The Effect of St. John's Wort Oil on Wound Healing and Pain in Women Undergoing Cesarean Section: A Randomized Controlled Trial

Cesarean section is a surgical procedure in which the fetus is delivered through an incision when vaginal delivery is not possible due to certain high-risk conditions (1). In recent years, cesarean rates have increased rapidly, showing a 75% rise over the last 15 years (2). While the global cesarean rate was 7% in 1990, it has now reached 21% and is expected to continue increasing over the next decade. In Latin America and the Caribbean, 43% of all births are cesarean deliveries. In countries such as Egypt, Brazil, Cyprus, the Dominican Republic, and Turkey, cesarean births have surpassed vaginal deliveries (3).

Cesarean section is a life-saving intervention when maternal or fetal morbidity and mortality are at risk. However, due to the nature of the surgical procedure and anesthesia, cesarean delivery can lead to numerous physical and psychosocial problems during the postpartum period. One of the main factors negatively affecting infant care, mother-infant interaction, and the mother's ability to resume daily activities after cesarean delivery is the presence of a surgical wound. Delayed wound healing and wound-related complications are among the major issues encountered in the postpartum period (4). Approximately 5% of women who undergo cesarean delivery experience wound site complications such as hematoma, infection, and seroma (5).

A wound is defined as the disruption of the anatomical and functional integrity of intact skin and tissues due to trauma or surgical intervention (6,7). Wound healing is a critical process following cesarean delivery and is influenced by both local and systemic factors. Local factors include infection, oxygenation, necrotic tissue, foreign bodies, repeated trauma, and radiation exposure, while systemic factors encompass gender, chronic diseases, advanced age, immunodeficiency, nutritional deficiencies, smoking and alcohol use, obesity, medication use, and stress (8). Successful wound healing requires the orderly progression of distinct healing phases: hemostasis, inflammation, proliferation, and remodeling (5,6,8,9).

The quality of treatment and care plays a crucial role in the healing of surgical wounds after cesarean section (10). In recent years, new methods and products have been developed for wound care and healing, some of which are derived from herbal sources (9). Failures in pharmacological treatments applied in the postpartum period, concerns about the safety of these methods for the mother and infant, the presence of side effects, negative impacts on breastfeeding, the emergence of resistant microorganisms, and the inability of existing antibiotics to address these issues have all prompted individuals to seek natural alternatives (7,10,11,12).

These natural alternatives, collectively referred to as Traditional and Complementary Medicine (TCM), are defined by the World Health Organization (WHO) as "a set of knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, used in the maintenance of health as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illnesses" (13). TCM practices are widely used around the world. In China, they account for 40% of all medical treatments, and 80% of the population in Asia and Africa use TCM in primary healthcare services. In developed countries, 70% of the population in Canada, 75% in France, 42% in the USA, 30% in New Zealand, and 53% in Singapore report using TCM methods (7).