A comparative study to assess the psychosocial well being among first time mother’s following caesarean and normal delivery in selected hospitals at Gulbarga.
proforma for registration of
subject for dissertation.
Ms. priya dharshini
M.Sc. Nursing – 1st Year
AL-KAREEM COLLEGE OF NURSING
GULBARGA
JUNE 2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXUTURE - II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the Candidate and Address(In Block Letters) / ms. PRIYA DHARSHINI
I YEAR M.Sc NURSING
Al-KAREEM COLLEGE OF NURSING
GULBARGA
2. / Name of the Institution / AL-KAREEM COLLEGE OF NURSING
BAREY HILLS, NEAR ADARSH NAGAR GULBARGA – 585105
3. / Course and Study subject / M.Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of Admission / 18.06.2009
5. /
Title of the Topic:
a COMPARATIVE study to ASSESS the PSYCHOSOCIAL WELL BEING AMONG FIRST TIME MOTHER’S FOLLOWING CAESAREAN AND NORMAL DELIVERY IN SELECTED HOSPITALS AT gulbarga.
INTRODUCTION
Well-being can be conceptualized in terms of an individual's physical, mental, social, and environmental status, each aspect interacting with other and having differing levels of importance and impact according to each individual, Of these dimensions the psychosocial element particularly in case of first time mothers calls for an immediate re-addressal, in order to prevent untoward sequelae during the early postnatal period for the child as well as for the mother.
The process of becoming a mother is described as a process of appreciation, discovery, learning, and acceptance of the woman's new role, which results in a positive and worthwhile experience. In addition to adapting to maternal role changes, new mothers may experience a variety of emotional changes. 1
A study by World Health Organization shows Maternal psychosocial well-being is maintained primarily by traditional systems of social support that are mostly outside the domain of statutory primary care2
Giving birth is an empowering experience for women and their partners when they have the opportunity to make choices that will influence the outcome of this significant life event. For some women, however, the birthing experience brings with it feelings of victimization, betrayal, or loss that can result in both emotional and psychological damage3
A study on Maternal Health Promotion after Childbirth shows evidence that after 6 weeks postpartum; mothers continue to face mental and physical health, lifestyle, and parenting concerns. 4
A study was conducted to examine and compare first-time mothers' postpartum stress, depression, social support, and health status over the first 6 weeks following discharge from hospital after childbirth which showed Most women had minimal
depression with 71.83% in the sixth week to 81.58% in the first week. Women perceived a high level of social support and their greatest amount of support was from
family. A range of women from 25.71% in the fifth week to 32.39% in the second week of postpartum was categorized as having minor psychiatric morbidity. However
Insight into the results of this study provides a framework for additional research that a longitudinal design is needed from immediate childbirth to 1 year postpartum in order to explore the fluctuations of women's psychosocial factors.5
A study to estimate the risk of postpartum mental disorders requiring hospital admission or outpatient contact for first-time mothers and fathers up to 12 months after becoming a parent was conducted in Denmark .The data was analyzed from Danish health and civil service registers. The study showed, For first-time mothers, the first weeks and months after the delivery were associated with an increased risk of first admission with any mental disorder, and the period from 10 to 19 days following the birth was associated with the highest risk (7.3 times increased risk) compared with women who had given birth 11 to 12 months previously. The increased risk of admission among mothers remained statistically significant through the first 3 months after childbirth regardless of age of the mother. Risk for mothers was also increased for psychiatric outpatient contacts through the first 3 months after childbirth, also with the highest risk occurring 10 to 19 days following the birth.6
Thus Midwives should try to enhance women's well-being which in turn has a beneficial impact on both mother and baby
6. BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the Study
The anticipation of a new child is often characterized by feelings of joy and great delight. At the same time, emotional, hormonal, and physical changes a woman endures during this process can be hard and stressful, causing her to feel sad, anxious, afraid, or confused. New mothers are often confused by these feelings when they fall
short of Society’s view of motherhood and may also feel guilt and shame. In the first year after childbirth, 94% of women experience one or more major health problems7
Post partum maternal health care is a neglected aspect of women’s health care this neglect is evident in the limited national health objectives and data related to maternal health. Missed opportunities for enhancing the health care of postpartum women occur in the scope of routine postpartum care. Differing perceptions of maternal needs between nurses and new mothers also contribute to inadequate health care. Therefore, collecting national data on postpartum maternal morbidity, reforming postpartum care policies, providing holistic and flexible maternal health care, encouraging family support and involvement in support groups, and initiating educational programs are recommended.8
Correlates and predictors of mood disturbances at 3 days and 6 weeks postpartum were assessed among 370 Irish mothers and their partners using The Edinburgh Postnatal Depression Scale (EPDS) and the Highs Scale. Factors associated with EPDS scores of > or = 13 and Highs score of > or = 8 were examined. The results on EPDS showed that 11.4% of mothers scored > or = 13 at 3 days postpartum and 11% at 6 weeks, while 18.3% of mothers scored > or = 8 on the Highs Scale at 3 days and 9% at 6 weeks. Factors associated with EPDS scores of > or = 13 at 6 weeks were single status, unemployment, unplanned pregnancy, public status and bottle feeding The study concludes that Mothers' mood within 3 days of delivery was the best predictor of later postnatal depression & Certain women may be at increased risk for postnatal mood disturbance and may be amenable to early identification and intervention. 9
A cross-sectional survey to assess Palestinian women’s postpartum quality of life and the factors associated with variations in their quality-of-life was done in Palestinian Territory where little is known regarding women’s postpartum wellbeing. 1020 women were being studied which depicted The mean overall quality-of-life score for the sample was 21.53 (maximum = 30), suggesting that women are slightly satisfied with their lives in the postpartum period. The results of this study highlight the diversity and complexity of the social context, in particular the region where women live, and the
issue of pregnancy wantedness in postpartum quality of life.10
A preliminary analysis of social factors that affect new mother’s mental health indicates that women who have midwives as maternity care givers are somewhat more likely to report higher rates of mental health than those receiving care from physicians. Thus dearth of data on maternal psychosocial well-being calls for evidence on which to base maternity, mental health and social care policy and practice.11
Due to the untoward effects of low psychosocial wellbeing on postpartum depression from various reviews, the investigator has developed a keen interest in addressing this immediate unseen problem, so that, the appropriate interventions can be drawn to safeguard the mothers from the potential psychosocial consequences.
6.2 Review of Literature
A comparative study was conducted to determine the differences in psychosocial outcomes between primipara experiencing vaginal deliveries and primipara experiencing cesarean deliveries. One hundred and ninety four vaginal delivery primipara and 81 cesarean delivery primipara were recruited at 6 weeks of postpartum. The data were collected using 36 item short form questionnaire by interview method after six weeks of delivery. The result of the study shows that, the mean and Standard deviation of mother’s mental health score were 62.8 ± 18.6 and 60.4 ± 19.4 in normal delivery & Cesarean Section groups respectively (t=2.1;p<0.05). Thus the study concludes that mothers who had Cesarean Section had lower mental health status than mothers of Normal Vaginal Delivery 12
A cohort study was carried out to assess the Primiparous well-being before and after birth and relationship with preferred and actual mode of birth in Germany and the USA. The purpose of this study was to evaluate which mode of birth the first-time mothers prefer and how this desire is related to maternal well-being. The findings revealed that there was a relationship between women's well-being and the preferred
mode of birth, but no relationship was found between women's well-being and the type of birth experienced. However Well-being in both samples decreased after giving birth,
but there was a difference between German and American first-time mothers on the postpartum well-being and depression scores. German mothers had a higher postnatal quality of life and lower postnatal depression scores compared to first time mothers of USA13
A study was designed to examine whether the women’s psychological condition during pregnancy correlates with their psychological well-being after emergency caesarean section. Questionnaires were administered to pregnant women (N=1981) during 32nd week of gestation. Findings of the study showed that, particularly fear of childbirth during late pregnancy, and general anxiety are associated with mental distress after a caesarean section.14
A qualitative study was undertaken in selected two community health centres and a school of nursing and midwifery. Focus-group interviews were done to know what psychosocial well-being in the postnatal period means to midwives. Thematic analysis revealed the midwives tended to describe women using stereotypical categories worrying behaviours, extreme or obsessive behaviours about self, the baby or house.15
A study was conducted to determine the experiences of labour and connections of social support among 200 mothers during pregnancy and childbirth. The data were collected using Norbeck's Social Support Questionnaire and a scale. The results indicated that the network of social support is a major source of emotional support, aid and affirmation for the mothers, and also it was observed that during labour the main source of emotional support for mothers was the midwife. In addition to these, for the vast majority (85%) of the mothers, childbirth was a positive experience and there was a significant association between the emotional support provided by midwives and mothers' positive experiences of childbirth. 16
6.3 Statement of the problem
A comparative study to assess the psychosocial wellbeing among first time mothers following caesarean and normal delivery in selected hospitals at Gulbarga
6.4 Objectives of the study
1. To assess the psychosocial wellbeing among first time mothers following normal delivery.
2. To assess the psychosocial wellbeing among first time mothers following caesarean section.
3. To compare the psychosocial wellbeing among first time mothers of normal delivery and caesarean section.
6.5 Operational definition
Psychosocial wellbeing: In this study, psychosocial wellbeing refers to the behavioral response with regard to psychosocial status as expressed by first time mothers following delivery.
First time mothers: In this study, first time mothers refer to primipara who have delivered either male or female child.
Normal Delivery: In this study, it refers to the normal vaginal delivery.
Caesarean section: In this study, it refers to the operative intervention performed on the pregnant woman to extract the baby through the abdomen.
Selected Hospital: In this study, it refers to hospitals of government and private sectors at Gulbarga
6.6 Assumptions
1. Psychosocial wellbeing is dynamic concept.
2. First time mothers are susceptible to psychological breakdown following delivery.
3. Birth of a baby either improve or deteriote psychosocial well being of a mother.
4. Mode of Delivery has an impact on psychosocial well being of a mother.
6.7 Hypothesis
H1 There will be a significant association between psychosocial well being among first time mothers following normal vaginal delivery and selected baseline variables.
H2 There will be a significant association between psychosocial wellbeing among first time mothers following caesarean section and selected baseline variables.
H3 There will be a significant difference in psychosocial well being scores of first time mothers following normal vaginal delivery and caesarean section.
6.8 Delimitation
The study will be delimited to:
1. First time mothers in the age group of 20-30 years.
2. Selected hospitals of Gulbarga.
7. MATERIAL AND METHODS
7.1.1 Source of data
Data will be collected from first time mothers
7.1.2 Research design
Descriptive design will be used for the study.
7.1.3 Setting
The study will be conducted in selected hospitals of Gulbarga.
7.1.4 Population
Primipara mothers.
7.2 METHODS OF DATA COLLECTION
7.2.1 Sample size
Total 50 (25 mothers with normal vaginal delivery & 25 with caesarean section )
7.2.2 Sampling technique
Convenient sampling technique will be used to select the sample.
7.2.3 Inclusion criteria
1. Primipara mothers who have undergone normal vaginal delivery
2. Primipara mothers who have undergone caesarean section
3. Who are willing to participate in the study.
5. Primipara mothers who are able to read & write either Kannada or English
6. Primipara who have given birth to a live baby
7. Primipara who has delivered either male or female child
7.2.4 Exclusion criteria
1. Primi mothers with co-morbidities either physical or mental
2. Primi mothers who are above the age of 30 years
3. Primipara who had still birth
7.2.5 Instrument intended to be used
1. Baseline proforma
2. Psychosocial wellbeing scale.
7.2.6 Data collection method:
After getting prior permission from the concerned authorities, the investigator will seek and collect the data by using baseline proforma and psychosocial wellbeing scale. Survey approach is used to collect the data from first time mothers who have undergone either normal vaginal delivery or caesarean section & who are admitted in the maternity wards of selected hospitals at Gulbarga. The data will be collected after one day of normal vaginal delivery and caesarean section.