RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE :
CANDIDATE
ADDRESS / Mr.BUDAN SAHEB. M.PEERWALE,
1st YEAR M.Sc Nursing,
GOVERNMENT COLLEGE OF NURSING, FORT,
BANGALORE : 560002
2. / NAME OF THE : INSTITUTION / GOVERNMENT COLLEGE OF NURSING, FORT,
BANGALORE : 560002
3. / COURSE OF STUDY & : SUBJECT / 1st YEAR M.Sc NURSING
OBSTETRIC AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION TO : COURSE / 20-06-2009
5. / TITLE OF THE TOPIC : / “A STUDY TO ASSESS THE KNOWLEDGE ON POSTNATAL EXERCISES AMONG POSTNATAL MOTHERS WITH A VIEW TO CONDUCT VIDEO-ASSISTED DEMONSTRATION IN SELECTED MATERNITY HOSPITALS, BANGALORE.”

“Perseverance is not a long race; it is many short races one after another”

-WALTER ELLIOTT

INTRODUCTION

Any changes in a mothers body during pregnancy are due to the effects of specific hormone. These changes enable her to nurture the fetus, prepare her body for labour, development of breasts and lay down stores of fat to provide calories for production of breast milk during the puerperium. It is important to discuss the physical and physiological changes during pregnancy and after delivery.4

Following the birth of the Baby and expulsion of the placenta, the mother enters a period of physical and psychological recuperation. The puerperium starts immediately after the delivery of the placenta and membranes and continues for 6 weeks. The overall expectation is that by 6 weeks after the delivery all the systems in the woman’s body will have recovered from the effects of pregnancy and returned to their non-pregnant state. However some women continue to experience problems related to child birth that extends well beyond the puerperium. Postnatal exercises after the baby is born gradually to regain and then improve the former level of fitness. Once the baby is born, women should return to exercising as soon as they feel able but this should be a gradual process. Postnatal depression is less likely in women who return to exercising relatively soon after birth but only if the exercise sessions are positive rather than negative experiences.1

Exercise is physical exertion of the body. The aim of exercise is to achieve a beneficial level of fitness and health, both physically and mentally. One should eventually aim to be exercising vigorously, but if you have not exercised before, or for a long time, you should talk to your obstetrician first about your fitness. It is important exercises following delivery. Postnatal exercises should be encouraged. They help to improve the muscle tone of the abdomen and pelvic floor and also bladder and bowel function.1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

Adequate rest for the new mother is essential immediate after birth. There should be started as soon after delivery as possible in order to improve circulation, Strengthen pelvic floor and abdominal muscles and prevent transient and long-term problems. The pelvic floor muscles have been under strain during pregnancy and stretched during birth and it may be both difficult and painful to contract these muscles postnatally. Mother should be encouraged to try the exercise as often as possible in order to regain full bladder control, prevent incontinence and prolapsed of uterus and ensure normal sexual satisfaction for both partners in the future.2

An experimental study was conducted to evaluate the need for an interactive product on exercise during pregnancy and postpartum using multimedia Compact Disc-Read-Only-Memory. Pregnant and post partum women were randomly assigned to experimental and control group and navigated to through the multimedia on Pregnancy exercises and neutral content respectively for one hour on exercise self-efficacy and knowledge. Findings revealed that experimental group had significant increase in self efficacy and knowledge. Multi-media had signifies delivering information about exercise motivation, guidelines and prescription was effective in improving exercises self-efficacy and Knowledge than that of control group.3

A study was undertaken to estimate the association between pelvic floor muscle training and demographic and health related factors that may influence pelvic floor muscle training postpartum among 17,978 women in the Norwegian. Questionnaires were used to collect the data from women. Results revealed that Women doing regular pelvic floor muscle training were more educated, likely to participate in general fitness activities, and had more children. Women experiencing urinary leakage and pelvic girdle pain postpartum were also more likely to do pelvic floor muscle training suggesting a strong need for more research concerning effective strategies to enhance postpartum pelvic floor muscle training.4

A study conducted on the post natal exercises illustrated is safe and effective and need to practice regularly and increased gradually. This study conducted that postnatal exercises needed for all post natal mothers to maintain their stiffness of pelvic floor muscles and correct posture. It is helpful to minimize the risk of puerperal venous thrombosis by promoting arterial circulation and preventing venous stasis, to prevent backache, to prevent genital prolapsed and stress incontinence of urine.3

Preventing and alleviating the early physical stresses of pregnancy and childbirth, should be taught as a priority. Common consequences of pregnancy and childbirth are the physical problems of pelvic girdle and low back pain or incontinence. The main aim in the postnatal period is to address health care needs and give advice and exercise to reduce the risk of future pelvic floor dysfunction or the possibility of long term back problems so that the women may recover normal function free of from pain. Women whose pain or incontinence problems do not resolve with simple advice and exercises should be referred to women’s health physiotherapist. Some 45 percent of all pregnant women suffer pregnancy related pelvic girdle pain and/or pregnancy related low back pain. Serious pain occurs in 25 percent of pregnant women severe disability in 8 percent of pregnant women by Wu et al 2004, pelvic floor dysfunction occurs in 52 percent of all pregnancy-related pregnancy girdle pain.4

Presently mothers after delivery will be busy in taking care of baby, she won’t give concentration towards her health. So, they are losing the elasticity, stiffness of pelvic floor muscles and suffering with puerperal venous thrombosis, backache, genital prolapsed and stress incontinence. It is necessary to assess the knowledge of post natal mothers regarding post natal exercises. The investigator felt that there is a lack of knowledge regarding postnatal exercises among postnatal mother, it is necessary to provide the knowledge on postnatal exercises among postnatal mothers. So, this study reveals provision of video-assisted demonstration of post natal exercises.

6.2 REVIEW OF LITERATURE

An experimental study was conducted with Systematic review and meta-analysis of randomized controlled trials to evaluate the Effectiveness of exercise in the management of post natal exercises depression among in England. Database searches and abstracts were reviewed independently by two authors with a main outcome measure as post-natal depression. Findings of the study revealed that only five studies fulfilled inclusion criteria. When compared with no exercise, exercise reduced symptoms of postnatal depression 95 percent.5

An experimental study was conducted to evaluate the efficacy of a home-based exercises intervention in reducing physical and mental fatigue scores in postpartum depressed women. Eighty-eight women in the postpartum period from 4-38 weeks obtaining a score more or equal 10 on the Edinburgh Postnatal Depression Scale were randomly assigned to a 12-week individualized home-based intervention where samples were 46 or a control group 42. Outcomes were physical and mental fatigue scores and were measured at baseline, post treatment and 3 months post treatment. At post treatment, mean change is -4.07 and 3 months post treatment mean change is -4.24. Significant reductions in mental fatigue with exercise were observed at post treatment for women reporting lower physical fatigue at baseline. The findings show that home-based exercise can reduce physical and mental fatigue in postpartum depressed women.6

A comparative study was conducted to find the relationship between practice of pelvic floor exercises and stress urinary incontinence after delivery. Postnatal postal questionnaire was used to collect data from 257 women through in the North-East of Scotland. One hundred and sixty-three women responded. Findings of the study revealed that women were practicising pelvic floor exercises after delivery than during pregnancy, 134 i.e. 83.2 percent compared with 123 i.e. 76.4 percent. 6 to 12 months after delivery, 96 i.e. 60 percent women said that they were still doing the exercises. A third of respondent samples are 54, 33.1 percent reported stress incontinence at some time since having the baby. Women who had an operative vaginal delivery like forceps or ventouse delivery were more likely to report the practice of pelvic floor exercises than those having a spontaneous vaginal delivery. The practice of pelvic floor exercises daily or more often during pregnancy was associated with less reported postnatal incontinence compared with less frequent practice.7

A study was conducted a systematic review on unassisted pelvic floor exercises for postnatal stress incontinence to identify effective interventions and highlight areas for further research. The review included randomized controlled trials, published in English, of unassisted pelvic floor exercises in postnatal women. Two reviewers independently extracted data and assessed study quality. Main outcomes were reduction in symptoms of incontinence, patient satisfaction and quality of life. Results revealed that only four randomized controlled trials met the inclusion criteria. Interventions ranged from written information to structured exercise classes, while usual care varied from a leaflet to group sessions with a midwife. Three out of four studies demonstrated short-term improvement in incontinence symptoms, which was statistically significant in two. All trials found that women in the intervention group were more likely to do the exercises.8

A study was conducted to describe the teaching and practicing of pelvic floor muscle exercise before and after delivery among Primiparous women 759 with term singleton delivery were interviewed 6 months after delivery. Findings of the study revealed that Sixty-four percent of the women had been taught Pelvic Floor Muscles Exercises, most with verbal 76 percent and/or written instructions 55 percent and a few 10 percent during pelvic examination. Women with anal sphincter tears were not more likely to receive instruction or reminders after delivery. More women with college education 74 percent were taught and compared with women without a college education 37 percent; Probability is less than 0.0001. Of those women who were taught, 68 percent performed Pelvic Floor Muscles Exercises after delivery, and 63 percent were still performing the exercises 6 months after delivery. Results recommended for tremendous potential for the improvement of Pelvic Floor Muscle Exercises education and targeting at-risk women in the peripartum period.9

A study was conducted Poland to review the existing evidence on the impact of pelvic floor exercises on the occurrence and the role in the treatment of stress urinary incontinence in the perinatal period. Analysis indicated that pelvic floor exercises are a safe and highly effective measure in the prevention of occurrence and treatment of stress urinary incontinence, both antepartum and postpartum. Their performance in the inpatient setting during early puerperium can allow proper physiotherapeutic instruction and supervision without additional admission and costs. Findings of the study suggested for the worldwide peripartum pelvic floor exercises as a preventive method for urinary incontinence on a regular basis.10

An comparative study was conducted to evaluate the effect of post-natal pelvic floor muscle exercise. A prospective comparison design comprising 66 matched pairs samples were 132 of mothers, divided into a training group and a control group was used. The attended an eight week special pelvic floor muscle exercise course, in addition they exercised at home at least three times per week. Pelvic floor muscle strength was measured at the 8th and the 16th week after delivery using a vaginal balloon catheter connected to a pressure transducer. Wilcoxon-Signed-Ranks-Test for matched pairs was performed to compare change in pelvic floor muscle strength within and between groups. Results revealed a statistically significant change in pelvic floor muscle strength in both the Training Group and the Control Group, the improvement for the training group was significantly greater. Concluding that a specially devised pelvic floor muscle strength training programme can add significantly to physical recovery after childbirth.11

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE KNOWLEDGE OF POSTNATAL EXERCISES AMONG POSTNATAL MOTHERS WITH A VIEW TO CONDUCT VIDEO-ASSISTED DEMONSTRATION ON POSTNATAL EXERCISES AMONG POSTNATAL MOTHERS IN SELECTED MATERNITY HOSPITALS, BANGALORE”.

6.3 OBJECTIVES OF STUDY

1.  To assess the knowledge of postnatal mothers regarding postnatal exercises.

2.  To find an association between the levels of knowledge among postnatal mothers regarding postnatal exercises with selected demographic variables.

3.  To conduct video-assisted demonstration on postnatal exercises among postnatal mothers.

6.3.1  ASSUMPTIONS

1.  The postnatal mothers may have some knowledge regarding postnatal exercises.

2.  The video-assisted demonstration may help to improve their knowledge regarding postnatal exercises.

6.3.2 VARIABLES

Demographic Variables : Age, Sex, Educational status, Occupation etc.

6.4 OPERATIONAL DEFINITIONS

a) Assess: Assess refers to the verbal response to the structured interview schedule among the postnatal mothers regarding the knowledge of postnatal exercises.

b) Knowledge: It is the ability of the Postnatal Mother’s correct responses to the structured interview schedule knowledge questions regarding postnatal exercises.

c) Video-assisted demonstration: it is a method of providing the knowledge to the post natal mother’s regarding post natal exercises.

d) Postnatal Mother: Refers to the Mothers up to six weeks after delivery.

7. MATERIALS & METHODS

7.1 Source of data : Postnatal mothers admitted at selected

Maternity Hospitals, Bangalore.

7.2 Methods of data collection

7.2.1 Definition of the Study Subject : Postnatal Mothers up to six weeks admitted

in selected maternity hospitals Bangalore.

7.2.2 Inclusion and Exclusion Criteria

a) Inclusion Criteria : 1. Post natal Mothers admitted in

selected Maternity Hospitals, Bangalore.

2. Mothers who are willing to participate

in the study.

3. Mothers who can understand Kannada or