1. Introduction

Pregnancy and child birth are special events in women’s lives. Naturally, expectant mothers spend a lot of time thinking about how they will give birth. Although most people believe that a vaginal birth is the best way to deliver, sometimes a Caesarean section (CS) cannot be avoided ^{[1, 2, 3]}.

Caesarean birth is used most often as a prophylactic measures, to alleviate problem of birth such as cephalo pelvic disproportion , failure to progress in labour or fetal distress. A major concern in maternal and child health nursing is the increasing number of caesarean birth being performed annually ^{[4, 5]}.

In India, the incidence of primary caesarean birth is about 30.2% or one–third of births (National Vital Statistics System, 2008). The majority of the states are within the WHO specified range of 5 to 15% Caesarean section, among that, five states are above the range and 12 states below the specified range. This rate ranged between 26 % and 2%.The prevalence of Caesarean section is generally more in the southern states and in Pondicherry it is around 31.93% in rural and 39.92% in the urban area ^{[6, 7, 8]}.

Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. ^[9]. Immediate management is essential to decrease the chance of infection, length of the hospital stay and to return for normal function. Infra red radiation is one of the modalities to treat the pain and wound.

Heat transmission with IR radiation is governed by inverse square law, it state that the intensity of radiation varies inversely with the square of the distance between the source of radiation &the skin. Intensity of the radiation is reduced; if the distance between the source & the target is increased & vice versa. The duration of the exposure should be 15 to 20 minutes once or twice a day. The treatment commence with the IR source placed at distance of 30” to 36” from the surface being treated ^{[10, 11, 12, 13]}.

Infrared Rays has therapeutic effect of increasing the blood supply and relieving the Pain. This will increase the supply of oxygen and nutrient available to the tissues accelerate the removal of the waste products and help to bring about the resolution of inflammation. When the heat is mild, the relief of pain is probably due to the sedative effect on the superficial sensory nerve endings. It is also helping achieve muscular relaxation and for the relief of muscle spasm associated with injury or inflammation ^{[14, 15, 16]}. Infrared rays also have the physiological effect on cutaneous vasodilation due to liberation of chemical vasodilators, histamine and similar substance, as well as possible direct effect on the blood vessels. ^[20] So the infra red radiation is considered as a choice of Electro Therapy Modality for the caesarean section mothers.

•  To evaluate the effectiveness of Infrared rays on wound healing and pain level in the experimental group comparison with control group.

•  To correlate the level of pain with the Wound healing.

Assumption: Infrared ray therapy may have an effect on wound healing and reduces the intensity of pain among the caesarean section mothers.

H1: There will be a significant difference between the pre &post tests wound healing & pain level scores among the control and experimental group.

2. Methodology

A Quantitative approach& True experimental - Pre-test/post-test control group design was adopted to fulfill the aim of this study. The sample for the study comprises of all Caesarean Section mothers and the sample size was 100 subjects, who underwent caesarean section of which 50 in the control group and 50 in the experimental group.

•  Mother who are willing to participate

•  Mothers are in 3^rdpost operative day

•  Post operative mothers with any complication or complication to baby of the mother during the study period.( other than pregnancy induced hypertension and anemia).

Simple Random sampling technique and it is used for the present study. Hundred mothers (50 in experimental and 50 in control group) were selected randomly by even and odd numbers with the help of lot method. The tool has two section A & section B, further the section A has two parts for collecting demographic & obstetric variables of mothers. Section B has two parts for assessing the wound healing and pain level of caesarean section by Modified Southampton Wound Assessment & Numeric Pain Rating Scale ^{[17, 18, 19]}.

Table 1. The wound grading was recorded and information about was regarded in four categories

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The most common pain assessment tools are verbal self report instruments such as the 0-10 Numeric Pain Rating Scale. Patients were asked to indicate the intensity of current, best, and worst levels of pain using an 10-point scale ranging from 0 (none) to 10 (severe pain imaginable) The average of the 4 ratings was used to represent the patient’s level of pain.

Table 2. The score will be as follows

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The tool was standardized but it was validated by submitting to experts and the modifications were incorporated in the final preparation of the tool. Inter rater method was used to determine the reliability and the ‘r’ value is 0.8 considered reliability of the tool.

Infrared ray therapy for an Experimental group was started on 3^rd postoperative day of caesarean section. The 3^rdpost operative day wound assessment was considered as pre –test .Only the surgical site was exposed to the infrared rays and the other area was draped. A sterile dressing was done before the exposure. The mothers were made into side lying position at a 45 degree angle to the infrared rays. Eye pad was given to protect their eyes from retinal damage due to infrared rays. Infrared ray therapy was given over the caesarean wound for 30 minutes duration, twice a day, for 3 consecutive days (3^rd, 4^th&5^thpost operative days). The irradiation distance was about 50 cm from the incision site. After exposure, the wound healing & pain level was assessed on 5th &7^thpost operative day with Southampton wound assessment and numeric pain rating scale respectively. The 5^th and 7^thpost operative day wound healing & pain level assessment was considered as post test.

Similarly the Control group was received sterile dressing on 3^rd postoperative day of caesarean section. The sterile dressing was done twice a day for 3consecutive days (3rd, 4th &5^thpost operative days). After dressing, the wound was assessed on 5th &7^thpost operative days with Southampton Wound Assessment and Numeric Pain Rating Scale. The 5^th and 7^thpost operative day wound assessment was considered as post test. Schedule for data collection was shown in the Appendices.

The demographic findings shows that majority 26(52%),28(56%) subjects were under the age group of 21-25 years in the control and experimental group respectively, 38(76%), subjects in control and experimental group had primary and secondary level of education, and 49(98%) subjects in control group & all subjects 50(100%) in experimental had less than Rs 5000 family income per month.

The 5^th day post test mean wound healing scores were 2 ± 1.4 & 1.38 ± 0.987 for the control & experimental group respectively, the calculate ‘t’ value is 2.559 shows that the ‘p’ value (0.12) was statistically not significant though the mean wound healing scores of the experimental group was less compare to control group.

On 7^th day post test mean wound healing scores were 1.86 ± 1.325 &1.26 ± 0.828 for the control & experimental group respectively. The calculated ‘t’ value is 2.715 shows that the ‘p’ value (0.008) was statistically significant in the experimental group in compare to the control group (Figure 1).

Similarly the 5^th day post tests mean pain scores was 3.08 ± 0.528 & 2.68 ± 0.551 for control & experimental group respectively. The calculated ‘t’ value 3.705 shows the (p<0.000) was statistically significant. Further the post test mean pain scores (7th day) 2.12 ±0.435 & 1.94 ± 0.424 for control and experimental group respectively. The calculated ‘t’ value is 2.094 with p value (0.39) is statistically significant (Figure 2).

Therefore it was inferred that the infrared therapy was effective in improving the wound healing as well as reducing the pain level among the subjects in experimental group.

Table 3. Highlights that there was highly significant difference found between the post tests wound healing scores of experimental group mothers, the calculated ‘f’ value shows 6.957 with ‘p’ value 0.001(p<0.001) ***.

Figure 1. Effectiveness of Post tests (5^th& 7^th day) wound healing scores among the control &experimental group

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Figure 2. Effectiveness of Post tests (5^th& 7^th day) pain level scores among the control &experimental group

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Table 3. ANOVA for effectiveness of the post tests wound healing scores in the experimental group

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Table 4. ANOVA for effectiveness of the post tests pain scores in the experimental group

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Table 4. Highlights that there was highly significant difference found between the post tests pain level scores of experimental group subjects, the calculated ‘f’ value shows 169.392 with ‘p’ value 0.000 (p<0.001)***

Table 5. Correlation between the wound healing & pain level scores of subjects among experimental group

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Table 5. Shows that there is positive correlation between the pain level and wound healing score r = 0.22, indicates there is reduction of pain as the wound healing occurs & vice versa.

3. Conclusion

The study result showed that infrared light application was effective in enhancing wound healing & relieving pain level among the caesarean mothers. All the subjects in the experimental group had healed caesarean wound and reduced pain level almost on 5^th and 7^thpost operative day. This is also the cheapest procedure & convenient measure. So this infrared light therapy can be administered as an adjunct therapy by health personnel in their day to day caring the mother in hospital setting.

4. Limitation

•  Time consuming

•  Man power and skilled person was needed to perform the procedure.

5. Recommendation

•  Replication of the study may be done with large samples in different setting to validate and generalize the findings.

•  A comparative study can be done between elective and emergency caesarean section mothers to find out differences of degree of wound healing.

•  The findings can be used as evidence based for providing infrared therapy among caesarean section mothers.

6. Ethical Consideration

Permission was obtained from the concern authority. The subjects were selected based on the inclusion and exclusion criteria for the study. Written consent was taken from each subject before the intervention. Confidentiality and anonymity were assured.

Conflict of Interest

there is no conflict of interest to disclose.

Acknowledgement

The author acknowledge the PG student and other hospital staffs for co-operation during the period of study, also acknowledges all the mothers for their co-operation and consent for study.

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