Introduction: 

Episiotomy is a surgical procedure commonly performed during childbirth, involving an incision in the perineum to widen the vaginal opening and facilitate delivery. Postpartum women who undergo episiotomy require effective wound care to prevent complications and promote healing.

Among the methods suggested for improving episiotomy wound healing, breast milk application has gained attention due to its antimicrobial, anti-inflammatory, and healing properties. Breast milk is known to contain numerous bioactive compounds such as immunoglobulins, lactoferrin, and lysozymes, which are believed to help reduce infection and promote tissue repair.

On the other hand, sitz bath have long been recommended as a soothing treatment to alleviate perineal discomfort, reduce swelling, and promote hygiene following childbirth

A sitz bath, where the perineum is immersed in warm water, is thought to improve blood circulation to the area, reduce pain, and assist in wound healing. Sitz baths are known to help maintain proper hygiene, which is crucial for preventing infection in the postpartum period

Need:

Episiotomy is a common surgical intervention performed during childbirth to prevent severe perineal tears, but the healing of the wound remains a critical concern for postpartum recovery. Poor wound healing or complications such as infection, pain, and delayed recovery can significantly affect the health and well-being of new mothers. Traditionally, episiotomy wound care has focused on antiseptic applications, analgesics, and suturing. However, these conventional methods do not always adequately address the need for accelerated wound healing, infection prevention, and pain management. This gap in care has led to increasing interest in alternative and complementary approaches, especially natural and accessible remedies. Two such interventions breast milk application and sitz bath have been identified as potential low-cost, non-invasive methods to promote wound healing, alleviate pain, and reduce the risk of infection

Review of literature:

1.      Patel A, Makwana et al. (2022) conducted a quasi-experimental study to assess the effect of Topical Application of Breast Milk on Episiotomy Wound Healing. Sample size was 40 post natal mothers from selected health centers of Central Gujarat, India. Pretest posttest design was used.  Intervention of topical application of breast milk was offered two times a day for seven continuous days in experimental group and routine care was provided to participants in control group. Data was collected using Redness, Edema, Ecchymosis, Discharge and Approximation (REEDA) scale on 1st, 3rd, 5th and 7th day. The result showed that the experimental group’s episiotomy wound healing significantly improved (before: 14.75±0.55, after: 4.55±1.32) as compared to the control group (before: 14.65±0.59, after: 9.35±1.46). The study concluded that here was a significant gradual healing of episiotomy wound after the use of breast milk topically in postpartum women. This also indicates that human breast milk can be an alternative strategy for accelerating episiotomy wound healing process

2.      Rani K., Kumar P. et al (2021) conducted an Observational Study to compare sitz bath and alternative treatments for episiotomy wound healing. Sample size was 100 participants who had undergone episiotomy from a maternity ward in Bhopal, Madhya Pradesh, India. Purposive sampling was used to select participants who had undergone episiotomy within 48 hours and were assigned randomly to either treatment group. Data was collected using the REEDA scale and pain scores measured via a 10-point scale were recorded daily. Infection rates were tracked with microbiological swabs. The result showed that the sitz bath group had a mean healing time of 9.7 days (SD = 2.3), while the control group had a mean of 14.3 days (SD = 2.8). The sitz bath group had a pain score of 3.6 (VAS), while the control group had a pain score of 5.9 (VAS). The study concluded that the sitz bath group had faster healing, reduced redness, and lower infection rates compared to the ointment group.

Problem statement

A comparative study to assess the effectiveness of breast milk application versus sitz bath on episiotomy wound healing among post natal mothers in selected community areas of Punjab

Objectives

·        To assess episiotomy wound healing among post natal mothers in both experimental group and comparison group.

·        To compare the effectiveness of breast milk application on episiotomy wound healing among post natal mothers in experimental group and comparison group.

·        To compare the effectiveness of sitz bath on episiotomy wound healing among post natal mothers in experimental group and comparison group.

·        To compare the effectiveness of breast milk application versus sitz bath on episiotomy wound healing among post natal mothers in experimental group and comparison group.

·        To find out the association of episiotomy wound healing among post natal mothers with selected demographic variables in experimental group and comparison group

Hypothesis

Hypotheses will be tested at p< 0.05

H₁- There will be significant difference in the episiotomy wound healing among post natal mothers in the experimental group (receiving breast milk application) and comparison group.

H₂-There will be a significant difference in episiotomy wound healing among post natal mothers in the comparison group as compared to the experimental group

Methodology:

Research Approach: Quantitative Research .

Research Design: A Quasi experimental Research design.

Research Variables:

Dependent variables: Episiotomy wound healing

Independent variables: Breast milk application, Sitz bath

Target Population: Women admitted in selected Hospitals.

Sample size: Total 64 subject will be selected 32 in experiment group and 32 in comparison group by using Power Analysis.

Formula d= M1 – M2 / Spooled

Where : M1 = Mean of group 1

              M2 = Mean of group 2

             Spooled = pooled standard deviation for the two groups

Sample and Sampling techniques: Sample subjects will be post natal women , who will fulfil the inclusion criteria and the Sampling technique is convenience Sampling Technique .

Eligibility criteria:

Inclusion criteria: It includes:

·        Mothers who are within 24 to 48 hours post-delivery.

• Mothers who don’t have any underlying medical conditions that could interfere with wound healing.
• Mothers with an episiotomy wound (simple or intermediate).

Mothers who are willing to participate in the study

Exclusion criteria: It includes:

·       Mothers who have sustained a perineal tear.

·       Mothers who are diagnosed with any breast complications like mastitis and breast abscess.

·       Mothers who have known allergies or hypersensitivity reactions.

·       Mothers who are diagnosed with complications related to puerperium like puerperal sepsis, Post partum hemorrhage.

Method of data collection:

.Formal permission will be obtained from the community health centre after discussing the purposes and objectives of the study.

·   Participants meeting the inclusion and exclusion criteria will be selected.

·   A brief explanation about the purpose and objectives of the study will be provided, and informed consent will be taken after assuring the confidentiality of the study subject.

·   Participants will be randomly assigned to one of the two intervention groups: Group 1: Breast Milk Application, Group 2: Sitz Bath.

·   Group 1 (Breast Milk Application): Participants in this group will be instructed to express fresh breast milk and apply it to the episiotomy wound 2 times daily up to 7 postpartum days.

·   Group 2 (Sitz Bath): Participants in this group will be instructed to take sitz baths with warm water, possibly with an antiseptic solution, for 15-20 minutes, 2 times daily up to 7 postpartum days.

·   Appropriate water temperature (between 100°F to 105°F), duration, and frequency of the sitz bath should be ensured.

·   Wound healing assessment will be done using the standardized REEDA scale, checking for redness, edema, ecchymosis, discharge, and approximation of the wound edges during baseline data collection.

·   Follow-up data will be collected on Day 3, Day 5, and Day 7.

·   Day 3: Initial follow-up after intervention begins, mainly to monitor early effects and check for complications. If any signs of bacterial infection (Staphylococcus aureus, E. coli, Pseudomonas aeruginosa, and Streptococcus pyogenes) is observed during follow-up, the breast milk application will be immediately discontinued. The participant, will be referred to standard medical care as per clinical protocol.

·   Day 5: Midway follow-up to assess wound healing progress and any adverse effects.

·   Day 7: Final follow-up to assess the complete or near-complete wound healing and participant satisfaction