring sexual function and postpartum dyspareunia in women after being attended for vaginal birth.

IMPLICATIONS FOR PRACTICE

The Carol Scale could be used both clinically and in research to improve the quality of care for the mother after childbirth. The scale could help to identify problems in the reinitiation of postpartum sexual activity and, therefore, could contribute to widening the clinical information about these women and help in decision making.

Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital

Objective:

The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital.

Materials and Methods:

This cross-sectional study was conducted between January 1^st, 2013 and December 31^st, 2014 at Aydın Maternity and Children’s Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis.

Results:

The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%.

Conclusion:

The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.

Lignocaine Versus Ropivacaine Infiltration for Postpartum Perineal Pain

Background:

Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery.

Aims:

To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief.

Materials and Methods:

After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18–40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0.75% ropivacaine infiltration for the repair of selective episiotomy or perineal injury. Time of the first analgesic (TFA) demand, maternal satisfaction at 24 h, and visual analog scale (VAS) pain score were studied.

Statistical Analysis:

Chi-square test and Student's t-test were used and P < 0.05 was considered as significant.

Results:

VAS pain score was significantly lower at 2 and 4 h in ropivacaine group versus lignocaine group (P < 0.0001). Significantly, longer TFA (10.2 ± 1.54 vs. 2.20 ± 0.44 h, P < 0.0001) and higher percentage of maternal satisfaction (86% vs. 44%) were observed in ropivacaine as compared to lignocaine group (P < 0.0001).

Conclusions:

Prolonged analgesia and higher rate of maternal satisfaction were found when ropivacaine infiltration was used for perineal repair as compared to lignocaine.

Incidence and risk factors of urinary incontinence in women visiting Family Health Centers

Background

The objective of this study is to determine the incidence and the risk factors of the urinary incontinence in women visiting the Health Family Center.

Methods

430 women, who visited three Family Health Centers in the city center of Erzurum for any reason between 25 November and 20 January 2016, were included in this study without any sampling. The data were collected by using the face-to-face interview method. Percentage distribution, Chi square test, and logistic regression analysis were used in order to analyze the data.

Results

It was determined that 37.2 % of these women had urinary incontinence, but only 29.3 % of them visited a physician because of this complaint. Among a total of 160 women with urinary incontinence findings, stress type incontinence was observed at the highest rate (33.7 %), which was followed by mixed type (31.8 %), urge type (20.6 %) and other types (overflow, continuous urinary incontinence) (13.7 %). It was found that urinary incontinence had a significant correlation with the number of children, genital prolapse, duration of delivery longer than 24 h, diabetes and urogenital infection, but not with the age at the first and last childbirth, presence of the episiotomy, birth weight over 4 kg, and smoking.

Conclusions

It was determined that one-third of the women had urinary incontinence and certain medical and obstetric conditions were affecting the development of urinary incontinence. It is thought that it is important for the healthcare personnel to take the progression of the urinary incontinence under control by preventing the risk factors and to encourage the patients to seek treatment with the help of the proper information indicating that urinary incontinence is a treatable and preventable condition.

Influence of elective and emergency cesarean delivery on mother emotions and bonding

BACKGROUND

Previous studies have indicated that mode of delivery could have a negative effect on bonding.

AIMS

To assess feelings towards newborn infants in mothers who delivered by cesarean delivery, elective (ElCD) or emergency (EmCD).

STUDY DESIGN

This observational prospective study took place at the Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy, from September 2014 to April 2015.

SUBJECTS

The sample included 573 puerperae divided into three groups: women undergone ElCD (n=73; 12.73%), women undergone EmCD (n=81; 14.13%) and women who underwent vaginal delivery (VD) (n=419; 73.12%).

OUTCOME MEASURES

The instrument used was the Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a self-report test to measure mother's feelings towards her baby. High scores indicate worse mother-to-infant bonding and a score≥2, established as cut-off, indicates an altered bonding.

RESULTS

The mean MIBS global score was 0.50±1.05 in the VD mothers, 0.67 (±1.14) for ElCD mothers and 0.92 (±1.05) for EmCD mothers, resulting significantly higher in EmCD mothers (p<0.001). The percentage of altered bonding (Score≥2) in the three groups was of 11.21% (n=47) in VD, 17.80% (n=13) in ElCD and 23.45% (n=19) in EmCD, significantly higher in EmCD women (p<0.006). In addition, EmCD mothers scored significantly higher Joyful (0.074±0.26 vs 0.185±0.39; p<0.005) and Disappointed (0.063±0.25 vs 0.123±0.36; p<0.008) subscales.

CONCLUSIONS

It was found that EmCD negatively affects mother bonding and opening emotions, and originates in mother feelings like sadness and disappointment for the unplanned delivery evolution.

Ananas comosus Effect on Perineal Pain and Wound Healing After Episiotomy: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Background:

Ananas comosus has long been used for medical purposes. Currently, we are experiencing an unprecedented interest in the use of complementary medicine as well as a growing attention to traditional products such as bromelain for wound healing and reducing pain.

Objectives:

The aim of this study was to determine the effect of oral bromelain on perineal pain and wound healing after episiotomy in primiparous women.

Patients and Methods:

In this double-blind placebo-controlled clinical trial, 82 primiparous women fulfilling the inclusion criteria received bromelain or placebo randomly. Participants were given three tablets, three times a day for six successive days. The initial dose was given 2 hours after delivery. Episiotomy pain was measured using VAS scale before the initial dose, as well as on the 1st hour and on the 3rd, 7th and 14th days after the initial dose. Wound healing was measured using REEDA scale on the 3rd, 7th and 14th days after delivery.

Results:

Episiotomy pain significantly reduced in bromelain group compared with the placebo group (P < 0.05) and wound healing was faster in bromelain group compared with the placebo group (P < 0.05) on follow-up days.

Conclusions:

The results showed the effectiveness of bromelain on episiotomy pain and wound healing. Therefore, it is suggested to use bromelain in postoperative stage to improve wound healing and reduce pain.

Effect of perineal massage on the rate of episiotomy and perineal tearing

OBJECTIVE

To examine the effects of perineal massage during active labor on the frequency of episiotomy and perineal tearing.

METHODS

A randomized controlled study was conducted at a center in Sivas, Turkey, between January 1, 2010, and May 31, 2011. Healthy pregnant women presenting for their first or second delivery at 37-42 weeks of pregnancy were enrolled during the first stage of labor. Participants were randomly assigned (1:1) to the massage group (10-minute perineal massage with glycerol four times during the first stage and once during the second stage of labor) or control group (routine care). The frequency of episiotomy and perineal tearing were compared between the groups. Participants and investigators were not masked to group assignment.

RESULTS

Both groups contained 142 participants. Episiotomy was performed among 44 (31.0%) women in the massage group and 99 (69.7%) in the control group (P = 0.001). Lacerations were recorded among 13 (4.2%) women in the massage group and 6 (4.2%) in the control group (P = 0.096).

CONCLUSION

Application of perineal massage during active labor decreased the frequency of episiotomy procedures. ClinicalTrials.gov:NCT02201615.

Prevalence of urinary incontinence in older Turkish women, risk factors, and effect on activities of daily living

PURPOSE

The study was conducted to determine the prevalence of urinary incontinence (UI) among older women, risk factors, and the effect on activities of daily living (ADLs).

METHOD

The study was conducted in family health centers located in a city in eastern Turkey. The study population consisted of 1094 women age 65 and older chosen with a simple random sampling method. The inclusion criteria were 65 years and older, female, and not diagnosed with mental or emotional diseases or conditions that obstruct communication. Data were collected in face-to-face interviews with the Questionnaire and Daily Life Activities Data Form created by the researchers based on the Roper, Logan, and Tierney model.

RESULTS

The prevalence of UI in women age 65 and older was 51.6%, and the most common type was urge incontinence. The number of births, number of abortions, age at last birth, and home births affected the development of UI (p<0.001). In addition, body mass index, constipation, urinary tract infection, cough, hormone replacement therapy, genital prolapse, cystocele, urogenital surgery, nocturia, and daily urine output were determined to be risk factors (p<0.001). Among the ADLs, 13.7% with UI reported that they had fallen when getting up from the toilet, 34.3% had experienced a sense of shame, 45.8% avoided coughing, and 46.5% restricted fluid intake.

CONCLUSION

Prevalence of UI in women age 65 and older was high, and the most common was urge incontinence. UI has many risk factors and affects many ADLs.

Birth-related, psychosocial, and emotional correlates of positive maternal-infant bonding in a cohort of first-time mothers

OBJECTIVE

to describe the development of a shortened 10-item version of the Postpartum Bonding Questionnaire (S-PBQ) and examine the relationship between birth-related, psychosocial, and emotional factors and maternal-infant bonding.

DESIGN

cross-sectional interview study.

SETTING

women having their first baby in Pennsylvania, USA.

PARTICIPANTS

we interviewed 3005 women in their third trimester and at one month post partum who were enroled in the First Baby Study.

MEASUREMENTS AND FINDINGS

for the S-PBQ, we completed factor analysis and examined instrument properties. We examined the relationship between birth-related, psychosocial, and emotional factors and maternal-infant bonding using adjusted linear regression models. The S-PBQ demonstrated acceptable internal reliability (Cronbach׳s α=0.67). Analysis revealed a socio-economic bias such that women who were older, more educated, not living in poverty, and married reported lower bonding scores. Maternal-infant bonding was significantly negatively correlated with maternal stress, maternal pain, and post partum depression, and positively correlated with partner support with the infant, and social support.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

For researchers who wish to measure maternal-infant bonding but are in need of a relatively short scale, the 10 item S-PBQ may be a useful alternative to the original version. However, it is important that researchers measuring maternal-infant bonding also investigate socio-economic bias in their studies and adjust for this effect as needed. Our results also indicate that clinicians should be aware of life stressors that may impact the maternal-infant relationship, in order that intervention may be provided to improved health outcomes for mothers, infants, and families.

Between suffering and hope: rehabilitation from urinary incontinence as an intervening component

This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.

State of the science of maternal-infant bonding: a principle-based concept analysis

OBJECTIVE

to provide a principle-based analysis of the concept of maternal-infant bonding.

DESIGN

principle-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES.

SETTING

literature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations.

MEASUREMENT AND FINDINGS

after a brief review of the history of maternal-infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal-infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal-infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated.

KEY CONCLUSION

despite widespread use of the concept, maternal-infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal-infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept.

IMPLICATIONS FOR PRACTICE

nurse midwives and other practitioners should use the theoretical definition of maternal-infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice.

Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial

OBJECTIVE

To evaluate the repair techniques of continuous and interrupted methods for episiotomy or perineal tears.

DESIGN

A randomised controlled trial.

SETTING

The Hospital Universitario Principe de Asturias, a state hospital belonging to the community of Madrid.

SAMPLE

Four hundred forty-five women who had undergone vaginal deliveries with episiotomies or second-grade tearing of the perineum between September 2005 and July 2007.

METHODS

One group was repaired with continuous, nonlocking sutures involving the vagina, perineum, and subcutaneous tissues. The other group had continuous, locking sutures of the vagina, interrupted sutures in the perineal muscles, and interrupted transcutaneous sutures. The threads used for stitching were identical in both groups.

MAIN OUTCOME MEASURES

The participants were questioned regarding the sensation of pain and the use of painkillers on the second and the tenth days, and 3 months postpartum.

RESULTS

When comparing the group with continuous suture to the group with interrupted sutures, the differences included less repair time (1 minute; P= 0.017) and less suture material used (relative risk [RR], 3.2, 95% CI: 2.6-4.0). The comparison of pain on the second and tenth days, and 3 months postpartum were not statistically different between the two techniques (RR, 1.08, 95% CI: 0.74-1.57; RR, 0.96, 95% CI: 0.59-1.55; and RR, 0.68, 95% CI: 0.19-2.46, respectively).

CONCLUSIONS

Although we did not demonstrate that one technique was better than the other in the incidence of pain in the short or long term, we showed that episiotomy and perineal tear repairs with continuous suturing were quicker and used less suture material without an increase in complication than interrupted suturing.

[What are the risk factors of anal incontinence after vaginal delivery?]

Fecal incontinence is one of the most feared complications of vaginal delivery. It may be the consequence of sphincter tears, of pudendal neuropathy, or of a combination of the two. Fecal incontinence occurs immediately following 13-54% of vaginal deliveries but its persistence in the mid and long term is poorly known. The incidence of perineal tear with anal sphincteric defect varies from 1-9% and the incidence of unrecognized sphincter injury may be as high as 18-35%. Half the women who undergo primary anal sphincter repair have short or long term continence problems. Pudendal neuropathy is caused by nerve stretch during pushing in the second stage of labor and descent of the fetal head; it may occur even with the first delivery. Risk factors for sphincter injury and pudendal neuropathy include forceps delivery, large neonatal size, and prolonged second stage of labor. The risk of fecal incontinence must be considered even during the first pregnancy. Routine episiotomy does not prevent sphincter injury and may even predispose to it. Pudendal neuropathy following delivery may lead to delayed fecal incontinence abetted by postmenopausal hormonal deficiency and tissue senescence. The possible benefit of early episiotomy for women at high risk of sphincter injury must be evaluated by prospective studies.

Challenges for the adoption of evidence-based maternity care in Turkey

Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs.

Episiotomy rates around the world: an update

Episiotomy, the unkindest cut of all, persists despite clinical practice guidelines recommending its restrictive use. The purpose of this paper was to compile international statistics on the use of this practice and examine whether current guidance on the restrictive use of episiotomy was being followed.

METHODS

We searched government websites and the Internet, contacted colleagues for references, and checked the references of retrieved citations.

RESULTS

Statistics from around the world revealed overall high rates of episiotomy with a decreasing trend in some countries. Considerable variation occurs in the use of the operation by country, within countries, and even within the same professional provider group.

CONCLUSIONS

Greater efforts are needed than currently in place to reduce the episiotomy rate, particularly in the developing world.