Postpartum Pain, Episiotomy Pain, Postpartum Care
Conditions
Keywords
Kangaroo care, skin to skin contact, Cheek Contact, Vaginal Birth, Postpartum Pain Management, Episiotomy
Brief summary
This randomized controlled trial aimed to evaluate the effects of skin-to-skin contact and kangaroo care on pain control during and after episiotomy repair following vaginal birth. The study was conducted at Izmir Bakircay University Cigli Regional Training and Research Hospital and included 155 healthy women who had spontaneous vaginal birth and healthy newborns. Participants were randomly assigned to three groups: kangaroo care (n=50), cheek-to-cheek contact (n=50), and standard postpartum care (n=55). Pain levels were assessed after episiotomy repair and at the 6th and 12th hours postpartum using the Verbal Rating Scale. Secondary outcomes included breastfeeding frequency and maternal satisfaction. The results indicate that kangaroo care and cheek-to-cheek contact may reduce postpartum episiotomy pain and improve breastfeeding outcomes, supporting their integration into routine maternity care.
Detailed description
This randomized controlled experimental study was conducted at Izmir Bakircay University Cigli Regional Training and Research Hospital in Türkiye. A total of 155 healthy women who had spontaneous vaginal birth at term (≥37 weeks) and their healthy newborns were included. Eligible participants were aged 18 years and older, had no medical complications, and had newborns with Apgar scores ≥7 at 1 and 5 minutes. Participants were recruited during active labour and randomly assigned to three groups: kangaroo care group (skin-to-skin contact, n=50), cheek-to-cheek contact group (n=50), and control group receiving standard postpartum care (n=55). Randomization was performed using a computer-generated random number sequence, with allocation concealed in sealed, opaque envelopes. The kangaroo care group received immediate skin-to-skin contact between mother and newborn. The cheek-to-cheek contact group received structured cheek-to-cheek contact. The control group received routine postpartum care according to hospital protocols. Primary outcomes included pain levels assessed after episiotomy repair and at the 6th and 12th hours postpartum using the Verbal Rating Scale. Secondary outcomes included breastfeeding frequency, amount of local anesthesia used, and maternal satisfaction. Data were collected using structured questionnaires on sociodemographic and obstetric characteristics. Statistical analyses were performed using descriptive statistics, chi-square tests, one-way ANOVA, and Bonferroni post-hoc tests. All participants provided written informed consent prior to participation. The study was approved by the Izmir Bakircay University Non-Interventional Clinical Research Ethics Committee and conducted in accordance with the Declaration of Helsinki.
Interventions
BEHAVIORALSkin-to-Skin Contact
Immediately after vaginal birth and during episiotomy repair, the newborn was placed prone on the mother's bare chest to provide continuous skin-to-skin contact. The infant was positioned in an upright and safe posture and covered with a blanket when necessary. The intervention was maintained according to the study protocol and supervised by trained midwives.
BEHAVIORALCheek-to-Cheek Contact
During and after episiotomy repair, structured cheek-to-cheek contact was established between the mother and the newborn. The infant's cheek was gently placed in contact with the mother's cheek in a comfortable position. The procedure was applied according to standardized instructions and supervised by trained staff.
Sponsors
Ege University
Izmir Bakircay University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
This study was designed as a three-arm, parallel-group randomized controlled trial. Eligible participants were randomly assigned during active labour to receive kangaroo care, cheek-to-cheek contact, or standard postpartum care. Outcomes were assessed after episiotomy repair and during the early postpartum period.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* Women aged 18 years or older Able to speak and understand Turkish Singleton pregnancy at ≥37 gestational weeks Spontaneous vaginal birth with mediolateral episiotomy Mother and newborn clinically stable after birth Newborn APGAR score ≥7 at 1 and 5 minutes Willingness to participate and provision of informed consent
Exclusion criteria
* Operative vaginal birth (vacuum or forceps) Third- or fourth-degree perineal tear or extensive perineal laceration Epidural analgesia during labor Maternal or neonatal complications requiring medical intervention Conditions requiring maternal-infant separation after birth Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Episiotomy pain intensity (Numeric Rating Scale) | Immediately after episiotomy repair, at 6 hours postpartum, and at 12 hours postpartum | Maternal pain intensity related to episiotomy repair measured using a 0-10 Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates worst possible pain. Pain scores were self-reported by mothers during follow-up assessments. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Breastfeeding frequency | Within first 12 hours postpartum | Number of breastfeeding episodes during early postpartum period |
| Newborn APGAR scores | 1st and 5th minute after birth | APGAR scores at 1 and 5 minutes after birth |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORAysun Ekşioğlu, Associate Professor
Ege University
Outcome results
None listed