Rajiv Gandhi University of Health Sciences s37
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate and address(in block letters) / CHINJU JOSE
SAHYADRI COLLEGE OF NURSING
SAHYADRI CAMPUS
ADYAR
MANGALORE-575007.
2 / Name of the institution / SAHYADRI COLLEGE OF NURSING
SAHYADRI CAMPUS
ADYAR
MANGALORE-575007
3 / Course of the study and subject / M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / Date of admission to the course / 30.6.2012
5 / Title of the study
EFFECTIVENESS OF JASMINE OIL AROMA THERAPY ON LABOUR PROGRESS AND PAIN AMONG PRIMI PARTURIENTS AT SELECTED HOSPITAL IN MANGALORE
6 / Brief resume of the intended work
6.1 Introduction
“Motherhood is a gift of god to women.”
- Mother Theresa
The act of giving birth is the only moment when both pain and pleasure converge in a moment of time. This is a miracle. Before the childbirth, the lady was a woman. After the childbirth, the woman is transformed into a mother. This is a revolutionary act; an evolutionary happening; in the manner of the silkworm getting transformed into some angel; this is also a miracle.1
“The greatest pleasure brings greatest pain”, it is said which holds perfectly true for labour pains. The pain of labour has been with us since the Garden of Eden. Labour pain occurs due to contractions, distension of the lower uterine segment, pulling on pelvic ligaments, dilatation of cervix, stretching of vagina and pelvic floor. Pregnancy and childbirth are wonderful and remarkable moments of life. Giving birth to a child can be one of the most joyful experiences of a woman's life, but it is one of the most painful.2
Childbirth does not come easily as it hurts because of all the pain that a woman has to undergo along with the stress and strain when she goes into labour. Sometimes the pain is so intense that it creates a life and death situation for the woman. There are a number of ways where a woman can decide to deliver her baby. The age old custom of giving birth to a baby in the natural way with the help of a midwife to the modern way giving birth to the baby in the hospital surrounded by qualified doctors and nurses.3
Labour pain is an excruciating, intolerable pain which results in changes in blood pressure, pulse, respiration, skin colour and pallor. The mother with labour pain may have bouts of nausea and vomiting, and she may have affective expressions which include anxiety, crying, groaning and excessive muscular excitability throughout the body.3
The management of labour progress consists of pharmacological management and non pharmacological management. The pharmacological management includes narcotics, epidural analgesia, nitrous oxide, tranquilisers, spinal block, and pudendal block. The non-pharmacological management includes massage, guided imagery, meditation, breathing techniques, positions, hot or cold therapy, music and audio analgesia, sterile water injections, calm birth, water birth, hypnosis, acupuncture, acupressure, aromatherapy, reflexology and machine operated, such as TENS or transcutaneous electronic nerve stimulation.4
Among all the non-pharmacological methods for labour progress jasmine oil aroma therapy is one of the best methods. In aroma therapy the treatment is safe, free from side effects, giving lasting cure, and it is compatible with other forms of treatment. Jasmine oil aroma therapy can help accelerating the action of the uterus and make contraction more effective; it can help speed up a labour process that is progressing slowly in primi parturients which is about 16-18 hours, help energies and uplift, giving the confidence to approach labour calmly.4
An experimental study was conducted on primi mothers to investigate the outcomes of labour, duration of labour and labour pain. The results indicated significant reduction of pain and difference in length of the labour after providing inhalational aroma therapy. Thus the study concluded that aroma therapy can be used for reduction of labour pain and duration of labour.4
6.2 Need for the study
Pregnancy is a special time in a woman’s life. Most women give birth without complications. The birth starts with the onset of labour, which is usually marked by the beginning of regular uterine contractions. Pregnancy, childbirth and motherhood are times where a woman undergoes a vast change in her body and it can be termed as an entirely new birth for the woman or time of rebirth. With the changing times, process of birth has also been modernised with less complications and become more capable of handling any complexities of childbirth. Pregnancy and childbirth are wonderful and remarkable moments in women life .5
Birth is the renewal of life. Birth is as ancient as itself and as natural as the process of breathing. A baby is God’s opinion that the world should go on and the birth pangs are just that old order giving way to the new. This is how nature creates a new mother. Giving birth to a child can be one of the most joyful experiences of a woman's life, but it is undeniably one of the most painful. It’s a heterogeneous feeling for a pregnant woman who, within a short span of time will give birth to a life. Labour is usually painful. Studies have shown that pain is registered the same by everyone. Research on labour pain resulted in the interpretation of worst possible pain imaginable. A Patients perception of worst pain imaginable may change over the course of childbirth.5
Childbirth is a special event in a woman’s life and she cherishes these moments all through her life. From the time a woman conceives and all through the period of childbirth there are various physical as well as mental changes that take place. Childbirth is a natural biological process and therefore pain associated with it is also perceived as normal. The nature of pain experienced during labour depends on physical and emotional status of women.5
Human body can bear only up to 45 Del (Unit) of pain. But at the time of giving birth, a woman feels up to 57 Del of pain. 46.2% of women are undergoing normal vaginal delivery; 88% of the primi mothers are experiencing sever labour pain. In 2006 UNICEF, analysis stated that based on the available data from the countries, 79% of births in the developing world were conducted by skilled health personnel. As per community medicine report in India, in Uttar Pradesh 42% were delivered by normal vaginal delivery.5
Ohel L. et al (2007) observed on changes in pain threshold before, during and after labour pain among 40 pregnant women. The study found that there was a significant rise in pain threshold during labour than before and after labour.6
A quasi-experimental study was conducted in Korea to review the effect of aroma therapy on pain and outcomes of the labour. The study concluded that the aroma therapy can lead to decrease in labour pain and duration. Aroma therapy can be replaced as an alternative for pharmacological method7.
A study was done using randomised time series design on the effectiveness of aromatherapy on labour process, labour pain, labour stress response and neonatal stress of primipara. The study was randomised repeated measures over time pre-test post-test design. The subjects were 48 primipara with single gestation full term, uncomplicated pregnancy. As at term the experimental group took aroma therapy with aroma therapy oil (1.5% dilution essential oil of clary sage, jasmine oil and rose oil). The control group took general obstetric care. Data collection was done by assessing general and obstetric characteristics. Data was analysed by ANOVA. As a result the length of deceleration phase of experimental group was significantly shorter than the control group. Thus the study concluded that aromatherapy is effective on labour pain and decreasing the duration of labour8.
The prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in America reveals that out of 120 licensed certified nurse midwives eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies administered them for the following indications: nausea and vomiting, labour stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labour, postpartum haemorrhage, labour analgesia, and malpresentation.9
From the above facts and evidences, the investigator decided to provide jasmine oil aroma therapy as an alternative terapy to accelerate labour progress and reduce labour pain among the parturient, which in turn will lead to better outcome of labour.
6.3 Review of literature
An evaluative study was conducted in United Kingdom to assess the effectiveness of aromatherapy on maternal comfort during labour. Women were offered aromatherapy to relieve anxiety, pain, nausea, and vomiting or to strengthen contractions. Use of aromatherapy over the period was analyzed. More than 50% of mothers rated it as helpful. The use of aromatherapy was not confined to low-risk mothers. Sixty percent of the sample was primigravidae, and 32% overall, had their labour induced. The administration of inhalation aromatherapy in childbirth reduced the need for additional pain relief. More than 8% of primigravidae and 18% of multigravidae used no conventional pain relief methods during labour after using essential oils. The study concluded that aromatherapy may have the potential to augment labour contractions for women in dysfunctional labour10.
A study was conducted at Oxford Brookes university to explore the effects that essential oils can have on helping a mother mentally cope with labour. During the eight-year study involving 8,000 mothers, they found that aromatherapy was effective in managing labour pains. They found that inhalation of essential oils lessened maternal anxiety and fear while inducing a sense of wellbeing. Fear and anxiety are two things which can slow labour and make the mother to be unable to cope with the pain of labour. The study showed a drop in the use of opiate pain relief by those mothers who used aromatherapy during labour. The normal uptake of opiate pain relief would have been expected to be 30% in the Oxford study this dropped to 0.4%. Thus the study concluded that aromatherapy is effective in managing labour pain12.
A quasi experimental study was conducted in Mangalore to evaluate the effectiveness of aromatherapy in reducing anxiety among pregnant mothers the study was delimited to mothers of age group 18-35 years. The sample size was 30 pregnant women. The samples were made to inhale 1-2 drops of essential oil applied over a tissue for 5 minutes. The women in the experimental group had less anxiety than the mothers in the control group. Thus the study concluded that aromatherapy is effective in reducing anxiety13.
A randomized clinical trial study was conducted in Chennai randomly to determine the effect of aromatherapy on pain intensity as well as to determine the duration of labour in primiparas and the sample size were 60 primiparas and aromatherapy was given by inhalation. Pain intensity at all the three stages of cervical dilatation was significantly lower in the aromatherapy group. During the 4-5 cm dilatation stage, women in the supported group reported less severe pain and duration of labour compared to those receiving routine care, This indicates that aromatherapy could decrease the duration of first, second and third stages of labour. Thus the study concluded that aromatherapy can be useful to decrease the pain intensity as well as duration of labour.14
An observational study was conducted in United Kingdom to assess the effectiveness of aroma therapy on pain and duration of labour among 8058 mothers in childbirth. In this study a total of 10 essential oils were used, plus carrier oil, which were administered to the participants via skin absorption and inhalation. The study concluded that the practice of aromatherapy reduces the need for pain relief during labour. The evidence from this study suggests that aromatherapy can be effective in reducing maternal anxiety, fear and pain during labour, recorded an associated symptom.15
A randomised double blind clinical trial was conducted in Hungkuang University, Taichung to assess the pain relief by aromatic essential oil inhalation aromatherapy on out patients with primary dysmenorrhoea. A randomized, double-blind clinical trial was conducted, The sample size was 48; convenience sampling technique was used to select samples. Verbal rating scale and had 10-point numeric rating scales were used. The patients were randomly assigned to an essential oil group (n = 24) and a synthetic fragrance group (n = 24). Essential oils blended with jasmine, clary sage and marjoram in a 2:1:1 ratio was diluted in unscented cream at 3% concentration for the essential oil group. Both the numeric rating scale and the verbal rating scale significantly decreased (P < 0.001) after one menstrual cycle intervention in the two groups. The duration of pain was significantly reduced from 2.4 to 1.8 days afteraromatherapyintervention in the essential oil group. Thus the study concluded that essential oil aroma therapy provides relief for the dysmenorrhea.16