The Effect of TENS Applied in the Early Postpartum Period on Incision Healing, Pain and Comfort

Introduction The postpartum period is a period with biopsychosocial effects in the life of the mother and her family. The mode of delivery may affect the adaptation of the mother to the postpartum period. Most women can have a vaginal birth with professional support. However, vaginal delivery can be risky in cases of fetal distress, large fetus, head and pelvis incompatibility, fetal posture disorders, and maternal illness that may prevent vaginal delivery. In these cases, cesarean section is an important decision for the health of both mother and baby. However, cerzerian surgery also brings some risks. Pain in the short term, difficulty in the recovery of the mother, delayed mobilization, infection, exposure to a surgical operation and a decrease in maternal comfort due to these may cause many problems such as breastfeeding problems, decreased mother-baby bonding.

The presence of persistent pain after cesarean section is the result of post-operative inflammatory reactions and adversely affects the mother. In a study, it was reported that 75% of women experienced moderate or severe pain after cesarean section, and this pain was high in the first 24 hours. The duration of pain may be prolonged depending on the individual's perception of pain and response to pain. It delays early mobilization by delaying pain relief and reduces maternal comfort. Effective treatment of pain is very important economically and because of its unpleasant physiological and psychological consequences for the patient. Recently, many methods have been developed with pharmacological and non-pharmacological approaches to pain in women with severe pain after cesarean section, and it has been reported that they accelerate pain, maternal satisfaction, recovery time and delay the use of analgesics. These include TENS, acupuncture, breathing exercises, and psychotherapy.

Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, low-frequency electrotherapy technique. The mechanism of action of TENS is still unknown. It was first used in obstetrics in 1970. It has been reported in the literature that TENS is used in chronic pain such as post-operative pain, vaginal delivery pain, dysmenorrhea, angina pectoris, orofacial pain, dental procedures, physical trauma-broken ribs and minor medical procedures, low back pain. Despite the widespread use of TENS in vaginal labor pain, it has been included in systematic reviews for which evidence of benefit is insufficient. In addition, it has been reported that TENS is effective in wound healing and faster wound area reduction in some dermatological studies and plastic surgery. It has been reported that TENS supports the long-term retention of flaps and grafts after plastic surgery, thereby accelerating postoperative recovery and reducing necrosis. The effectiveness of TENS in wound healing has been associated with an increase in blood flow (Visconti et al., 2020). However, there is no study in the literature that determines the effect of TENS on incision healing, pain and comfort after cesarean section.

Considering the cesarean section rates in the world and in Turkey, the importance of these risks emerges. While the Dominican Republic ranks first with 56.4% in the WHO's cesarean section rates, Turkey ranks fourth in this ranking. The rate of cesarean section in Turkey was determined to be 52% in 2018, according to the report of the Turkey Demographic and Health Survey (TNSA).

Considering the problems mentioned above, it is important to search for non-pharmacological interventions that will minimize health risks along with full holistic care for mothers in the post-cesarean period. Therefore, in this study, it was aimed to determine the effect of TENS applied in the early postpartum period at the end of the cesarean section on incision healing, pain and comfort.