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ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 24-30

Effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing


Department of Nursing Service, Holy Spirit Hospital, Mumbai, Mahakali Caves Road, Maharashtra, India

Date of Web Publication2-Feb-2017

Correspondence Address:
Vevila Ronald Fernandes
D 302, Dheeraj Darshan, Opposite Kokan Hospital, MHADA, Jogeshwari East, Mumbai - 400 060, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-9727.199367

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  Abstract 

Background: Methods to provide comfort and relieve pain are of paramount importance for the child bearing woman. Unfortunately very little importance is given to reduce the pain and discomfort of the women during episiotomy suturing. Aim: The aim of the study was to assess the effectiveness of breast crawl on the intensity of episiotomy pain and behavioural response among women during episiotomy suturing. Method: A quasi experimental design with a sample size (N=40) were selected using purposive sampling technique. The data were obtained by using a baseline proforma for the mother, Visual Analogue Scale (VAS) and an observation checklist. Statistical analysis was done using SSPS. Results: Findings showed that the present study findings also revealed that there is a significant difference in the mean scores of behavioural response of mothers during suturing between the experimental and control group (t38= 2.042, P < 0.05). Also there is a significant difference in the mean scores of reduction in intensity of episiotomy pain of mothers during suturing between the experimental and control group (t38=2.042, P < 0.05). Hence breast crawl is effective in reducing the intensity of pain during episiotomy suturing and there is a favourable behavioural response among women who received breast crawl during episiotomy suturing. Conclusion: The findings concluded that breast crawl is a simple and cost effective method to reduce the intensity of episiotomy pain in women during episiotomy suturing. Nurses can in co operate this practice and thus initiate the bond of motherhood.

Keywords: Behavioral response, breast crawl, effectiveness, episiotomy suturing, intensity of episiotomy pain


How to cite this article:
Fernandes VR. Effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing. Muller J Med Sci Res 2017;8:24-30

How to cite this URL:
Fernandes VR. Effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing. Muller J Med Sci Res [serial online] 2017 [cited 2022 Jul 5];8:24-30. Available from: https://www.mjmsr.net/text.asp?2017/8/1/24/199367


  Introduction Top


Childbirth is a natural and universal phenomenon. Although labor is often thought of as one of the most painful events in human experience, supportive care is intended to ease a woman's anxiety and discomfort. A wide variety of pain relief measures, pharmacological and nonpharmacological are available for women in labor.

The pharmacological management for pain during episiotomy suturing is the administration of 10 ml of 2% lignocaine before the suturing. Many of nonpharmacological management can be used. Breast crawl is one of the methods to distract the mother from pain during episiotomy suturing. It is therefore imperative to study the effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing as a diversional therapy and a pain relief measure.

Need of the study and literature review

Breast crawl is the most natural, spontaneous, and logical method of initializing breastfeeding.[1] It is a simplest method that provides prolonged skin-to-skin contact and will culminate in first breastfeed.[2] It is easy, does not require elaborate preparations, can be done in any settings and is readily reproducible.[3] Breast crawl is evidence based and has been field tested. It is a critical component of infant and young child feeding.[4]

In 2007, a group of caregivers and community workers in Nandurbar district of Maharashtra witnessed a demonstration of newborn performing Breast crawl. After the demonstration, all were so impressed that they decided to make the method part of their routine. To advance this initiative, UNICEF has partnered with various state and public health institutions and is distributing an instructional film on breast crawl with specifics an each step.[5]

Many health personnel in maternity services is unaware of breast crawl, i.e. awareness of breast crawl is lacking. Few textbooks other than book by Dr. Klaus mentions this phenomenon. Unfortunately, breast crawl is not a part of standard medical or health curriculum.[6]

Widstorm et al(1987) who firstly described Breast Crawl at Karolinska Institute in Sweden, conducted studies on it. The findings in this study suggested that an organized feeding behavior develops in a predictable way during the first hours of life initially expressed only as spontaneous sucking and rooting movement, followed by hand-to-mouth activity and finally culminating in sucking of breast.[7]

Christenson et al. (1992) conducted a study to compare temperatures of newborns that were kept in skin-to-skin contact with their mothers in breast crawl position with those who were kept in cots in the first few hours after birth. They found that former had better body and skin temperature, higher blood glucose level, and rapid recovery from transient acidosis at birth.[8]

Moreover, maximum benefits of early initiation of breastfeeding are best achieved with breast crawl and to mention a few as it helps to keep the baby warm. It leads to faster and effective achievement of baby feeding skills.[9] It promotes better mother–infant bonding and reduces abandonment.[10] The baby starts getting colostrum as its first feed, and thus the gut starts getting colonized by bacterial flora from mother which helps in offering protection against infections, thus promoting optimal maturation of the gut and immune system.[10] Early breastfeeding helps uterine contraction, faster expulsion of placenta, reduces maternal bleeding, and prevents anemia. It enhances successful early and long-term breastfeeding. It promotes better blood glucose levels and other biochemical parameters in first hours of birth. It boosts the development of the baby's nervous system [11] and offers appropriate acclimatization from intrauterine to extrauterine life.[12]

A study was conducted to assess the effectiveness of breast crawl as a diversional therapy for reduction of pain in primipara women, during episiotomy suturing in selected maternity hospitals of a metropolitan city. The findings of the study proved that breast crawl was effective as diversional therapy for reduction of pain in primipara women, during episiotomy suturing.[13]

During the clinical postings, the investigator noticed that almost all the mothers experience pain during episiotomy suturing. The investigator also found that different mothers responded differently to episiotomy suturing procedure due to various factors. Hence, it led to the investigator to find the effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing.

Objectives of the study

  1. To assess the intensity of episiotomy pain before episiotomy suturing in experimental and control group
  2. To assess the intensity of episiotomy pain during episiotomy suturing in experimental and control group
  3. To assess the behavioral response during episiotomy suturing in experimental and control group
  4. To compare the effectiveness of breast crawl in experimental and control group
  5. To find the association of the intensity of episiotomy pain with selected maternal demographic variables
  6. To find the association of the behavioral response with selected maternal demographic variables.


Hypotheses

Hypothesis will be tested at 0.05 level of significance.

  • H1: There will be a significant difference in the mean scores of intensity of episiotomy pain of women during episiotomy suturing between the experimental and control group
  • H2: There will be a significant difference in the mean scores of behavioral responses of women during episiotomy suturing between the experimental and control group
  • H3: There will be a significant association of the intensity of episiotomy pain of women during episiotomy suturing with the selected maternal demographic variables
  • H4: There will be a significant association of the behavioral response of women during episiotomy suturing with the selected maternal demographic variables.



  Methodology Top


Research approach

The research approach used for this study was experimental approach.

Research design

A quasi-experimental design research design was used. Posttest only control group design with experimental and control group which is a subtype of quasi-experimental design.

Setting of the study

The study was conducted at the Labor Room of Father Muller Medical College Hospital.

Population

All primiparous parturients with episiotomy wound who met the inclusion criteria admitted in the labor room of the selected hospital.

Sample and sampling technique

Purposive sampling was adopted to select a sample comprising forty primiparous parturients who fulfilled the sampling criteria.

  • Twenty mothers - experimental group (primiparous parturients who received breast crawl during episiotomy suturing)
  • Twenty mothers - control group (primiparous parturients who did not receive breast crawl during episiotomy suturing).


Criteria for sample selection

Inclusion criteria

  1. Parturients who are primipara
  2. Primiparous parturients who:

    • Have delivered full-term newborn by normal vaginal delivery
    • Have their newborns with them
    • Themselves and their newborn are without complications
    • Know either English or Kannada well.




Exclusion criteria

  1. Primiparous parturients

    • Who have medical or surgical disorders
    • Delivered by instrumental delivery
    • With perineal tear
    • Who are not willing for breast crawl.


  2. Newborns

    • With high-risk conditions such as convulsion, hypoglycemia, and asphyxia
    • Who have delivered by the cesarean section
    • That has an Apgar score below 9.


Data collection instrument

  1. Interview technique was used to collect information on demographic data which consisted of seven items
  2. Numerical pain scale assessed the pain prior and during episiotomy suturing
  3. Observation checklist was used to assess the behavioral response of women during episiotomy suturing.


Data collection process

Formal written permission was obtained from the concerned authorities to conduct the research study in the labor room of the selected hospital. The head of department, the postgraduate medical students, labor room in charge, and staff nurses of labor room were intimated. The purpose of the study and time required to respond to the items were explained to the participants. They were also assured of the confidentiality of the information. Informed consent was obtained from the respondents indicating their willingness to participate in the study. Participants who fulfilled the sampling criteria were selected. Breast crawl was given to twenty primiparous parturients in the experimental group. Information was collected using baseline pro forma, the numerical pain scale to assess the intensity of episiotomy pain prior and during episiotomy suturing, and observation checklist to assess the behavioral response during breast crawl and episiotomy suturing. The collected data were compiled for analysis.


  Results Top


Section I: Description of demographic variables

  • Most of the women (55%) were of the age group 23–27 years in both experimental and control group. None of them were of the age group >37 years. The age of the youngest and the eldest woman who received breast crawl was 18 years and 33 years, respectively
  • Majority (45%) of the women from the control group had secondary education and about 40% of the women from the control group had no formal education
  • More than half (70%) of women in the experimental group and 45% of women in the control group were Muslims. About 30% of women in the both groups were Hindus
  • Majority (90%) of the women from the control group were from the rural area, and a very few 2 (10%) from control group were from urban area
  • None of the women both from control and experimental groups had prior knowledge regarding breast crawl
  • Majority (70%) of the women in the control group and 60% in the experimental group were administered 0–3 ml of lignocaine for episiotomy suturing [Table 1].
Table 1: Frequency and percentage distribution of women of experimental group and control group according to baseline characteristics (n=40)

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Section II: Intensity of episiotomy pain of women prior to episiotomy suturing in experimental and control group

The study findings revealed that majority of participants (80%) in the control group and 70% in experimental group had mild pain, 60% in the control group and 20% in experimental group had moderate pain before episiotomy suturing. None of the women had no pain or severe pain [Table 2].
Table 2: Frequency and percentage distribution of women showing the intensity of episiotomy pain prior to breast crawl and episiotomy suturing of experimental and control group (n=40)

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Section III: Intensity of episiotomy pain of women during episiotomy suturing in experimental and control group

The study findings revealed that 20% in the control group and 40% in experimental group had mild pain, 35% in the control group and 60% in experimental group had moderate pain. Forty-five percent in control group had severe pain during episiotomy suturing. None in the experimental group had severe pain [Table 3].
Table 3: Frequency and percentage distribution of women showing the intensity of episiotomy pain during breast crawl and episiotomy suturing of experimental and control group (n=40)

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Section IV: Behavioral response of women during episiotomy suturing in experimental and control group

Only one (5%) woman in control group and 14 (70%) in experimental group had a favorable response and 12 (60%) in control group and 6 (30%) in experimental group had satisfactory responses and 7 (35%) in control group had unfavorable response. None in the experimental group had unfavorable responses [Table 4].
Table 4: Frequency and percentage distribution of women showing the behavioral responses during breast crawl and episiotomy suturing in experimental and control group (n=40)

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Section V: Comparison of effectiveness of breast crawl among women during episiotomy suturing in experimental and control group

The data in [Table 5] reveal that there is a significant difference in the mean scores of reduction in intensity of episiotomy pain of mothers during suturing between the experimental and control group (t > 2.042). Hence, alternate hypothesis is accepted, and null hypothesis is rejected and can be concluded that breast crawl is effective in reducing the intensity of pain during episiotomy suturing.
Table 5: Comparison of scores of intensity of pain during breast crawl and episiotomy suturing in experimental and control group (n=40)

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The data in [Table 6] reveal that there is a significant difference in the mean scores of behavioral response of mothers during suturing between the experimental and control group (t > 2.042). Hence, alternate hypothesis is accepted, and null hypothesis is rejected, and it can be concluded that there is a favorable behavioral response among women who received breast crawl during episiotomy suturing.
Table 6: Comparison of scores on behavioral responses of the women during breast crawl and episiotomy suturing in experimental and control group (n=40)

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Section VI: Association of the intensity of episiotomy pain of women during episiotomy suturing with the selected baseline variables

The findings in [Table 7] revealed that Fisher's exact test used to compute an association of the intensity of episiotomy pain of women during episiotomy suturing with the selected baseline variables is more than table value at 0.05 level of significance. Hence, the null hypothesis was accepted, and research hypothesis was rejected, and it can be concluded that there is no association of the intensity of episiotomy pain during episiotomy suturing and selected baseline variables in experimental group.
Table 7: Fisher's exact test showing association of the intensity of episiotomy pain of women during episiotomy suturing with selected baseline variables (n=40)

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Section VII: Association of the behavioral response of women during episiotomy suturing with the selected baseline variables

The findings of [Table 8] revealed that Fisher's exact test used to compute an association of the behavioral response of women during episiotomy suturing with the selected baseline variable is more than 0.05. Hence, the null hypothesis was rejected, and research hypothesis was accepted, and it was concluded that there is no association of the behavioral response of mothers during episiotomy suturing and selected baseline variables.
Table 8: Fisher's exact test showing association of the behavioral response of women during episiotomy suturing with selected baseline variables (n=40)

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  Discussion Top


The study findings revealed that there is a significant difference in the mean scores of reduction in intensity of episiotomy pain of mothers during suturing between the experimental and control group (t > 2.042). Hence, can be concluded that breast crawl is effective in reducing the intensity of pain during episiotomy suturing.

The findings are supported by a study conducted to assess the effectiveness of breast crawl as a diversional therapy for reduction of pain in primipara women, during episiotomy suturing in selected maternity hospitals of a metropolitan city. The mean score obtained in the experimental group before episiotomy suturing was 6.2 and during suturing with breast crawl intervention was 2.72 with a mean difference of 3.48 which shows a significant difference in reduction of pain. Furthermore, the comparison between the mean scores of experimental group during episiotomy suturing which was 2.72 and control group which was 6.80 with a mean difference of −4.08 shows that the data are extremely significant at P < 0.0001 level of significance. The findings of the study proved that breast crawl was effective as a diversional therapy for reduction of pain in primipara women, during episiotomy suturing.[13]

The present study findings also revealed that there is a significant difference in the mean scores of behavioral response of mothers during suturing between the experimental and control group (t > 2.042). Hence, it can be concluded that there is a favorable behavioral response among women who received breast crawl during episiotomy suturing.

The findings of the study are supported by a study conducted to assess the effectiveness of transcutaneous electric nerve stimulation on pain and behavioral responses of women during the first stage of labor. Friedman's test was used to test the significant difference among area wise behavioral responses score during the first stage of labor. The results showed that there is a significant difference between the area wise behavioral responses in experimental and control group.[14]


  Conclusion Top


Nurses in the labor room can practice breast crawl effectively and efficiently as a technique on the basis of maternal comfort during episiotomy suturing. Nurse educators can update the nursing personnel at the birthing units on benefits of early skin-to-skin contact for the infant and its influence on the physical and mental growth and development.

The bonding benefit of breast crawl can be a useful nonpharmacological measure in providing diversion to the mother during episiotomy suturing. Nurses as health professionals can bring forth and promote breast crawl initiative into maternity hospitals, it will be beneficial for mother and baby as well as for the entire family and country.[15] The investigator therefore takes this study to educate and motivate the antenatal mothers for practicing this initiative which will be in turn contributing to healthy children and thereby healthy future citizens of our country.

Acknowledgment

My heart overflows with gratitude to Lord Almighty for bestowing his grace and blessings upon me that led me easily throughout my study.

I, the investigator of the study, owe my sincere thanks and gratitude to all those who have contributed to the successful accomplishment of this endeavor.

“A thankful heart is not only the greatest virtue but also the parent of all other virtues.” The investigator expresses sincere gratitude to her mentor, Rev. Angeline (Sr. Aileen) Mathias, Professor, Father Muller College of Nursing, for her sincere guidance and encouragement. Her whole-hearted approach, intellectual vigor, her concern, and constructive criticism were the catalyst in the creation of this magnificent thesis. I remain really indebted to her for making my research experience successful, enriching, and rewarding.

I am pleased to extend my sincere thanks to Ms. Darryl Aranha, Nursing Superintendent, for her zealous guidance, suggestions, and constant encouragement to make this attempt a successful learning experience.

I owe my gratitude to Rev. Fr. Patrick Rodrigues, Director, Father Muller Charitable Institutions and Rev. Fr. Denis D'sa, former Administrator, Father Muller College of Nursing, for their goodwill and prayerful blessings. Rev. Fr. Richard Coelho, Administrator (FMMCH), for granting me the permission for conducting my study in Father Muller Hospital.

My heart overwhelms with a deep sense of gratitude to Rev. Sr. Winnifred D'Souza, Principal, Father Muller College of Nursing, for the prudent and timely advice and significant contributions made directly or indirectly.

I am equally thankful to Mrs. Victoria D'Almeida, Vice Principal, Father Muller College of Nursing, for her thoughtfulness and contributions made in the preparation of this research study.

I am very grateful to our research coordinator Mrs. Bridget D'Silva for her timely guidance and untiring help rendered throughout my study.

I owe a very special debt to Mrs. Irene Alvares, P.G. coordinator, Professor, and HOD, Department of Community Health Nursing, for the privileged inspiration I have drawn from her and for her thoughtfulness and timely help which was most valuable throughout the study.

Also my words of sincere gratitude to Mrs. Savitha coutinho, Professor and HOD of Obstetrics and Gynaecological Nursing, for her inspiring advice and contributions to this work.

I am indebted to the teaching faculty of Father Muller College of Nursing, especially to all the PG teachers for their timely support and guidance.

I express my heartfelt gratitude to Mrs. Alphilin, Lecturer, and all the staff, Department of Obstetrics and Gynaecological Nursing, Father Muller College of Nursing, for their timely support, valuable suggestions, and guidance throughout the study.

Staff in charge, nursing staff, and postgraduate medical students of labor room and maternity ward for their cooperation and help throughout the study.

My sincere thanks and appreciation to Mrs. Sucharitha Suresh, Statistician, Father Muller Charitable Institutions, for her expert guidance and tireless help.

I express my thanks to the experts for their valuable judgments, constructive recommendations, and enlightening suggestions while validating the tool.

I am extremely grateful to all the participants of the study, for their whole-hearted help and cooperation because of whom the study was made possible.

My sincere thanks to Sangeetha Bharathraj for editing the manuscript meticulously.

My sincere thanks to all my classmates who have directly or indirectly helped in the successful completion of this study.

Special thanks to A1 solutions for Xerox and binding of the materials with much valued skills.

I gratefully acknowledge the generosity of the authorities of Father Muller Medical College Library, for permitting me to utilize the library facilities.

My whole hearted thanks to my parents, for their constant prayers and support. They have made this endeavor possible through their love, patience, and concern.

With heartfelt and everlasting gratitude.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.[17]

 
  References Top

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ILCA. Clinical Guidelines for the Establishment of Exclusive Breastfeeding. International Lactation Consultant Association's Revision Task Force. Available from: http://www.breast feeding.com. [Last cited on 2013 Aug 12].  Back to cited text no. 12
    
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Varendi H, et al. Breast Odour as the only Maternal Stimulus elicits Crawling Towards the Odour Source. Acta Pediatrica. 2001;90:372-375. Available from: www.ncbi.nlm.nih.gov/pubmed/11332925. [Last cited on 2012 Sep 4].  Back to cited text no. 13
    
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Lily CD. A Study to Assess the Effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) Application on Pain and Behavioural Responses of Primigravid Women During theFirst Stage of Labour, [M. Sc. Thesis]. Father Muller Medical College Hospital, Mangalore. Rajiv Gandhi University of Health Sciences, Bangalore.  Back to cited text no. 14
    
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Gangal P. Initiation of Breast Feeding by Breast Crawl. Harish Enterprises: UNICEF Maharashtra. Available from: http://www.breast crawl.org. [Lats cited on 2012 Sep 4].  Back to cited text no. 15
    
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Polit DF, Hungler BP. Nursing research principles and methods. Philadelphia: JB Lippincott Company; 1999. Available from: https://books.google.co.in/books/about/Nursing_Research.html. [Last cited on 2013 Aug 14].  Back to cited text no. 16
    
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Kothari CR. Research methodology: Methods and techniques. 2nd ed. New Delhi: New Age International Publishers; 2004. Available from: https://books.google.co.in/books/about/Research_Methodology.html. [Last cited on 2013 Aug 14].  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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