A STUDY TO ASSESS THE EFFECTIVENESS

OF BACK MASSAGE DURING FIRST STAGE OF LABOUR

AMONG EXPECTANT MOTHER’S,

IN SELECTED MATERNITY HOSPITAL, IN GULBARGA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Mrs. GOUSIA BEGUM

M.Sc. Nursing – 1st YEAR

AL - KAREEM COLLEGE OF NURSING GULBARGA

2012-2013

“RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA BANGALORE”

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

01 / Name of the Candidate and address (in block letters) / Mrs. Gousia Begum
1st YEAR, M.Sc., NURSING AL-KAREEM COLLEGE OF NURSING, GULBARGA
02 / Name of the institution / AL-KAREEM COLLEGE OF NURSING
BAREY HILLS, NEAR ADARSH NAGAR
GULBARGA-585104
03 / Course and study of subject / M.Sc., NURSING OBSTETRICAL AND GYNAECOLOGICAL NURSING
04 / Date of admission / 01-08-2012
05 / Title of the topic / “A STUDY TO ASSES THE EFFECTIVENESS OF THE BACK MASSAGE DURING FIRST STAGE OF LABOUR AMONG EXPECTANT MOTHER’S, IN SELECTED MATERNITY HOSPITAL’S, IN GULBARGA

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Woman is great

Yes, women is greatest of all

She is determined and quite stead fast

Whether rich or poor every women

Suffer from agony and pain

But, with her sole determination

She brings in her life all again.

------Rajani Nair

It is very difficult to describe a woman. She comes in different forms at every stage of our life. To provide warmth and ample of love. The reproductive process through which a new baby is conceived, incubated and ultimately born in to the new world.

Pregnancy is a unique, exciting, and often joyous time in a woman’s life , as it highlights the woman’s amazing creative and nurturing powers while providing a bridge to the future pregnancy comes with some cost , however , a pregnant woman needs also to be a responsible so as to support the health of the future child. The growing foetus depends entirely on the mother’s health for all needs. The most important consideration in pregnancy is that there are in fact two individuals that receive the treatment i.e. mother and baby, many facts of pregnancy are covered starting with preparation,planning stages, moving through conception, foetal development, labor and post partum changes.

The reality is that, the mother will bear the child for forty(40) weeks and gives birth to baby. The life of baby exists in mother.Mother means love, sacrifice,forgiveness, patience and protection etc. It can not be returned or measured says Kola Bhaskara Rao, in his article “Ammantae? ". To become a mother she has to undergo painful labour process .

Labour purely is physical sense . it may be described as the process by which the foetus,placenta and membranes are expelled through the birth canal ( Myles , 2003 ).Whatever happens during the labour can effect the relationship between mother and baby can influence on future pregnancies.The length of labour varies widely and it is influenced by parity, birth interval, psychological state, presentation , position of foetus, maternal pelvic shape ,size and the character of uterine contractions. Labour is considered to be normal, when the mother is at near to term, no complications exist , a single foetus presents by vertex , and labour is completed within twenty four hours.

There are mainly four stages of labour. The first stage of labour is considered to be first from the onset of regular uterine contractions to full dilatation of cervix .The second stage OF labour last of from full dilation of cervix birth of foetus. birth of foetus. The third stage of labor lasts from birth of foetus, until the placenta is delivered The fourth stage starts from expulsion of placenta to six weeks of post – natal period. Labour usually starts within two weeks estimated date of delivery. On average , labour starts 12-18 hours in a woman's first pregnancy and tends to be shorter , averaging 6-8 hours in subsequent pregnancies.

The first stage of labour has been divided in to three main phases . The latent phase , active and transition phases . The first stage of labour begins with regular uterine contractions and ends with complete cervical dilatation at 10 cm . Friedman says that the latent phase begins with mild , irregular uterine contractions that softens the cervix. The contractions become progressively more rhythmic and stronger. This is followed by the active phase of labour , which usually begins at about 3-4 cm , of cervical dilatation and is characterized by rapid cervical dilatation and descent of presenting foetal part . The first stage of labour completes with 10 cm . of cervical dilatation when each time she delivers a baby.Tt is a new life to mother.

Although each labour is different, by far the greater part of labour is taken up by the first stage of labour.Labour pain represents the most common form of acute severe pain and lack of its treatment results in severe psychological effects lasting in late stage of life. Pregnant women are mostly worried about pain. It is said that the eradication of pain is purchased at a price. The pricein the form of increased anesthetic morbidity or mortality. The treatment involves managing two people Mother and New born. In India ,still there is lack of awareness and need for relief of labour pain in clients and Obstetricians. This is still taken as joyous occasion of a new birth by the family. Obstetricians also are still developing their attention to safe birth, instead of treating mothers pain , which is still taken as curse of God to Eve .

Pain and its relief for women in labour has been subject of interest since the dawn of Mankind. “Pain is unpleasant, sensory , emotional experience associated with actual or potential tissue damage or described in terms of such damage ‘’ ( American pain society , 2003 ).Pain in labour is universal experience for child bearing women. A variety of factors affect the intensity and amount of pain experienced by women ; is based on , perception of pain , tolerance of pain , communication of pain, cultural characteristics and environment of pain – whether in hospital or at home etc., The pain perceived mainly during first stage of labour is located at lower portion of abdomen and radiated to lumbar area of back and down to thighs.

The psychological stressors of life events are noxious stimuli which exacerbate or reappear in lower back ache . Pain is caused by stimulus. Increased activity of sympathetic nervous system may occur in response to pain resulting in changes in pulse , respiration , blood pressure , skin colour , “ Pallor and Diaphoresis ‘’ (Rottery & Perry , 1995 ) . Pain sensation may be distinguished from other sensations, all though experiences such as fear and anxiety are experienced at the same time .

The essence of midwifery can be ‘with woman’ providing comfort in labour. Touch communicates caring and reassurance . Manual healing methods used today during delivery include touch and massage therapy. Painful uterine contractions can be treated by applications of pressure with the hands to womans back , hips, thighs and sacrum. By massage therapy , pharmacological management during the first stage of labour can be reduced . So less negative effects will be there on foetus and mother . (Lee et al ) .

Massage stimulate the body to release endorphins , which are natural pain killing substances and stimulates for the production of oxytocin , decreases stress hormones and neurological excitability.The individual cells of body are dependents on abundant supply of blood and lymph because these fluids supply nutrients , oxygen and carry waste and toxins . Hence, these can be achieved by massage ( Patricia 2007 ).

6.1NEED FOR THE STUDY

Expecting a baby is definitely one of the most joyful experiences in a women’s life. The child birth for a mother is an important contribution to parenthood and is highly personal and individual experience. Journey in life is equally important as arriving at the destination.”The journey towards giving child birth may be long and painful experience but the result is very sweet ‘’ ( Trainer 2002 ) . The experience of pain during labour is complex , individual and multifaceted response to sensory stimuli generated during child birth . The most important consideration in pregnancy is that there are in fact two individuals receiving the treatment the mother and the baby ( than suet Las , Lee tat Leang ) .

Labour and delivery cause pain in most patients . Nulliparous are more likely to experience severe pain than multi parous women (Melzack 1984 ) .Pain may be aggravated by anxiety , fear, maternal expectations and mothers state of preparation for delivery. It increases maternal oxygen consumption , cardiac out put , circulating catecholamine levels (Schinderetal 1983 ). The rise in serum catecholamine can cause foetal tachycardia , bradycardia and contractions . The technique should therefore be taken in to consideration of maternal wishes and preferences , available expertise, support of staff and facilities . Practice in various countries vary culture to culture the technique used should be cheap , easy to administer, good and reliable relief from pain .

Attempts to minimize the pain of labour is non pharmacologically first began in 20th century . Natural child birth was pioneered by Grantly Dick Read in 1932 . He suggested that pain of child birth is brought about by fear and tension and recommended passive muscle relaxation to reduce the pain ( Dick Read 1933, 1944 ) .

The psychoprolaxis is a technique which involves educating mother about functioning of her body and physiology of labour . It originated in Russia and was later popularized in France by Lamaze ( Lamaze 1958 ) . Leboyer ( 1975 ) advocated a modification of natural child birth and advised delivery in dark and quiet place with massage of new born , and warm bath for the baby shortly after delivery . He claimed that the technique produced a happier and healthier neonate . The other techniques include simple emotional support from patient partner or another labour companion, touch and massage , the application of hot or cold compress , hydrotherapy , adoption of vertical position and husband companion, ambulation during early labour, using squatting position or birthing chair and may aid maternal comfort ( Minnich 1994 ) .

During 1930 and 1940s influence of massage decreased as a result of medical advancements of the time . Since 1970s , the influence grew once again , because of public and medical acceptance of the value of massage and increased consumer usage of massage therapy . In 1997, United States health survey showed that there was an estimated 14 million visits to massage therapist by women .

Massage therapy is the most commonly used type of complementary and alternative medicine. People states that they use massage because it relives pain , reduces stress and enhance relaxation and increases general well being. Touch and manipulation with the hands has been used in the practice of medicine since its inception . “the value of touch and massage and polities Effect’’(Alwyn & Hurtley Keyword ) . Massaging muscles and other tissues not only relaxes the muscles but also alleviates pain.

Massage therapy during labour , helps to reduce side effects like nausea , vomiting, drowsiness, decreased gastric emptying , respiratory depression at birth , decreased variability in the foetal heart rate . Gentle massage to relieve problems such as back-ache , oedema , head-ache and other minor complaints.

Massage is the application of pressure with both hands on mother’s back, it helps the body to release endorphins. which are natural pain killing substances and stimulates the production of oxytocin, decreases the stress hormones and decreases the neurological excitability. The individual cells of body are dependent on supply of blood and lymph, because these fluids supply nutrients, oxygen and carry waste toxins. Hence, these can be achieved by massage.

The American Massage Therapy noted that 47% of the people polled in a consumer survey, used massage therapy to relieve and manage their labour pain and 91% of the people said massage therapy was effective in reducing pain.

A study was conducted by Mrs. Padmavathi(2002) conducted a study on effects of back Massage during the first stage of labour in Raichur.On experimental group (n=30); control group (n=30).The‘t’-Test shows that significant difference between experimental and control group. This study concluded that continuous back massage from beginning till the end of first stage of labour had significantly reduced pain, anxiety and fatigue levels in experimental group.

Chang et al conducted a study on 60 primipara mothers. They are assigned as experimental group n=30. In experimental group, the woman received 30 min massage during each contractions first 30 min by the researcher, then by the partner during the three (3) phases of labour. The intensity of pain between the two groups were compared with latent phase (cervix dilated 3-4 cm.), Active phase (5-7 cm) and transitional phase (8-10cm).Finally, ‘t’-Test demonstrated that massage group had significantly lowered pain in latent, active and transitional phases.

Very few studies are being conducted in this area, may be due to lack of knowledge among nurses regarding contemporary non pharmacological management for pain relief during the first stage of labour . To take an active step in managing pain and anxiety during first stage of labour . Hence, the investigator felt the need to assess the effectiveness of back massage during the first stage of labour among expectant mothers , which in turn helps nurse to practice the same on mothers during their laboring process .

6.2 REVIEW OF LITERATURE

Review of literature is a broad systematic, critical collection and evaluation of the important scholarly published print material. it serves an evidence and essential background for any research . It helps the researcher to formulate and clarify the research problems. In order to accomplish the goal of present study , an attempt has been made to review and discuss the literature which shall cover the following areas.

Literature related to complementary and alternative therapies in labour.

Literature related to massage therapy in labour.

Chang et al “ complementary and alternative medicine ‘’ ( December , 2008 ) stated that Aroma Therapy uses essential oils extracted from aromatic botanical sources to treat balance the mind , body and spirit . it combines the physiological effects of massage with use of essential oils . One of the purpose of this method is to relieve anxiety and stress help in relaxation. Massage around lower back with jasmine , juniper , geranium, clay sage , rose and lavender have been reported to provide subjective benefit to labour.

Backmann MM (2007 ) conducted a systematic review on “ back aches related to pregnancy : the risk factors , etiologies , treatments, controversial issues”. On 5th December2007’ in North America , the findings of study presented that Non – pharmacological or complementary treatments such as posture adjustment, acupuncture , physical therapy, physiotherapy , yoga are the first line of treatment options. Both allopathic and complementary medicines are frequently used as treatment for backache related to pregnancy.

SM Kalus , et al ( 2007 ) conducted a randomized trail on “ Managing back pain pregnancy using a garment ‘’ in the University of Norte Dame , Australia , Borac Way , New South Wales , Australia . The aim of this study was to determine whether the use of belly bra in pregnant women with back pain is associated with changes in assessment of pain severity , physical activity and satisfaction with life after 3 weeks of intervention compared with turbigrip , a generic form of support .Study was conducted on pregnant women between 20-36 weeks of pregnant women with lumbar back or posterior pelvic pain. On 200 women, the mean analogue scale score of pain severity decreased from 6.1 to 4.5 in the device group, ( P= 0.001 ) and from 6.0 to 4.7 in the control group ( P= 0.003 ) . The likert scale assessment of the impact of back pain on sleeping (P= 0.007 ) , getting up from a sitting position ( P=0.002 ) and working (P= 0.001) than the control group.There was also significant reduction in the use of analgesic medication in the study group ( P= 0.01 ) . The study concluded that Belly Bra and turbigrip were both associated with a reduction in severity of pregnancy related to low back pain.

C.Bhargavi ( 2009 ) Conducted a study on effectiveness of lower back massage during first stage of labour , study conducted on 60 primi para mothers . Experimental ( 30 ) and control group ( 30 ) , lower back massage administered for experimental group through out first stage of labour . The findings show that the lower back massage was found to be an effective strategies in reducing pain, “ t ‘’ value computed ( t=33.15 ) which was significant at p < 0.01 .

Decemve (2007 ) conducted a comparison of massage effectiveness on labour pain by using the Mc Grill pain questionnaire . The purpose of the study was to describe the characteristics of pain during labour with and with out massage . Sudy was conducted on 60 prime para mothers. Data was collected by Mc Grill pain questionnaire at three phases of cervical dilation . Massage is given for experimental administrated for control group . The results of the study concluded that although massage can not change , the characteristics of pain experienced by women in labour . Tt can effectively decreases the labour pain intensity of first and second stage stage at cervical dilatation.

6.3STATEMENT OF THE PROBLEM

“A study to “assess the effectiveness of back massage during the first stage of labour among expectant mothers in selected Maternity Hospital’s in Gulbarga .’’

6.4 OBJECTIVES OF THE STUDY

The objectives of the study are to

  1. To assess the intensity of pain and anxiety among expectant mothers of experimental and control group during first stage of labour.
  2. To give back massage to the mothers of experimental group during first stage of labour.
  3. To analyse the significant difference between experimental and control group in terms of pain and anxiety by t- test .
  1. To see the association between post test scores of pain and anxiety with selected demographic variables of experimentalgroup andcontrol group.

6.5OPERATIONAL DEFINITION

1)ASSESS:

To determine the effectiveness of back massage during first stage of labour.

2)EVALUATE :

To determine the effectiveness of back massage during first stage of labour

3) EFFECTIVENESS :

It is difference between response scale score before and after back massage during first stage of labour .