The Most Comfortable Posture at First Postnatal Day in Women With Episiotomy for Breastfeeding and Routine Activities

Background: Episiotomy is a common procedure in vaginal deliveries. It was thought that episiotomy reduces the risk of severe perineal injuries, but now in various studies it has been observed that it is associated with increased perineal pain, sexual problems, and incontinence in the postpartum period. Purpose: This study was carried out to assess pain score on first postnatal day in women with episiotomy during breastfeeding and daily activities. Method: The consecutive patients who underwent normal vaginal delivery with episiotomy from November 1, 2020 to December 1, 2020 in the Department of Obstetrics and Gynecology at Safdarjung Hospital were evaluated. The patients with vulval edema; vulval hematoma; instrumental delivery; and cervical, vaginal, and perineal tear were excluded from the study. The episiotomy pain during routine activities and breastfeeding was assessed at first postnatal day by Visual Analogue Scale (VAS) pain score. The analysis of variance (ANOVA) was used to compare the VAS score in different positions for breastfeeding and routine activities. The most comfortable posture was with lowest VAS pain score. Results and conclusion: Overall 73 patients were enrolled in the study, mean age was 23.48 ± 2.49 years, 47/73 (64.38%) were primigravida, and mean birth weight of neonate was 2.79 ± 0.43 kg. The mean VAS pain score during breastfeeding in crossed-leg position was 74.82 ± 28.33, and in left lateral position, the score was 14.51 ± 11.65 (p [U1] = 0.0001). The mean VAS pain score during resting position in sitting with leg down was 56.52 ± 21.23, and in left lateral position, the score was 21.25 ± 13.95 (p= 0.0001). The VAS score was increased as the birth weight (p= 0.302), and the duration of second stage of labor was increased (p = 0.047). The severe pain was in 5/73 patients using Western toilet and in 46/73 Indian toilet (p≤ 0.0001). Conclusion: The left lateral position for breastfeeding and resting supine are least painful positions. The Western-style toilets are more comfortable than Indian-style toilets.