الفهرس 
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Abstract
Postnatal period is a critical phase in the life of mothers and newborn babies. Major changes occur during this period which determine the well-being of mothers and newborns. This period starts from the time following delivery of the placenta until the woman’s body and reproductive organs return to normal pre-pregnant state. It is a crucial period of caring for mothers, especially those who had undergone episiotomy. Episiotomy is strongly associated with perineal pain a stressful factor for postpartum mothers during the first few postpartum days which interferes with their ability of nursing and doing their duties.
Postnatal care has proved to be more cost-effective care in reducing maternal morbidity and mortality than antenatal care and intrapartum care. During the postnatal period variety of intervention aid in relieving perineal pain and improving episiotomy healing includes cleanliness, prevention of infection, exercise and nutritional diet reduce the discomfort and allow the woman to take care of herself and her baby.
This study aimed to:
Determine the effect of perineal self care instructions on episiotomy pain and healing among postpartum women.
To fulfill the study aim the study was conducted at the postpartum unit in obstetrics and gynecology department of Abou Homos general hospital, Albehera Governorate. 80 postpartum women were divided into two group (study and control). They were selected from the previously mentioned setting.
A Pilot study:
After the development of the tools, a pilot study was conducted on 8 women excluded from the study subjects the pilot study revealed that the sentences of the tool were clear and relevant, but few words have been modified.
Tools used in this study:
Three tools were used for data collection Tool I: Socio-demographic and clinical data structured interview schedule, Tool II: Pain intensity visual analogue scale (VAS), and Tool III: The standardized REEDA scale.
• Collection of data covered a period of 8 months from first January to end of august 2016.
• Data of tool I was collected from both groups through an interview schedule, which was conducted individually and in total privacy.
• Each study subject was interviewed 5-10 minutes during immediately postpartum period, women were assigned to control group and study group.
• The control group was received the routine hospital care provided by hospital personnel, assessment of episiotomy pain and healing immediately postpartum, then after 48 hours at home and after 7 days at home using Tool II and Tool III.
• The study group was instructed immediately postpartum to apply perineal self care instructions through individualized educational session, the researcher was demonstrated for each woman how to do perineal self care, and it was followed by re demonstrations and discussions. after 48 hours home visit was done to assess the intensity of perineal pain using VAS (tool II) and degree of episiotomy healing using REEDA scale (tool III), to compared it with the previous observation done immediately postpartum also instructed the woman to prepare the equipment she used to make perineal self care and re demonstrated perineal self care as mentioned before at hospital. after 7 days postpartum the second home visit was done to assess the intensity of perineal pain using VAS (tool II) and degree of episiotomy healing using REEDA scale (tool III) to compared it with the previous observation done immediately postpartum and at 48 hours postpartum.
The main findings of the present study were:
1. Subject’s general characteristics
- It was observed that the majority of the control (90%) and study (85%) groups were aging from 20 to less than 30 years. Less than three-quarters (72.5%) of the control group and more than two-thirds (67.5%) of the study group were illiterate or have basic education. The majority of the control (80%) and study (87.5%) groups were housewives. More than three- fifths of the control (67.5%) and study (60%) groups were from rural area.
- More than three-fifths (62.5%) of control group were primigravida, while slightly less than two-fifths (37.5%) of them had 2-3 pregnancies compared to the majority (82.5%) of the study group were primigravida, while only 17.5% of them had 2-3 pregnancies.
- Slightly more than one- third (37.5%) of control group had 1or2 abortion, while more than three-fifths (62.5%) of them had no history of abortion compared to only 17.5% of study group had 1 or 2 abortion, while the majority (82.5%) of them had no history of abortion.
- Majority of the control (85%) and study (95%) groups had 4 or more antenatal visits.
- Three-quarters (75%) of control group didn’t received antenatal health education about perineal care while, one- quarter (25%) of them received antenatal health education about perineal care compared to Three-fifths (60%) of study group didn’t received antenatal health education about perineal care while, two-fifths (40%) of them received antenatal health education about perineal care.
2. Knowledge about episiotomy
- Concerning the total score of knowledge about episiotomy, it was found that one-half and one-third of the study and control groups, respectively had poor knowledge regarding episiotomy care compared to nearly one-half of the study group and three-fifths of the control group had fair knowledge, while only 5% and 2.5% of the control and study group had good knowledge about episiotomy care.
3. Intensity of perineal pain.
- There was a statistically significant difference between both groups at 48 hours (p = 0.005) and 7th postpartum day (MCp < 0.001) as regards intensity of episiotomy pain.
- After 48 hours postpartum, more than one-fifth (22.5%) of control group compared to one-half (50%) of the study group had moderate episiotomy pain. Moreover, severe episiotomy pain was observed only among 12.5% of the control group.
- After 7 days postpartum, it was observed that about three- quarters (72.5%) of the study group had mild episiotomy pain compared to only 15% of control group. While, only 17.5% of the study group had moderate episiotomy pain compared to three-fifths (60%) of control group. Only one-tenth (10%) of the study group had severe episiotomy pain compared to one-quarter (25%) of control group.
4. Healing about episiotomy wound.
- As regard redness of episiotomy, it was observed that after 48 hours postpartum, two-fifths (40%) of the control group compared to more than one-quarter (27.5%) of study group had moderate redness around the bilateral sides of episiotomy incision area.
- Meanwhile, after 7 days postpartum, more than two-fifths (45%) of control group had moderate redness of perineal area compared to only7.5% of the study group. More than one-third (35%) of the control group had severe redness of perineal area compared to only 2.5% of the study group.
- Concerning edema of episiotomy wound, it was found that after 48 hours postnatal, more than one-quarter (27.5%) of the study group show no signs of edema of episiotomy wound compared to only 2.5 % of control group. Sizable proportions (27.5%, 25%) of the control and study groups were observed to have moderate perineal edema. Severe perineal edema was observed among more than one-quarter (27.5%) of the control group only.
- While after 7 days postpartum, perineal edema was absent among 30% from the study group. More than one-half (55%) of the control group was observed with moderate edema in the perineal area compared to 15% from the study group. where severe edema in perineal area, was observed among 32.5% of control group compared to only 5% of study group.
- As regards episiotomy wound discharge, it was found that after 7 days postpartum only one-tenth (10%) of control group had no type of discharge from episiotomy sutures compared to near two-fifths (37.5%) of study group. Sizable proportions (45% and 42.5%) of the study and control groups had serum discharge from episiotomy wound. While, more than two-fifths (42.5%) of the control group compared to 17.5% of the study group was observed with serosanguinous discharge from episiotomy wound. Purulent discharges from episiotomy wound incision, was observed among only 2.5% of the control group.
- Regarding approximation After 7 days postpartum, more than one-third 35% of the control group had closed episiotomy suture line compared to near one-half (47.5%) from the study group. While, 17.5% from the control group had slight skin edge separation of episiotomy wound compared to 45% from the study group. More than two-fifths (45%) of the control group had skin and subcutaneous fat separation of episiotomy wound compared to only 7.5% from the study group.
Recommendations
• All governmental hospitals should provide adequately planned in -service training programs for the maternity nurses regarding the benefits of perineal self care instructions for all postnatal women in order to develop their best practice.
• The nursing curriculum should be revised and updated to include perineal self care instructions.
• Women must be informed and guided during their prenatal care concerning the episiotomy’s procedure.
• Health professionals must be properly trained and updated regarding guidelines based on evidence, with the aim of contributing with the decrease in unnecessary rates of episiotomy, and its harmful consequences to women’s physical and psychic health.