Healing of the perineum, a follow-up study

A study was undertaken over a five and one-half month period in a 21 bed post partum unit of 276 bed general teaching hospital to evaluate postpartum perineal healing after delivery of a single fetus in vertex presentation over a mid line episiotomy. A tool from the Davidson study (1970) was improved upon and used to evaluate healing. Factors of redness, edema, ecchymosis, discharge from the wound, and approximation of the perineal tissues were used, thus the tool became known as the REEDA tool of evaluation. A comfort evaluation tool was implemented for the mothers to assess their own comfort after use of a randomly assigned comfort measure (e.g., shower, perineal light, sitz bath). The mothers were free to choose when and how many times to use the comfort method. Minimal perineal and shower hygiene instructions were given each mother. The researcher and 4 assistants, whose inter-rater reliability reached the 95% significance level, made daily morning rounds to evaluate the perineal REEDA healing score and answer questions raised by the mother. A home visit was scheduled with each woman for the 14th to 16th day of the post partum period. The first and second post partum day healing scores were obtained for all mothers. Analysis of variance showed that the healing scores during the first two post partum days were not significantly different between the group's studies or between the days. Interaction of the days with healing scores of primiparae and multiparae was significantly different at the .05 level. The primiparae REEDA scores were generally lower for day 1 and 2. Correlations showed no significant difference between the estimated blood loss at delivery and the healing scores of between the third postpartum day hematocrit and healing scores. The correlations of the REEDA healing score on day 1 with the weight of the baby in grams was significant (P < .01). Mothers who delivered heavier babies generally had higher REEDA scores indicating a higher response to tissue trauma. Perineal healing was evaluated during the home visit. All except one mother rated her episiotomy as comfortable at that time. During the home visit the researcher was available as a health resource person. It can be concluded the perineal healing scores and episiotomy comfort assessments are no different between mothers matched for primiparity or multiparity using the shower only, the perineal light, or the sitz-bath. Primiparae and multiparae REEDA healing scores are significantly different. Healing scores of both are significantly correlated with the baby's weight in grams. Estimated blood loss and third day hematocrits were not significantly correlated with the REEDA healing scores. Home visits were seen as beneficial to the new parents who used the researcher as a health resource person to answer questions and concerns on many topics.