RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-11
PROFORMA FORREGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS(IN BLOCK LETTERS) / MS. ASWATHY SURESHS.C.S COLLEGE OF NURSING SCIENCES
K.E.C.T TOWER
ASHOKNAGAR, MANGALORE-06
2 / NAME OF THE INSTITUTION / S.C.S COLLEGE OF NURSING SCIENCES
ASHOKNAGAR, MANGALORE-06
3 / COURSE OF STUDY AND SUBJECT / IST YEAR MSC NURSING
OBSTETRICS AND GYNECOLOGICAL NURSING
4 / DATE OF ADMISSION TOTHE COURSE / 28-6-2012
5. / TITLE OF THE STUDY:
“A STUDY TO ASESS THE KNOWLEDGE ON LABOUR PROCESS AMONG PRIMIGRAVIDA MOTHERS IN SELECTED HOSPITALS AT MANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”.
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8. / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Nature has designed labour and birth simply and elegantly. Although every labour and birth is unique, the process is remarkably and beautifully constant. Childbirth is also called labour (birth, partus, or parturition).A pleasant labour provides safe child birth to the mother.1 Labour process is a more painful situation of every primigravida women. They will have stress and anxiety during labour.2
Pain is unpleasant, complex, highly individualized phenomenon with both sensory and emotional components, pregnant women commonly worry about the pain they will experience during labour and how they will react to and deal with that pain. A variety of childbirth preparation methods can help the women or couples cope with the discomfort of labour. The child birth education regarding labour management helps to cope with the discomfort of the labour and also helps to understand the potential benefits to the mother regarding natural birth process.3
Although each labour and delivery is different, most follow a general pattern. Therefore an expectant mother can have a general idea of what changes will occur in her body to enable her to deliver the baby. 4
6.1 Need for the study
At least half of the world population comprises of women and sooner or later almost all of them undergo the primigravida phase of life. In India, most mothers have poor knowledge of ante-natal and intranatal care available to them5.
Fear related to pregnancy and childbirth is common. A variable number of 20% to 78% of pregnant women report fear associated with the pregnancy and childbirth. However 13% of nongravid women report fear of childbirth sufficient to postpone or avoid pregnancy. Fear can be more common and more intense in nulliparous than in parous women. In many cases, with increasing frequency, childbirth is achieved through caesarean section, the removal of the neonate through a surgical incision in the abdomen rather than through vaginal birth. Studies reveal that that there is increase rate of caesarean section due to inadequate knowledge of labour process.6
Child bearing period is an important and precious stage in the life of a woman which needs a lot of care during entire period of pregnancy until the birth of the child takes place. Women should have adequate information prior to labour. Series of events take place in the vagina in an effort to expel the viable products of conception out of womb through vagina into the outer world is called Labour. This information is also needed to allow women to make their own choice based on good unbased evidence. The complex, physical, psychological and emotional experience of labour affects every woman differently.7
A qualitative study was conducted to describe the women's perceptions on the effectiveness of antenatal education on pregnancy, childbirth and the post-partum period and also to describe their impressions on the type of education received in Izmir, Turkey. The sample consisted of 15 primipara mothers. Data was gathered through semi structured interviews and analyzed by using the content analysis method. The findings revealed that education has positive effects on pregnancy, childbirth, breastfeeding, motherhood and infant care, and it relives fear of childbirth. It was also discovered that the study participants were much more satisfied with attending group sessions.9
Primigravida mothers usually have difficulty in recognizing the changes that occur in the body that cause discomfort during her pregnancy. This affects the mothers psychological factors because of lack of knowledge of pregnant women. Lack of knowledge can also lead to increase the stress related to labour process. Effective education will help to reduce the anxiety and provides a pleasant labour to primigravida mother.8
An experimental studywas conducted in Dr. Prabhakar kore hospital at Belgaum, regarding knowledge and reducing anxiety about labour among primigravida mothers. The sample consisted of 60 primigravida mothers, The study methodology had one group pre-test-post-test design. The result showed that in thepre-test majority of primigravida 29(97%) had extreme anxiety and 1(3%) had marked to severe anxiety. In post-test majority 13(43%) had average knowledge, 9(30%) had poor knowledge and 8(27%) had good knowledge on labour process. A structured knowledge questionnaire and standardized self-rating scale was developed. The study suggests the need for education guidance and counselling of primigravida mothers about labour process.10
The promotion of normal childbirth to women, through information and the spread of knowledge is most important it helps to avoids the occurrence and rate of caesarian section and promotes pleasant labor to mother.
Hence the researcher selected the study to deliver the knowledge to primigravida mothers regarding labour process which will help them to control fear and anxiety at the time of delivery.
6.2 Review of literature
A quasi experimental study was conducted in Mangalore regarding birth process in primigravida mothers. The samples consisted of 30 primigravida. The sample was divided into experimental and control group of 15 primigravida women each. Methods used for thestudy was post-test control group design. Data was collected by using observation checklist. The objective was to identify the coping strategy of primigravida mothers in experimental and control group during birth process. The primigravida women in the experimental group had higher mean score (64.3±5.94) for positive coping abilities than that of the control group with mean and standard deviation as 40.60±4.611. There was highly significant difference between mean score on positive coping ability of experimental and control group (t = 12.365, p < 0.001). The study found no association between the coping strategies of both experimental and control group. The study concluded that knowledge regarding birth process helps to reduce anxiety and improves the coping ability of primigravida mothers.2
A descriptive study was conducted in Indore, India, to assess Birth Preparedness and complication readiness (BPACR).The sample consisted of 312 mothers. The mothers were asked whether they followed the desired four steps while pregnant such as identified a trained birth attendant, identified a health facility, arranged for transport, and saving money for emergency. Taking at least three steps was considered being well-prepared. Taking two or less steps was considered being less-prepared. The findings revealed that one hundred forty-nine mothers (47.8%) were well-prepared. Deliveries in the slum-home were high (56.4%). Among these, skilled attendance was low (7.4%); 77.3% of them were assisted by traditional birth attendants. Skilled attendance during delivery was three times higher in well-prepared and complication readiness. The Study concluded that antenatal outreach sessions can be used for promoting birth preparedness11.
A cross-sectional descriptive study was conducted to assess status of Birth Preparedness and Complication Readiness among 2022 recently delivered and pregnant mothers in second and third trimester selected through cluster sampling technique in Rewa, Madhya Pradesh. Data was collected by using pre designed schedule. Seven indicators were derived and mean of seven indicators were taken as birth preparedness and complication readiness index. The findings revealed that Birth Prepareness and Complication Readiness index was found to be 47.5. Birth preparedness and complication readiness index was significantly high in above poverty line families (50.9), higher educational level (63.6). Birth preparedness and complication readiness was significantly higher in multipara (50.9) as compared to primi-para (40.1).12
A comparative study was conducted to compare the process in nulliparous women enrolled in a structured antenatal training programme, with women allocated to routine care in Denmark. 1193nulliparous Women were included in the study. The parameters used for the study included cervical dilation, use of pain relief, medical interventions during the labour process and women’s birth experience. The findings revealed that women who attended the antenatal training programme arrived at the maternity ward in active labour more often than the reference group, and they used less epidural analgesia during labour.The Study concluded that, attending the antenatal training programme may help women to cope better with the birth process.13
A prospective observational study was conducted to assess the benefits of antenatal education during child birth process in Bizkaia, Spain. The sample consisted of 616 low risk pregnant nulliparous women who had attended different number of antenatal education sessions. They were compared in terms of arrival at hospital on time, type of anaesthesia, length of first and second stage, anxiety, type of birth, perineal injury. The findings revealed that antenatal mothers who had attended antenatal education classes experienced less anxiety during birth than those who had not (hospital anxiety and depression scale score adjusted difference= -1.5, 95% confidence interval = -0.1 to -3.0).The study recommended that antenatal education is necessary.14
A quasi experimental study was conducted to develop and evaluate a childbirth educational programme at Blantyre, Malavi.The sample consisted of 109 pregnant women attending ante natal clinic. A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of pregnant women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. The findings revealed that an overall significant increase in knowledge across all time periods was demonstrated (P < 0.01). The study concluded that childbirth education programme, was associated with increasing in maternal knowledge regarding antenatal, labour and birth.15
6.3. Statement of the problem
“A STUDY TO ASSESS THE KNOWLEDGE ON LABOUR PROCESS AMONG PRIMIGRAVIDA MOTHERS IN A SELECTED HOSPITALS AT MANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.”6.4. Objectives
1. To assess the level of knowledge of primigravida mothers on labour process as measured by using structured knowledgequestionnaire.
2. To find an association between the knowledgescoresof primigravida mothers with selected demographic variables.
6.5 Operational definitions
Knowledge:
It refers tocorrect responses given by the primigravida mothers on labour process as measured by structured knowledge questionnaire.
Labour process:
In this study labour process includesconcept of events in different stages oflabour, nutrition, position and ambulation during labour.
Primigravida mothers:
It refers to primigravida mothers who are in the 3rd trimester and attending the antenatal OPD in selected hospitals at Mangalore.
Information booklet assisted teaching:
It refers to a systemically organized teaching material with the help of information booklet on concept of events in different stages oflabour, importance of nutrition, position and ambulation during labour, designed for primigravida by the investigator.
6.6Assumptions
The study assumes that:
· primigravida mothers have inadequate knowledge about labour process
6.7Projected outcome / Hypothesis
The study is based on following hypothesis, and it is been tested at 0.05 level of significance.
H1There will be a significant association between the knowledge scores of primigravida mothers with selected demographic variables.
6.8 Delimitations
The study delimited to,
Primigravida mothers who are in the 3rd trimester and attending the antenatal OPD in selected hospitals at Mangalore.
MATERIALS AND METHODS.
7.1. Source of data collection
Data will be collected from primigravida mothers who are in the 3rd trimester and attending the antenatal OPDin selected hospitals at Mangalore, who fulfil the inclusion criteria.
7.1.1. Research Design
The research design adopted for the study is Descriptive design.
7.1.2. Setting of the study
The study will be conducted in selected hospitals at Mangalore, Dakshina Kannada Karnataka.
7.1.3. Population
Population consists of all primigravida mothers who are in the 3rd trimester and attending the antenatal OPDin selected hospitals at Mangalore.
7.2. Methods of data collection
7.2.1. Sampling procedure
Purposive sampling technique is used in this study.
7.2.2Sample size
100 primigravidamotherswho are in the 3rd trimester and attending the antenatal OPD inselected hospitals atMangalore.
7.2.3. Inclusion criteria
The study will include
· Primigravida mothers who are in the 3rd trimester and attending the antenatal OPD.
· Primigravida mothers who can read Kannada.
7.2.4 Exclusion criteria
The study will exclude
· Primigravidamothers withhigh risk pregnancy.
· Primigravida mothers who are not willing to participate inthe study.
7.2.5. Instruments intended to be used
It consist of two parts
Part 1 : Demographic Performa
Part 2: Structured knowledge questionnaire: A structured knowledge questionnaire will be developed to determine the knowledge of primigravida mothers on labour process.
7.2.6. Data collection method
The data will be collected after getting permission from concerned authorities of selected hospitals at Mangalore. The researcher will introduce herself to the participants. The objectives of the study will be explained and written consent will be taken from participants. Data will be collected by structured knowledge questionnaire. At the end a well-designedinformation booklet on labour process will be distributed among the participants.
7.2.7. Plan for Data Analysis
The collected data will be analysed by using descriptive and inferential statistics.
7.3. Does the study require any investigations or intervention to be conducted on patients or other animals?
Yes, an information booklet will be administered to the primipara mothers.
7.4. Has ethical clearance been obtained from your institution?
Yes, ethical clearance has been obtained from the ethical committee of the institution. Consent from the samples will be taken at the time of data collection.
LIST OF REFERENCES
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2. Adin, Leena.A planned teaching on child birth process in a selected hospital at Mangalore. Available from: http://hdl.handle.net. /123456789/4275.
3. Honour birthMother-Friendly Care: Available from:www.Motherfriendly.org.
4. Brown HL.Introduction to normal labour and delivery,Women’s health issues:Available from :http://www.merckmanuals.com
5. José M. Belizán, Jeremy A Lauer, Fernando Althabeetal. Unnecessary Caesarean Sections:World Health Report (2010).Available from:www.who.int/health system/topics/..
6. Mehta A, Sharma B, Bakshi R. Fear of pregnancy and childbirth:Internet journal Of Gynecology and Obstetrics 2008. Available from:http://www.ispub.com
7. D.C Dutta.Text book of obstetrics. Regarding normal labour. 6thedition.Culcutta, newcentral agency publications; p.114.
8. Anen dos diosas.facing anxiety primigravida labour process:Indonesian-stylehealth.Available from: http://www blogspot.com.
9. Serçekuş P,Mete S. Turkish women's perceptions of antenatal education:InNurse Rev.2010 Sep; 57(3):p.395-401.
10. Gayathrik.v,SudhaA,Raddi,MC,Metgud.Effectiveness of planned teaching programme on knowledge and reducing anxiety about labour: at Belgaum. South Asian federation of obstetrics and gynaecology, May-Augest2010.p.163-168.
11. Agarwal S,Sethi V,Srivastava K,Jha PK,Baqui AH. Birth preparedness and complication readiness among slum women in Indore city2010 Aug; 28(4):p.383-91.
12. Kushwah SS,Dubey D,Singh G,Shivdasani JP,Adhish V,NandanD.Birthpreparedness & complication readiness in Rewa District of Madhya Pradesh:Indian J Public Health.2009 Jul-Sep; 53(3):p.128-32.
13. Maimburg RD,Vaeth M,Dürr J,Hvidman L,Olsen J .structured antenatal training sessions to improve the birth process at Denmark:BJOG.2010 Jul; 117(8):p.921-8.
14. Artieta-Pinedo I,Paz-Pascual C,Grandes G,et al. The benefits of antenatal education for the childbirth process in Spain:Nurs Res.2010 May- Jun; 59(3):p.194-202.
15. Malata A,Hauck Y,Monterosso L,McCaul K. Development and evaluation of a childbirth education programme for Malawian women:JAdvNurs.2007 Oct; 60(1)p.:67-78