High frequency current and post-partum perineal pain
Final dissertation – École universitaire de maïeutique (Midwifery school) Marseille-Méditerranée Université Aix- Marseille – 2017
By Marine Golka, midwife
Under the supervision of Florence Bretelle, gynaecology and obstetrics lecturer, Hôpital Nord de Marseille. With the support of Chantal Fabre-Clergue, midwife, contact person who initiated the project. With materials loaned by the Winback company, tecartherapy specialists.
A study of the post-partum period showed that, among women who have delivery vaginally and have perineal lesions (episiotomy, first to fourth degree tears), between 95% and 100% of them have perineal pain 24 hours after giving birth, and between 60% and 91% have perineal pain 7 days after giving birth.
The principal aims of the study were to evaluate the effectiveness of Winback treatment on post-partum perineal pain in women who have delivered vaginally and have perineal lesions; to assess the effect of high frequency treatment on the comfort of patients in the post-partum period.
The goal of the study was to explore whether it would be appropriate to introduce routine high frequency current treatment in maternity care, and to identify the role that midwives could play in new pain management techniques for women.
In order to meet these research objectives, a monocentric prospective study examining treatment/no treatment was undertaken at the Marseille Nord hospital, focussing on inpatients in the care of the maternity service after having given birth. The patients were divided into two groups, one receiving high frequency current treatment and the other not receiving high frequency current treatment, on a voluntary basis.
Women who gave birth on the Nord hospital site during the inclusion period and were present at the same time as the researcher were invited to participate in the study. Only patients presenting with perineal lesions following vaginal delivery were invited to participate. In total, 96 patients were included in the study in the period from 3 June 2016 to 30 September 2016 on the days when the researcher was present at the maternity services. Among these patients, 31 were included in the group exposed to Winback treatment and 65 in the group without Winback treatment.
The treatment was composed of applying a at probe to the perineum with rotating movements, with a return plate placed under the patient to allow the waves to work on the desired area. The sessions lasted ten minutes and were undertaken with the patient in a supine position with legs bent, the device set to a pre-set capacitive programme.
Data was collected at three points:
– before the session: E1 (T0);
– immediately after the session: E2 (T10);
– one hour after the session: E3 (T60).
The main evaluation measures were:
– Perineal pain measured using a tool: a numerical pain scale (EN).
– The comfort of patients was evaluated using a questionnaire about interference with routine activities: presence of pain and/or difficulty when sitting, walking, urinating and when at rest.
The two populations studied were: the treated group “E”: “Treatment with high frequency current” and the untreated group “NE”: “No treatment with high frequency current”.
To analyse the data regarding the scale of interference with routine activities, a number of scores were used:
– Pain score: Pain when sitting + pain when walking + pain when urinating + pain when at rest
– Difficulty score: Difficulty sitting + difficulty walking + difficulty urinating + difficulty at rest
– Total score: Pain score + Difficulty score.
These scores were taken at three points T0, T10 and T60, to give Pain Score 1, Pain Score 2, Difficulty score 1, Total score 1, etc.
To calculate the scores, the responses to questions “presence of pain and/or difficulty when sitting, walking, urinating and at rest” were counted as follows:
– “Yes”, “Same” or “More” given value 1,
– “No” and “Less” given value 0.
Example: at time T0, for Pain Score 1, a patient who said they were in pain when sitting, walking and urinating would have a score of 3.
An average decrease of 3.58 points was observed after the session (T0-T10) as well as a decrease of 3.48 points one hour after the session (T0-T60) in the treated patients (p<0.0001). Furthermore, for the patients who were not treated, the decreases were 0.02 (T10) and 0.31 points (T60) (p<0.0001).
The development in the Pain and Difficulty criteria on the scale of interference with routine activities was investigated only for patients (treated and untreated) who responded “Yes” when first questioned (T0).
It was noted that the patients treated with high frequency current all responded “No” to the Pain question when asked after the session; only two of these patients responded “Yes” when asked at T+1.
In the untreated group, there was no reduction in the number of patients experiencing pain by the second evaluation, and an increase in the number of patients experiencing pain at the T+1 evaluation.
For the Difficulty measure, the changes for treated and untreated patients was the same as with the Pain measure.
• Many think that analgesics are not effective for this type of pain;
• Practitioners also think that analgesics are not very effective for perineal pain and tend to use non- pharmaceutical methods such as cold.
It is important to remember that only perineal pain was considered, other post-partum pains not being included.
Other observations encourage me to think that this could be used during post-partum perineal rehabilitation. The feeling of well-being felt by the patients and the muscular relaxation are benefits that enhance a perineal rehabilitation session.
The use of high frequency current, an innovative treatment for post-partum perineal pain, reduced pain in the women treated, improving their experience of birth. The satisfaction of patients during these sessions convinced me of the effectiveness of the treatment in this study. The effects of treatment by high frequency current are currently been evaluated via a double blind randomised trial at the Hôpital Nord de Marseille hospital, under the supervision of lecturer Florence Bretelle, with the support of the Winback laboratory.