Perineal Wound Identification With Maternity Cool Gel Pad (MCGP) Care Interventions

Postpartum mothers with an indication of episiotomy will experience a higher level of pain. This birth canal trauma is acute and is expected to recover in a short period of time, can be measured, and without serious complications. The aim of this study was to identify the healing process of postpartum maternal perineal wounds. The intervention was carried out on 31 postpartum mothers with the selection using purposive sampling technique. Maternity cool gel pad (MCGP) which was applied to the perineal wound care intervention on the 2nd and 3rd day after delivery showed the wound healing process was observed using the REEDA measuring instrument and analyzed using the T one sample test. The repair of the wound repair scale from the mean REEDA score (10.81 ± 2.98) occurred in all wounds of the study respondents at post intervention (5.32 ± 1.73). Maternity cool gel pad intervention assisted the wound healing process in post intervention data (P <0.005). The results of this study can be indicative of an inflammatory response locally in perineal wounds, but further research is needed to observe the impact of perineal wound healing with a combination of methods that can help evaluate the perineal wound repair process that can be done by mothers independently at home.


INTRODUCTION
Tears of the perineal tissue at delivery, either spontaneously or with an episiotomy, in 70% of cases require perineal suture treatment.
Postpartum mothers with an indication of episiotomy will experience a higher level of pain (1), more than 60% of mothers with pain complaints are experienced with a classification of pain levels ranging from moderate to severe pain within five days of delivery (2). Indications for episiotomy are performed with the aim of widening the birth canal, and minimizing severe perineal tears due to larger expulsion of the baby (3).
Episiotomy is a tear in the perineum which is a trauma that can be considered as serious treatment. Trauma to the birth canal is acute and is expected to recover in a short time, can be measured, and without serious complications.
Delayed wound healing process can be caused by various factors that can affect the mother individually, and requires handling care during the postnatal period, especially at home (4,5). The most felt experience of the effects of laceration of the birth canal by the mother is pain (6). The pain felt by postpartum mothers can directly affect the bonding process between mother and baby, so that it has an impact on the breastfeeding process, the limitations of the mother in caring for the baby, mobilization disorders which affect the healing process (7).
Based on several research results it has been suggested that there are several approaches in the treatment of perineal wounds that include pharmacological methods such as the use of analgesic and non-pharmacological drugs such as cold therapy (8,9). Several pharmacological practices in the management of perineal wounds are reported not to significantly address the response to pain and discomfort of postpartum mothers due to their limited use. This is evidence that perineal wound management services are needed in maternity care (10).
The use of cold therapy using ice packs has previously been studied reported to delay healing of perineal wounds (11). Its hard, stiff, wet texture causes discomfort, and can cause ice burns (12,13).. This problem is often ignored by health workers, so that health workers are needed to actively promote effective ways of postpartum mothers in the treatment of perineal wounds so that they can easily adapt to their role as mothers (9). Cold gel pad is a method that is considered more efficient, because it does not cause side effects, is comfortable and practical when used and does not cause ice burns (14). Cold therapy produces local anesthetic effects and changes in collagen produced by the peripheral nerve block mechanism. The viscoelastic changes of collagen and the reduction of muscle flexibility have the effect of decreasing the edema of the perineal wound (15).

MATERIALS AND METHODS
This research is a randomized interventional study to identify wounds from maternity cool gel pad intervention, using a quasi experimental design, one group pre post test only design. The  The assessment of wound characteristics with REEDA scale shows a picture of the difference in scale values on the first and second day of assessment (Figure 1). Research proves that the discomfort of postpartum mothers in doing cold sitz baths is due to the wide surface area of the skin that is exposed to cold temperatures, and is at risk of experiencing ice burns. Local application of cold therapy to perineal wounds is the method preferred by postparum mothers (18).
The assessment of the wound area is an important study to estimate the evolution of wound healing and the professionalism of health workers to be able to change the method of treating perineal wounds (19). An accurate holistic assessment of the patient and the wound will provide an understanding of the primary care goals resulting in improved perineal wound repair.
There are differences in the appearance of wounds on the first day and the second day after the intervention using the maternity cold gel pad ( Table 1)  can be applied in obstetrics and social maternity services and will empower postpartum mothers in carrying out perineal wound care with correct management that is easy to do (24).

CONCLUSION AND RECOMMENDATION
According to some researchers, treating perineal wounds using cold therapy can accelerate the wound healing process. Maternity cool gel pad (MCGP) applied to perineal wound care interventions on the 2nd and 3rd day postpartum helped the wound healing process in the post intervention data (P < 0.005). Cooling localized to the perineal wound has a significant impact on the perineal wound healing process.
Further research is still needed as a method and operational procedure that can be applied to postpatum mothers in carrying out perineal wound management independently at home.