RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING ANTENATAL EXERCISES AMONG ANTENATAL MOTHERS IN CHIGATERI DISTRICT HOSPITAL AT DAVNAGERE”.
Ms. KOMALA N.
FIRST YEAR M.Sc. NURSING,
OBSTETRICS AND GYNECOLOGICAL NURSING
BAPUJI COLLEGE OF NURSING
DAVANGERE – 577 004.
15
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA, INDIA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) / KOMALA N.FIRST YEAR M.Sc. NURSING,
BAPUJI COLLEGE OF NURSING,DAVANGERE – 4,
KARNATAKA.
2. / NAME OF THE INSTITUTION / BAPUJI COLLEGE OF NURSING,
DAVANGERE - 4.
3. / COURSE OF STUDY AND SUBJECT / FIRST YEAR M.Sc. NURSING,
OBSTETRICS AND GYNECOLOGICAL NURSING.
4. / DATE OF ADMISSION TO COURSE / 01-06-2010
5. /
TITLE OF THE TOPIC
/ “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING ANTENATAL EXERCISES AMONG ANTENATAL MOTHERS IN CHIGATERI DISTRICT HOSPITAL AT DAVNAGERE”6. / BRIEF RESUME OF THE INTENDED WORK :
6.0 Introduction :
“Those who do not find time for exercise, will have to find time for illness”.
Earl of Derby
Preparation for parenthood classes provide the opportunity for talks, exercise and discussion sessions with a combined approach from midwives, physiotherapists, health visitors and other care professional. They should aim to create a learning environment with a relaxed atmosphere, where parents can enjoy developing a confidence to cope with pregnancy, labour, delivery. Specific therapeutic aims of physical preparation include the prevention / relief of minor discomforts such as backache, the prevention of future gynaecological / orthopedic problems. Exercise sessions should be designed to stimulate interest in the physical changes occurring, to promote body awareness and to facilitate physical and mental relaxation.1
Most pregnant women restrict their mobility and their participation in routine activities, but studies have proved that daily exercise can reduce chance of miscarriage by 40%, 1,2 united state researchers James Clapp and Co-workers have observed that moderate exercises such as walking / cycling can prevent pregnancy induced hypertension (PIH). Exercise can also prevent early onset of labour, premature rupture of membrane and can help to shorten the duration of labour. Exercise helps mother to loose pregnancy weight faster, it decreases aches and pain associated with pregnancy.2
The general benefits of aerobic exercise for pregnant women include reducing blood pressure decreases cardiac-vascular such as clot formation, helping to maintain ideal body weight and managing stable diabetes. Pregnant women who exercise have generally shorter labour and faster, easier deliveries. A study of conditioned female athelets showed that 2nd stage of labour was shorter, presumably owing to strengthened abdominal muscles.3
“Walking is the best possible exercise”
Thomas Jefferson
Moderate exercise during pregnancy stimulates circulation, helps to keeps joints flexible, creates good muscle tone and promotes a general sense of well-being (Jacobson et al 1991). It is also suggested that women who exercise regularly during pregnancy have an improved course of pregnancy and labour compared to those who lead a sedentary life style.1
Exercise during pregnancy continues to demonstrate marked benefits for mother and fetus. The type, intensity, frequency and duration of the exercises seems to be important determinants of beneficial effects. Maternal benefits include improved cardio-vascular function, limited weight gain and fat retention, improved attitude and mental state, easier and less complicated labour, quick recovery and improved fitness. Fetal benefits may include decreased growth of the fat organ, improved stress tolerance, and advanced neurobehavioural maturation. In the absence of medical contraindication, women should be encouraged to maintain their pregnancy activity level.4
This initiated the investigator to conduct study on antenatal exercises among antenatal mothers.
6.1 Need for the study :
Pregnancy is a time when women need to be prepared mentally and physically to meet the challenges of child birth and the transitions to parenthood. The main aim of the authors study were to investigate the effects of undertaking a regular exercise programme during and following pregnancy on psychological well being, pregnancy and birth outcomes. Data were collected at 3 points during and following pregnancy using a variety of outcome measures and was analyzed using appropriate statistical testing, conclusions were drawn indicating that women who participated in regular physical activity tend to have protection against reduction of psychological well being as measured by variety of psychological constructs.5
The purpose of teaching and practicing of pelvic floor muscle exercise in primiparous women during pregnancy and the postpartum period. This was a secondary data analysis from a prospective multicenter cohort study, the childbirth and pelvic symptoms study, by pelvic floor disorders network. Primiparous women (n = 759) with term singleton delivery were interviewed 6 months after delivery. 64% of the women had been taught PFME, most with verbal (76%) and written instructions (55%) and a few (10%) during pelvic examination. The results of the study shows, more white women were taught PFME than were Asian women (48%), African American women (36%) / Hispanic women (39%, p < 0.001). More women with college education (74%) were taught, compared with women without a college education (37%, p< 0.001).6
Walking for health in pregnancy assessed by RT3 accelerometer activity accounts and activity energy expenditure of 36 pregnant women at 20-32 weeks of gestation during treadmill walking and free-living conditions. During treadmill walking; oxygen consumption was collected, and activity energy expenditure was estimated for a 30 minutes walk at a self-selected walking pace.Results shows that: Encouraging pregnant women to walk for 30-40 minutes per day at a self-selected walking pace, may be an appropriate health recommendation.7
Use of an exercise intervention for high risk and vulnerable population, such as pregnant women at risk for gestational hypertension / preeclampsia requires special consideration. A comparative trial testing the two types of physical exercises-stretching and walking – for sedentary pregnant women at risk for preeclampsia. The intervention consists of 40 min walking at moderate intensity five times a week from 18 weeks gestation until birth. The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10% of resting heart rate, five times a week from 18 weeks gestation until birth.8
During clinical posting investigator has observed and also asked many of the mothers regarding importance of antenatal exercises and practice of antenatal exercises among antenatal mothers. The most of them are having lack of knowledge on antenatal exercise. This indicated that the investigator to understand structured teaching programme on antenatal exercises.
6.2 Review Of Literature :
Review of literature is a key step in research process. Review of literature provides basis for future investigations, justifies the need for replication throws light upon the feasibility of the study, indicates constrains of data collections and helps to relate findings of one study to another. 9
A study was conducted on all women who gave birth at two hospitals in North Sweden from 1st January 2002 to 30th April 2002, through Cox regression analysis / women with low back pelvic pain reporting a pain maximum of 7 at more on a visual analogue scale. The sample was analyzed with calculation of odds ratio (OR) and their 95% confidence intervals. Results shows that, a higher number of regular leisure physical activity decreases the risk of low back pelvic pain.10
The study examines pregnant women’s beliefs and influences regarding exercise during pregnancy in the university of Mississippi Medical centre, USA. To sample women’s exercise habits and beliefs regarding exercise during pregnancy and to determine patient awareness and physicians communication of ACOG’s 2002 guidelines by a 28 item questionnaire method. 45% of women believed that participating in prenatal exercise was helpful. Results ; Approximately 92% of the women who discussed exercise with their physicians were encouraged by them to exercise. In addition women who were encouraged to exercise by their physician were more likely (p = 0.005) to exercise those who were not.11
A study reveals the patterns, attitudes, and general effects of exercise during pregnancy outcome were retrospectively studied on a consecutive series of Thaiwan pregnant women at the Kin Chulalongkorn Memorial Hospital between April and June 2000. Two hundred and three postnatal patients were recruited and interviewed systematically. About 42.36% of cases reported exercise while 57.64% did not. The most common mode of exercise was walking, reported in 95.3% and was most commonly performed in the afternoon (94.2%). Results the proportion of the study group actually exercising was less than half and might be related to the infrequent advice given by obstetricians and nurses.12
A Study was conducted to establish levels of knowledge about pelvic floor exercises during pregnancy ; and prevalence of stress urinary incontinence in a sample of women in the III trimester of pregnancy in North-East Scotland. A structured cross sectional interview survey was done. In this, pregnant women over the age of 16 years and more than 30 weeks of gestation attending antenatal clinics in North-East Scotland of 350 women who agreed to participate, 289 (82.6) were interviewed between July 1999 and March 2000. 225 women (77.9%) reported being given/obtaining information about PFE in the current pregnancy. Practice of the exercises during pregnancy was reported by just over half the sample (n = 156, 54.0%) and more than once a day by 26.3% (n = 76) younger women, and those from more deprived backgrounds, were less likely to report the practice of exercises. Results of this study implies, no relationship was found between reported practice of PFE and stress urinary incontinence.13
A study was conducted on women’s behaviour, beliefs and information sources about physical exercise in pregnancy to examine the potential effect of low risk pregnancy on women’s recreational activity patterns and to explore pregnant women’s beliefs and information sources regarding physical exercise participation through preliminary prospective survey. They were selected 57 nulliparous pregnant women, participant’s homes in the East Midlands UK. A 10 item scale assessed maternal beliefs regarding the importance of physical activity in pregnancy and are enhanced by asking open ended questions about women’s information sources. The results of this study implies improving the quality and quantity of information related to physical exercise has the potential to correct inaccurate perceptions and confer several benefits on maternal and fetal health.14
A study stated that, walking combination with nutritional control may be effective in preventing excessive weight gain in overweight and obese women. Maternal exercise prescription should use the frequency, intensity, time spent and type of exercise principle, with a frequency of three to four sessions per week as ideal Intensity based on a target heart rate zone of 110 to 131 beats per minute for women 20 to 29 years of age and 108 to 127 beats per minute for women 30 to 39 years of age, coupled with use of the rating of perceived exertion scale and the “Talk test” is suggested. Results : Dieting and exercise together are most effective in reducing weight after childbirth and compliance may be improved by incorporating child-care and children into the exercise routine.15
A study was conducted to examine the pregnancy the pregnancy related changes in physical activity, fitness, and strength in women of varying body mass indices (BMI) in the centre for human nutrition, Johns Hopkins Bloomberg school of public health, Baltimore. Women were studied before pregnancy and post partum for body composition and for physical activity, fitness and strength. Physical activity was assessed by questionnaire fitness by maximal oxygen consumption test on a cycle ergometer and strength by one repetation maximum test. Data were analyzed by repeated measures ANOVA testing for time and BMI group. Results : Relative to pregnancy performance, fitness and strength declined in the early postpartum period but improved by 27 weeks post partum.16
A study was conducted to investigate the effect of exercise during pregnancy on the intensity of low back pain in the Shahed university, faculty of medicine, Tehran, Iran. A prospective randomized study was designed 107 women participated in an exercise programme 3 times a week during second half of pregnancy for 12 weeks and 105 as control group. A filled questionnaire between 17-22 weeks of gestation and 12 weeks later for assessment of their back pain intensity. Low back pain intensity was increased in the control group. Lardosis and flexibility of spine were measured by flexible ruler and side bending test, respectively at the same times. Weight gain during pregnancy length and neonatal weight were recorded. Results shows that, exercise group showed significant reduction intensity of low back pain after exercise.17
A study was conducted to assess the effectiveness of antenatal pelvic floor muscle training (PMFT) on stress urinary incontinence (SUI) in the department of urology Christian medical college vellore, Tamilnadu. This study was a fallow up of a randomized, controlled trail. The study involved primigravidae with bladder neck mobility who were randomly assigned to either monthly PMFT supervised by physiotherapist or verbal advice and /or a leaflet on PMFT. The significant improvement in postnatal SUI Originally shown in the PMFT group compared with controls (19vs.33%; p = 0.02) at 3 months was not evident 8 years later (35 vs. 39%; p = 0.7).Results : On direct questioning, 68 patients in study group claimed that they still performed PMFT as taught during the study with 38 of them performing this twice or more per week.18
The study shows that impact of exercise and occupational activity on birth weight. This case-control study involved singleton infants at ³ 34 weeks gestation without congenital anomalies. Case subjects had birth weights at < 15th percentile for gestational age, and 2 control subjects were selected per case subject. Data were collected by self-completed questionnaire and analyzed by mean of logistic regression. Results : Relative to those who participated in structured exercises 3/4 times per week during the third trimester, the odds of lower birth weight were adjusted odds ratio, 4.61:95% confidence interval (1.29-5.39).19
A study was conducted to explore the attitudes of first-time mothers towards antenatal education from the perspective of attenders and non-attneders. A qualitative approach was utilized during focus group interviews to collect the data. The study was conducted in one local health office area of the Health-service executive-South East, Ireland. A purposive sample of first-time mother was interviewed to explore the area of antenatal education. These women included both attenders and non-attenders at antenatal education. The findings suggest there are many strengths, weakness, opportunities and barriers to antenatal education. Strengths of antenatal education included the facilitator received, and the social aspect of meeting other expectant mothers. Results : Barriers to attendance at antenatal education included working night staffs, no interest, transport difficulties, inflexible employer, and involvement of parents was identified as necessary. 20