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Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 11 November 2023
THE EFFECT OF EARLY MOBILIZATION ON THE PROCESS OF
WOUND HEALING IN THE INFLAMMATORY PHASE OF POST SECTIO
CAESAREA
Solihudddin Harahap, Suri Imelda Sianturi, Dina Yusdiana Dalimunthe
Poltekkes Kemenkes Medan, Indonesia
Email:
Abstract
Sectio caesarea is an artificial birth where the fetus is born through an incision in the
abdominal wall and uterine wall provided that the uterus is intact and the fetus
weights more than 500 grams. The incidence of sectio caesarea in Indonesia is
15.3%. Sectio caesarea surgery performed in an attempt to expel the baby will leave
an incision wound condition. One of the factors that support the process of wound
healing is early mobilization. Early mobilization carried out in stages will help to
improve blood circulation so it can accelerate the healing process, especially during
the inflammatory phase, so mothers can return to normal daily activities. This
research aims to determine the effect of early mobilization on the wound healing
process in the inflammatory phase of post sectio caesarea, The purpose of this
research is to find out how early mobilization influences the wound healing process
in the inflammatory phase of post sectio caesarea at Sufina Aziz General Hospital,
Medan in 2023. This research used a quantitative research method with the Quasi
Experiment Design Method with the One Group Pre-test Post-test Design. The
population of all post sectio caesarea patients at Sufina Aziz General Hospital in
Medan City with a sample of 15 respondents used the Accidental Sampling
Technique. Data analysis in this research used the Paired Sample T-Test. The results
showed that almost all respondents, namely 14 respondents, experienced wound
healing in the inflammatory phase category either on the third day post sectio
caesarea or after (post-test) early mobilization. The results of the Paired Sample T-
Test obtained a p value (0.000) <α (0.05) which means that there is an effect of early
mobilization on the wound healing process in the inflammatory phase of post sectio
caesarea at Sufina Aziz Hospital, Medan City in 2023. Health workers are expected
to increase professionalism in providing services to patients, especially in providing
early post-sectio caesarea mobilization.
Keywords: Sectio caesarea , Early Mobilization, Wound Healing
INTRODUCTION
Childbirth is the process in which the product of fertilization (fetus, placenta,
and amniotic fluid) is pushed out of the uterus through the birth canal or by others.
Sectio caesarea is an artificial birth in which the fetus is born through an incision in
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the abdominal wall and uterine wall provided that the uterus is complete and the
fetus weight more than 500 grams (Jitowiyono & Kristiyanasari, 2022).
According to the World Health Organization (WHO), in 2020 the number of
sectio caesarea has increased in the world and exceeded the recommended range of
10-15%. America Latin and the Caribbean had the highest percentage of cesarean
section births at 40.5%, followed by Europe 25%, Asia 19.2% and Africa 7.3%.
According to statistics, there were 3,509 cases of section cesarea with indications of
21% fetal pelvic disproportion, 14% fetal distress, 11% placenta previa, 11% having
had a cesarean section, 10% abnormal fetal position, 7% pre-eclampsia and
hypertension (WHO, 2020).
According to Basic Health Research in (2018) there was 15.3% of childbirth
carried out by sectio caesarea . The maternal childbirth rate in Indonesia in 2018
reached 79.3%. The highest provinces with childbirth by sectio caesarea were DKI
Jakarta 27.2%, Riau Island 24.7%, and West Sumatra 23.1%. According to the
Ministry of Health of the Republic of Indonesia (Kementrian Kesehatan Republik
Indonesia), the number of mothers giving birth in Indonesia in 2018 was 5.043.078
and there was 4.351.389 mothers in Indonesia assisted by health workers. The
indications of childbirth by sectio caesarea in Indonesia are caused by several
complications with a percentage of 23.2% including transverse fetal position 3.1%,
bleeding 2.4%, seizures 0.2%, premature rupture of membranes 5.6%, prolonged
labor 4.3%, umbilical cord entanglement 2.9%, placenta previa 0.7%, placenta left
behind 0.8%, hypertension 2.7%, and others 4.6% (Kemenkes RI, 2018).
Based on the Riskesdas of North Sumatra (2018) the incidence rate of sectio
caesarea in North Sumatra was 23.89% and rate of the normal birth was 75.95%.
The number of mothers giving birth in the province of North Sumatra in 2018 was
321.232, and mothers who were assisted by health workers at health facilities was
265.212 (Kemenkes RI, 2018).
Sectio caesarea surgery that carry out to deliver the baby will leave an incision
wound condition. Post caesarean incision wound is a type of acute wound caused by
sectio caesarea surgery when a woman cannot give birth normally.
Wound healing in sectio caesarea is estimated to take approximately 1 week.
The condition of the incision wound requires optimal care to ensure the recovery
process runs optimally as well. One of the things that supports the wound healing
process is early mobilization (Zuiatna D, 2018).
Early mobilization can begin within the first 6 hours after post sectio caesarea .
The goals of mobilization is to accelerate the wound healing process, improve
circulation, prevent venous stasis, and support optimal respiratory function. So that
the mother can gain strength, accelerate reovery, improve bowel and bladder
function, stimulate intestinal peristalsis to return to normal and mobilization also
helps speed up the body's organs to work as before (Nadiya & Mutia, 2018).
Step by step of early mobilization carried out will help to improve blood
circulation so it can accelerate the healing process, especially during the
inflammatory phase, so mothers can return to normal daily activities. Delaying early
mobilization can worsen the mother's condition and hinder the healing process of
sectio caesarea wounds (Hartati & Ferinawati, 2019).
Based on a preliminary survey which conducted by researchers at Sufina Aziz
General Hospital Medan on November 14 2022, data was obtained from nurses
regarding early mobilization of post-sectio caesarea mothers that nurses tell to the
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patients about early mobilization. However, there are many mothers who do not
want to do early mobilization after post section caesarea because of the mother's fear
of moving and fell worry about surgical wound will open and feel pain in the surgical
wound. In terms of wound care post sectio caesarea , it was found that all post sectio
caesarea wound care still used sterile gauze for post sectio caesarea wound dressings.
Based on a preliminary survey conducted by researchers, it was found that
medical record data from Sufina Aziz General Hospital Medan recorded 818 cases
of sectio caesarea in 2019, there were 876 cases of sectio caesarea in 2020, 930 cases
of sectio caesarea in 2021 and 821 cases of sectio caesarea in 2022. From the
background above, the researcher is interested in conducting research on "The Effect
of Early Mobilization on the Wound Healing Process of the Post Sectio caesarea
Inflammatory Phase at Sufina Aziz General Hospital General Medan City 2023".
RESEARCH METHODS
This research used quantitative research with using the Quasi Experiment
Design method with the One Group Pre-test Post-test Design. The population in this
research were all post sectio caesarea patients at Sufina Aziz General Hospital
Medan from January to May 2023. Sampling in this research used the Accidental
Sampling technique from January to May 2023 with a total of 15 respondents.
The instrument used in this variable is the post sectio caesarea wound healing
observation sheet to collect data before and after being given an early mobilization
intervention using the REEDA scale (Redness, Edema, Ecchymosis, Discharge,
Approximation) which is a wound healing assessment instrument that contains five
factors. There are redness , edema, ecchymosis, discharge, and approximation of the
two edges of the wound. Each factor is given a score between 0 to 3 which represents
the absence of signs to the presence of the highest level of signs. Thus, the total score
scale ranges from 0 to 15, with a higher score indicating poor wound healing.
Observations were made 2 times, namely on day 1 and day 3 after sectio caesarea .
Data analysis was done by using univariate analysis and bivariate analysis.
Univariate analysis only produces frequency distributions. Using the Shapiro-Wilk
test for the normality test and the Parametric test with the Paired Sample T-Test for
bivariate analysis.
RESULTS AND DISCUSSION
Table 1 Frequency Distribution Based on Respondent Characteristics at Sufina
Aziz General Hospital, Medan City in 2023
Table 1 Frequency Distribution Based on Respondent Characteristics
Characteristics
F
%
Age
21-25 year
26-30 year
31-35 year
36-40 year
4
6
4
1
26,7
40,0
26,7
6,7
TOTAL
15
100
890
Work
House Wife
Entrepreneur
Nurse
10
3
2
66,7
20,0
13,3
TOTAL
15
100
Dressing
Kasa Steril
15
100
TOTAL
15
100
Based on table 1 above, it is known that from 15 respondents (100%) the
characteristics of respondents based on age obtained the majority of respondents aged
26-30 years as many as 6 respondents (40 %), the characteristics of respondents based
on work obtained the majority of respondents with IRT jobs (housewives) as many
as 10 respondents (66.7%) and the characteristics of respondents based on the
dressing used showed that all 15 respondents (100%) used sterile gauze.
Table 2 Frequency Distribution of the Inflammatory Phase Wound Healing
Process on the First Day of Post Sectio caesarea
Wound Healing Process
Inflammatory Phase
Pre-Test
F
%
Good
15
100
Bad
0
0
TOTAL
15
100
Based on table 2 above, it is known from 15 respondents (100%) showed that
all respondents experienced the process of healing the wound in the inflammatory
phase on the first day post sectio caesarea before (pre-test) early mobilization was
carried out with a good category of 15 respondents (100%).
Table 3 Frequency Distribution of the Wound Healing Process of the
Inflammatory Phase Third Day of Post Sectio caesarea
Wound Healing
Process
Inflammatory Phase
Post-Test
F
%
Good
14
93,3
Bad
1
6,7
TOTAL
15
100
Based on table 3 above, it is known from 15 respondents (100%) showed that
the majority of respondents experienced the wound healing process in the
inflammatory phase on the third day post sectio caesarea after (post-test) early
mobilization was carried out in a good category, 14 respondents (93.3%).
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Table 4 Statistical Test Results Based on the Influence of the Post Sectio caesarea
Inflammatory Phase Wound Healing Process
Wound Healing Process
Inflammatory Phase
Pre-Test
Post-Test
P Value
F
%
F
%
0,000
Good
15
100
14
93,3
Bad
0
0
1
6,7
TOTAL
15
100
15
100
Based on table 4 above, it can be seen that the results of the statistical test using
the Paired Sample T-Test show a sig (2-tailed) value or a p value of 0.000, which
means a p value <0.05 (0.000 <0.05). If the p value <0.05, there is a significant
difference so that it can be concluded that there is an effect of early mobilization on
the wound healing process in the post-sectio caesarea inflammatory phase.
Wound Healing Process Inflammatory Phase First Day of Post Sectio caesarea
Before (Pre-test) Early Mobilization
The results of the research conducted by the researcher found that all
respondents experienced the wound healing process in the inflammatory phase on
the first day post sectio caesarea before (pre-test) early mobilization was carried out
with a good category of 15 respondents (100%). This is because the wound healing
process in the first day of the inflammatory phase in the respondents after performing
a sectio caesarea operation was the same because it was still covered with stitches.
The wound healing phase begins with the inflammatory phase. This phase
starts with the body's reaction to the wound starting a few minutes after the injury
and lasts for several days. In this phase, a hemostatic process (controlling bleeding)
occurs, that is, according to the brain's orders, the body will send blood supply to the
injured area, then form epithelial cells (epithelialization) (Arisanty, 2022).
During this process the blood vessels that supply blood to the wound area will
constrict and platelets will gather in the wound area to stop the bleeding process by
forming a network of fibrin threads (fibrin matrix) from this fibrin matrix which will
later become the framework for cell repair. Then the damaged tissue secretes
histamine which stimulates capillary vasodilation in the wound area and secretes
serum and white blood cells (Arisanty, 2022).
These two components will cause inflammation to kill germs that may be
present when the wound occurs. This inflammatory process will certainly cause signs
of inflammation in the form of redness, swelling, warmth and pain (Arisanty, 2022).
The results of this research are in line with Mustikarani (2019) regarding the
effect of early mobilization on wound healing post sectio caesarea , namely a pre-
experimental research with a one group pretest posttest design approach. 100%).
Wound Healing Process Inflammatory Phase Third Day Post Sectio caesarea After
(Post-test) Early Mobilization
Early mobilization post sectio caesarea is a movement, position or activities
carried out by the mother immediately after giving birth. Step by step for mobilization
is very useful to help the patient's healing process.
Mobilization is carried out in the first 6 hours after surgery by moving the arms
and legs, tilting the right side to the left, sitting up until they can stand up and do
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normal activities and breathing exercises can be done by the patient while sleeping
on his back after he is conscious (Rukiyah & Yulianti, 2018).
Based on the results of research conducted by researchers that early
mobilization can affect the healing of post sectio caesaria wounds because early
mobilization can improve blood circulation so that the nutrients needed by the
wound are met and speed up wound healing. The results showed that the majority of
respondents experienced the wound healing process in the inflammatory phase on
the third day of post sectio caesarea after (post-test) early mobilization was carried out
with a good category of 14 respondents (93.3%). It's just that there was one
respondent who did early mobilization well and experienced wound healing in the
bad category. This was known from observations made by researchers on the third
day when changing the wound dressing, the wound experienced redness and swelling
around the wound.
This condition is suspected to be due to the age factor of the respondents. Age
can interfere with all stages of wound healing such as vascular changes that interfere
with circulation to the wound area, decreased liver function interferes with the
synthesis of clotting factors, slow inflammatory response, decreased formation of
antibodies and lymphocytes, less soft collagen tissue, less elastic scar tissue. Healthy
reproductive age is a safe age for a woman to get pregnant and give birth, namely the
age of 20-35 years (Arisanty, 2022).
Respondents who experienced wound healing in the poor category were aged
37 years, so skin moisture was reduced which could affect a decrease in skin elasticity.
In addition, as we age, the collagen content in the skin also decreases so that the
process of regeneration of new cells becomes hampered. This of course can affect the
wound healing process post sectio caesaria (Arisanty, 2022).
The Effect of Early Mobilization on the Wound Healing Process of Post Sectio
Cesarea Inflammatory Phase
From the research conducted by researchers on 15 respondents (100%) with
pre-test and post-test, it was shown from the results of the research that there was an
effect of early mobilization on the process of wound healing in the post-sectio caesarea
n phase of inflammation at Sufina Aziz General Hospital, Medan in 2023.
This is proven based on the results of statistical tests using the Paired Sample
T-Test showing a sig value (2-tailed) or a p value of 0.000, which means that the value
of p <0.05 (0.000 <0.05). If the p value <0.05, there is a significant difference so that
it can be concluded that there is an effect of early mobilization on the wound healing
process in the post-sectio caesarea inflammatory phase.
The results of this research are in line with Mustikarani's research (2019)
concerning the effect of early mobilization on wound healing post sectio caesarea ,
namely pre-experimental research with a one group pretest posttest design approach,
it was found that early mobilization had an effect on post sectio caesarea wound
healing with almost all respondents experiencing wound healing post sectio caesarea
with the category of wounds healed within 3 days after carrying out early
mobilization, namely 19 (95%) respondents. Based on the results of statistical tests
using the Wilcoxson test it is known that the p-value of 0.000 is smaller than the value
of α = 0.05 (0.000 <0.05) so that H0 is rejected and H1 is accepted, meaning that
there is an effect of early mobilization on wound healing post sectio caesarea.
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Based on the research results of Mutianingsih R (2017) regarding the process of
wound healing in the inflammatory phase with early mobilization of post sectio
caeserea patients, the results obtained from a research of 30 respondents, most of
them carried out early mobilization in the first 6 hours as many as 23 respondents
experienced wound healing in the inflammatory phase of surgery on the day the third
is in the healed category and 7 respondents who did not perform early mobilization
experienced healing of non-healing inflammatory phase wounds with a sig or p value
of 0.000, which means that the value of p <0.05 so it can be concluded that early
mobilization of post section caesarea patients is effective in the wound healing
process inflammatory phase of surgery on the third day.
Based on the research of Rottie & Erlita (2019), the results of the research
showed that all respondents who carried out early mobilization were 21 patients, and
it was seen that more respondents mobilized early with good post-sectio caesarea
wound healing. Based on the results of statistical tests using the binomial test, the p
value = 0.027 is less than the value α = 0.05. So that H0 is rejected, there is an effect
of early mobilization on wound healing post sectio caesarea .
From the results of the research conducted by the researchers, it was found that
the wound care carried out at Sufina Aziz Hospital, all post-caesarean wound care
still used sterile gauze for post-cesarean wound dressings. According to the
researchers, the results of this research indicated that wound healing would be
maximized if patients who experienced post sectio caesarea were given intervention in
the form of early mobilization.
CONCLUSION
From the results of the research that has been done, it can be concluded that
there is an effect of early mobilization on the wound healing process in the
inflammatory phase of post sectio caesarea at Sufina Aziz General Hospital, Medan
in 2023. This is proven based on the results of statistical tests using the Paired Sample
T-Test showing a sig value (2-tailed) or a p value of 0.000, which means that the value
of p <0.05 (0.000 <0.05). If the p value <0.05, there is a significant difference so that
it can be concluded that there is an effect of early mobilization on the wound healing
process in the inflammatory phase of post sectio caesarea at Sufina Aziz General
Hospital, Medan in 2023.
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