JOURNAL ANALYSIS

GIVING SITZ BATH WARM WATER TO REDUCE

EPISIOTOMY PAIN LEVELS IN POSTPARTUM
MOthers

Theresia Anindita Putri Wardani

202031041
background
Sitz bath is a sitting soak that functions to
increase the circulation of the local area
(immersion area) which is done specifically on
the perineum in warm or cold water.
Warm therapy also has an effect on the nervous
system because it causes pain to be obstructed by the
sensation of temperature so that it has a suppressive
effect or pain reduction.
Based on the Nursing Interventions Classification (NIC), one of the nursing
actions with a nursing diagnosis of infection risk is non-pharmacological therapy
with warm water sitz baths to reduce pain levels and accelerate the healing of
postpartum maternal perineal wounds with post episiotomy.
Research problem
Knowing the effectiveness of sitz bath applications in reducing the
level of episiotomy pain in postpartum mothers

Research hypothesis
The research hypothesis is not mentioned in the journal

Method Quantitative

Research DESIGN

This research is a Quasi Experimental study with a pretest and posttest

control group design
POPULATION
All postpartum mothers in the postpartum ward at the Taluk Nedumangadu
Government Hospital..
SAMPLE
Amount : 60 patients
Inclusion criteria:
Not mentioned in the journal
Exclusion criteria:
Not mentioned in the journal.

Sampling technique:
This research used purposive sampling technique
intervention

• This study was divided into two groups, namely the intervention group and the
control group
• In the intervention group, postpartum mothers were given a sitz bath, asking
respondents to go to the toilet to urinate, wash the perineal area and remove
sanitary napkins and instructed not to wear panty. Then the perineum / pelvis and
buttocks of the subject were immersed in a large basin containing 4 liters of
warm water at 38-410C for 20 minutes. After the sitz bath is done, the perineal
wound and its surroundings should be dried using a soft towel or sterile gauze.
Then do a post test using a numerical rating scale
• The control group is still monitored, after 20 minutes a posttest is carried out
using a numerical rating scale.
• This research was conducted for 1 month.
The data that has been obtained are then analyzed
Statistical test
using the paired T test. The results obtained data p-
value <0.001.
Research result
1. The presentation of the research results is based on the statistical tests used
Table 1. Mean, Standard Deviation, and t value before being given the sitz
bath intervention and after being given the sitz bath intervention in the control
group and the intervention group.
From this study in table 1. The mean, standard deviation and t value
of the two groups are known. In the experimental group the average
pretest pain score was 5.2 and the posttest average score was 2.3. In
the control group the average pretest score of pain was 5.9 and the
average posttest score was 6.3. Then the paired T test was carried out
and it was found that the score was very significant with a p value
<0.001.
Conclusion of resulth

Based on the results of statistical tests, there was a significant effect of the
application of the sitz bath on episotomy pain. The results of this study
indicate the severity of episiotomy pain in the intervention group is lower
than the control group with p value <0.01.
Research Discussion
RESEARCH LIMITATIONS
Not mentioned in the journal

GENERAL CONCLUSIONS AND DETAILED DISCUSSION

The results showed that there was a significant effect of the

application of the sitz bath on episiotomy pain. Episiotomy
can reduce the mother's urges during labor and can reduce
trauma to the vaginal tissue and speed up labor.
Episiotomy and tears can cause pain, swelling and
inflammation. This can be reduced by using warm water
with a sitz bath action.
This application of the sitz bath has proven to be beneficial for
healing therapy. Treatment that uses water is known as water
therapy or can be called hydrotherapy. Sitz bath is a sitting soak
that functions to increase the circulation of the local area
(immersion area) which is done specifically on the perineum in
warm water. This action also helps relax the muscles. The effect of
warmth on the skin, especially the external genetalia area, causes a
sensation of temperature at the nerve ending on the skin surface.
ANALYSIS OF RESEARCH RESULTS AND
RELEVANCE

The postpartum period is the period after delivery of the placenta until the
reproductive organs recover as before pregnancy and normally the postpartum
period lasts for 6 weeks. Things that are often experienced by postpartum mothers
and cause pain in the postpartum period are injuries to the perineum that occur
during childbirth. In labor, an episiotomy is often performed to control perineal
tearing so that it makes it easier to heal the wound because it is easier to sew and put
back together. Wounds in post episiotomy if not treated properly will cause physical
and psychological complications. Pain is one of the complications due to episiotomy
which can affect the mother's psychology. Pain can be controlled in 2 ways, namely
pharmacological and non-pharmacological.
One example of non-pharmacological therapy is the hydrotherapy sitz bath.
Sitz bath is a sitting soak that functions to increase the circulation of the
local area (immersion area) which is carried out on the perineum in warm
water. Warm therapy has a "crowding process" effect on the nervous
system because pain is inhibited by the sensation of temperature received
by the nerve endings, thereby providing a suppressive or pain reduction
effect. The warm water sitz bath is a pain management that can be applied
to help comfort postpartum mothers to reduce pain and increase blood flow
to the episiotomy so that healing is faster.
Based on research conducted by Annie Verghese, Ribie and D, Malathi in 2016 which
stated that the episiotomy pain severity in the experimental group was lower than the
control group p <0.01 so that there was a significant effect on episiotomy pain.

This study is also in line with research conducted by Amandeep et al. In 2015 stated
that the application of the sitz bath experienced a significant increase (p = 0.001) in
episiotomy wound healing because the average score of episiotomy wound healing
decreased from 8.26 ± 2.03 to 2.70 ± 0.65 in the experimental group and 7.73 ± 1.61
to 3.233 ± 1.47 in the control group. In the experimental group given sitz baths had a
greater change in the mean score of episiotomy pain and wound healing on days 1, 2
and 3 after the intervention.

Another study conducted by Jyoti Kapoor in 2018 said that the application of a sitz
bath was effective in relieving episiotomy pain and improving wound healing with a
significance value (p = 0.001).
THE RELATIONSHIP BETWEEN RESEARCH RESULTS
AND MANAGED CASES
In the journal, it was found that the sitz bath performed on postpartum mothers who experienced post-
episiotomy pain for 1 month of treatment, this sitz bath treatment performed once a day for 20 minutes
was proven to be effective in reducing post episiotomy pain and wound healing in clients with perineal
sutures. In the managed case, it was a postpartum mother on day 1 with obstetric status G1P1A0.
Currently the patient complains of pain in the episiotomy wound, the wound is not reddish, is not
swollen and the patient complains of mules in his stomach. From the physical examination, it was
found that the conjunctiva was pale, TFU 1 finger below the center, uterus felt hard, vaginal discharge
1 cot for 3 hours, dark red color and fishy smell. It is hoped that if someone who experiences this can
be given non-pharmacological therapeutic interventions using warm water sitz baths it will reduce pain
intensity, pain, peace of mind and overall maternal satisfaction. This sitz bath is a non-pharmacological
therapy that is safe, economical, free from side effects, and provides long-lasting healing.
SUGGESTIONS OR FOLLOW-
UP
Hopefully it can be given to postpartum mothers with post-episiotomy pain. This
sitz bath can be used as an alternative treatment for post-episiotomy postpartum
mothers. For further researchers, further research can be carried out in improving
non-pharmacological therapy to reduce the intensity of post-episiotomy
postpartum pain by applying warm water sitz baths.

RECOMMENDATIONS THAT NURSING

STUDENTS
It is hoped that health nursing students will increase information about non-
pharmacological therapies using sitz baths to help manage post-episiotomy
postpartum pain.
THANK YOU