RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MS. VINUTHA .N.GNO.5, NOOR HOSTEL
BHOOPASANDRA
MAIN ROAD, RMV II STAGE,
BANGALORE-94.
2 / NAME OF THE INSTITUTION / NOOR COLLEGE OF NURSING,
NO.5, BHOOPASANDRA
MAIN ROAD, RMV II STAGE,
BANGALORE-94.
3 / COURSE OF THE STUDY AND SUBJECT / M.SC. NURSING, 1ST YEAR,
OBG NURSING
4 / DATE OF ADMISSION /
01.10.2010
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE KNOWLEDGE REGARDING ICE MASSAGE ON LABOUR PAIN REDUCTION AMONG STAFF NURSES IN SELECTED HOSPITAL AT BANGALORE WITH A VIEW TO DEVELOP INFORMATION PAMPHLET”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Pregnancy is considered as a very precious event in every woman's life. It is filled with happiness, joy and surprises. Every parents hopes for a healthy baby, but may sometimes become sorrowful when danger sets in either to the mother or to the fetus. Pregnancy links mother and fetus together and is the basis for regenerating the generation. Most pregnancies and with work of a live baby to a healthy mother. In high risk pregnancies the mother may sometimes escape death but fetus and neonates often become the victim.1
Childbirth is one of the most memorable and rewarding events of a couple’s life. No matter how often a woman gives birth, each experience is an intimate and unique celebration of life. Though labour and delivery are not without pain and some degree of anxiety, if the mother remains confident, well informed and fully supported by the caregivers, she is likely to have no problem handling the awesome task of bringing a child into the world. 2
While labor can seem like a scary experience for many pregnant women, there are a variety of methods through which to cope with pain during labor. Some of these methods work by easing labor pain naturally, while others reduce the pain of birth medically. Pain during labour is caused by the contractions of the uterine muscles of the body, as well as pressure on the cervix. Some women experienced all over body cramps including in the abdomen, groin and back, while others feel pain on their sides and thighs. Women may describe pain during labor as being similar to menstrual cramping, while others describe it as feeling extreme pressure on their bodies.3
Massaging with the ice helps to avoid use medical intervention during labour to reduce pain. Other benefits of Massage in acupoint during labour such as: to induce labour naturally, better cervix dilatation, speed up slow early labour, helps baby to descend, turns a posterior baby, stimulate and strengthen labour contractions and most effectively it relieve labour pain to great extend. It helps body to work better in an optimal way and because pressing specific spots along with the skin could start labour in a safe and natural way in 48 hours.4
An increasing number of pregnant mothers and pregnancy care professionals use acupressure today, if this technique had caused any distress for the mother or the baby the labour acupressure would have disappeared long ago. It has been shown that acupressure prevents the baby from becoming distressed, because it makes labour easier and shorter and helps to avoid medical interventions for to reduce pain. 11 Maternity Acupressure is safe for mother and baby. Simple labour acupressure techniques give effective labour pain relief, without any risk of stopping the contractions.5
Much of the women’s new or changed role in tried out, developed and refined in fantasy, imagination and day dreaming. The important activity of a nurse is patient teaching. Teaching includes information on promotion of health, prevention of disease or complications, early diagnosis and treatment. Involving patients in their care has demonstrated improved outcome in terms of gain in knowledge and skill. This facilitates decision making and encouraging them to perform simple clinical skill. 6
6.1 Need for the study
As the mother progress from the early to the active phase, her attention focuses completely on labour and she may begin to long relief from the pain and tension of labour. Though medication is an obvious solution for your discomfort, she must consider the safety for the baby as many drugs cross the placenta and affect the baby7
Labour or maternity acupressure is a safe and natural holistic method that can have an extremely positive effect in preparing the mother and the baby for the birth. It is a very simple hand – on non-intrusive techniques that is similar to acupuncture – but without the needles. It uses only application of pressure on specific spots on the skin and can be safely used at home with basic instructions.8
A wide variety of cognitive, behavioural, and sensory interventions may contribute to a mother’s pain management and overall sense of comfort. Included among the benefits of using non-pharmacologic pain techniques in labour are their attributes of being nonintrusive, non-invasive, low-cost, simple, effective, and without adverse effects. Non-pharmacologic methods have been shown to promote a higher satisfaction with the labour experience because of perceived control and empowerment.9
Studies show that over 80 percent of pregnant mothers using acupressure to induce labour naturally, experience a normal and natural childbirth with significantly less complications than others who are not familiar with this technique. The use of labour acupressure also significantly shortens the total labour time. Women who have used acupressure during pregnancy and childbirth have been incredibly satisfied with the results of this method in reducing the labour pain. The midwife has an important enabling and facilitating role to help the woman maintain control of pain during childbirth.10
It is hoped that a greater use of techniques can contribute to better outcomes, lower costs, and higher patient satisfaction. Continued investigation is needed to determine pain-relief strategies that are safe and effective and enhance patient satisfaction during the birth experience, which is one of life's most memorable and challenging experiences.11
Acupressure—the application of finger pressure or deep massage to traditional acupuncture points located along the body's meridians or energy flow lines—has been reported to reduce labour pain among women in labour. Simple labour acupressure techniques give effective labour pain relief, without any risk of stopping the contractions. Acupressure has been actively used by millions of people for almost four thousand years.12 This ancient technique has also been studied in depth by Western institutions for several decades. It has also been proven to be safe by the World Health Organization (WHO) and the US National Institutes of Health (NIH), among other reputed research institutions. If you can press a spot on your skin with your thumb, you can do acupressure too.12
Cold application is a simple and inexpensive therapy which has been accepted for decades as an effective non-pharmacologic intervention for pain management. It increases the pain threshold. Cold is commonly used in the treatment of acute soft tissue injuries and has been shown to reduce pain effectively in the post-operative period after orthopaedic surgery procedures. The evidence base to support the common practice of superficial cold is limited and there is a need for future higher-quality randomised controlled trials. The purpose of this review is to explore the literature regarding the physiologic effects of cold, the effectiveness of cold, different modalities used for cold application, and the potential complications associated with the use of cold application.13
The nurse has a vital role to play as they have opportunity to give Care to the mothers regarding the simple yet effective method of labour pain reduction .Sharing the following information with the mothers help them understand what is happening and more aware of the activities of pain reduction. Nurses should assess the existing knowledge in the labour pain reduction . By considering all the above, the researcher felt that there is a need to know about the effectiveness and the technique to apply the ice massage in the particular area during labour and to observe the outcome of it by using Visual Analog Scale (VAS) Hence the investigator designed the study to assess the knowledge regarding ice massage on labour pain reduction among staff nurses.
6.2 REVIEW OF LITERATURE
Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the study. It is an essential part of every research, which helps to support the hypothesis under the study and to critically analyse the structure and content of the research report. Review of literature makes the researcher familiar with the existing studies and provides information, which helps to focus on a particular problem and lays a foundation upon which the new knowledge can be based.
Ø The literature related to ice massage as follows
A study was conducted with the purpose to evaluate the effects of Sanyinjiao point SP6 acupressure on labor pain and delivery time in women in labor. The design was randomized clinical trial. The study was conducted in delivery room. 75 women in labor were randomly assigned to either the SP6 acupressure (n = 36) or SP6 touch control (n = 39) group. The participants were matched according to parity, cervical dilation, labor stage, rupture of amniotic membrane, and husband's presence during labor. There was no additional oxytocin augmentation or administration of analgesics during the study period. For 30-minute acupressure or touch on SP6 acupoint was performed. The outcome of labor pain was measured 4 times using a structured questionnaire, a subjective labor pain scale (visual-analogue scale [VAS]): before intervention, immediately after the intervention, and 30 and 60 minutes after the intervention. Length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilatation, and full cervical dilatation to the delivery. The result shows that there were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention (p = 0.012); 30 minutes after the intervention (p = 0.021); and 60 minutes after the intervention (p = 0.012). The total labor time (3 cm dilatation to delivery) was significantly shorter in the SP6 acupressure intervention group than in the control group (p = 0.006). It is concluded that these findings showed that SP6 acupressure was effective for decreasing labor pain and shortening the length of delivery time. SP6 acupressure can be an effective nursing management for women in labour.14
As current research on massage interventions was designed in light of experimental findings that repeated massage sessions over 14 days increases pain threshold, by an interaction between oxytocin and opioid neurons. A 4 week time-frame was selected to coincide with a physiological increase in maternal pain threshold. The main objective was to measure the effects of the programme on maternal pain perception during labour and birth. To detect any effect of massage during labour, on maternal cortisol and catecholamines, cord venous blood was taken to measure plasma concentrations following birth. Twenty-five nulliparous (N) and 10 multiparous (M) women participated in the study. Cortisol values were similar to published studies following labour without massage but pain scores on a Visual Analogue Scale (VAS), at 90 min following birth were significantly lower than scores recorded 2 days postpartum. The mean score was 6.6. Previous studies suggest that a reduction from 8.5 to 7.5 would significantly reduce pharmacological analgesia in labour.15
A study was conducted to investigate the effects of massage on pain reaction and anxiety during labour. A randomized controlled study was conducted. 60 primiparous women expected to have a normal childbirth at a regional hospital in southern Taiwan were randomly assigned to either the experimental (n=30) or the control (n=30) group. The experimental group received massage intervention whereas the control group did not. The nurse-rated present behavioral intensity (PBI) was used as a measure of labour pain. Anxiety was measured with the visual analogue scale for anxiety (VASA). The intensity of pain and anxiety between the 2 groups was compared in the latent phase (cervix dilated 3-4 cm), active phase (5-7 cm) and transitional phase (8-10 cm). The result shows that, in both groups, there was a relatively steady increase in pain intensity and anxiety level as labour progressed. A t-test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the 2 groups in the latent phase. 26 of the 30 (87 percent) experimental group subjects reported that massage was helpful, providing pain relief and psychological support during labour. Findings suggest that massage is cost-effective nursing interventions that can decrease pain and anxiety during labour, and partners' participation in massage can positively influence the quality of women's birth experiences. 16
This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2-3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women's scores before and after childbirth, indicated by few statistically significant differences, it confirms their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research.17