Maternity Blue Final Thesis

8/13/2019 Maternity Blue Final Thesis

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CHAPTER-1

INTRODUCTION

INTRODUCTION

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The postnatal period is well established as an increased time of risk for the

development of serious mood disorders. There are three common forms of

postpartum affective illness: the blues (baby blues, maternity blues), postpartum

(or postnatal) depression and puerperal (postpartum or postnatal) psychosis each of

which differs in its prevalence, clinical presentation, and management.1

Maternity Blues The maternity ,baby or third day blues occur in the first two to

three weeks after delivery. The depression often follows a latent period of three or

four day ,is usually mild and transitory but can be more intense .Ma!imum

tearfulness and depression occur on fifth postpartum day. This condition is often

aggravated by a sore perineum ,breast, fatigue from broken nights and endless

visitor. " woman#s sense of success or failure about her labour, delivery and baby,

as well as thoughts comments from staff can be triggering factors too. The

mother#s response to her baby may not have been what she had e!pected perhaps

the automatic surge of love did not materli$e, the fact that friends, relations and

hospital staff seem more interested in the baby than in her life. "ny or all of these

can play a part in the blues, which are e!perienced by as many as %&'of newly

delivered mother. esearch suggests that about *'of mother e!periencing severe

postnatal blues will go on to develop post natal depression2.

The postpartum blues, maternity blues, or baby blues is a transient condition with a

comple! mi!ture of physical, emotional, and behavioral changes that mothers

could e!perience shortly after childbirth with a wide variety of symptoms which

generally involve mood liability, tearfulness, and some mild an!iety and

depressive symptoms. Baby blues is not postpartum depression, unless it is

abnormally severe.1

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+ostpartum blues is the most common observed puerperal mood disturbance, with

estimates of prevalence ranging from &-*' 3.The symptoms begin within a few

days of delivery, usually on day or , and persist for hours up to several days.

The symptoms include mood labiality, irritability, tearfulness, generali$ed an!iety,

and sleep and appetite disturbance. +ostnatal blues are by definition timelimited

and mild and do not re/uire treatment other than reassurance, the symptoms remit

within days 4.The propensity to develop blues is unrelated to psychiatric history,

environmental stressors, cultural conte!t, breastfeeding, or parity, however, those

factors may influence whether the blues lead to ma0or depression . 1p to &' of

women with blues will go on to develop ma0or depression in the first year

postpartum.3

" wide variety of complementary therapies claim to improve health by producing

rela!ation. 2ome use the rela!ed state as a means of promoting psychological

change. 3thers incorporate movement, stretches, and breathing e!ercises.

ela!ation and 4stress management5 are found to a certain e!tent within

conventional medicine.

5

3ne wellknown e!ample of a rela!ation techni/ue is known variously as

progressive muscle rela!ation, systematic muscle rela!ation, and 6acobson

rela!ation and Mitchell#s rela!ation. The patient sits comfortably in a /uiet room.

7e or she then tenses a group of muscles, such as those in the right arm, holds the

contraction for 8* seconds, then releases it while breathing out. "fter a short rest,

this se/uence is repeated with another set of muscles. 9n a systematic fashion,ma0or muscle groups are contracted, then allowed to rela!. radually, different

sets of muscle are combined. +atients are encouraged to notice the differences

between tension and rela!ation. ;hile postpartum depression is a ma0or health

issue for many women from diverse cultures, this condition often remains

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undiagnosed. "lthough several measures have been created to detect depressive

symptomatology in women who have recently given birth, the development of a

postpartum depression screening program re/uires careful consideration.1

ela!ation can help to relieve the symptoms of stress. "lthough the cause of the

an!iety will not disappear, you will probably feel more able to deal with it once

you have released the tension in your body and cleared your thoughts.

6acobson#s progressive rela!ation techni/ue involves contracting and rela!ing the

muscles to make you feel calmer.


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rela!ation of muscles would lead to rela!ation of the mind, ??because an emotional

state fails to e!ist in the presence of complete rela!ation of the peripheral parts

involved#’7. 9n other words, rela!ation inhibits the generation of thoughts and

emotions, and undoes the effects of neuromuscular hypertension on the body.

Briefly, in +M clients sit in a comfortable chair and the therapist instructs them in

contracting and releasing different muscle groups. "n individual ??learns to

recogni$e contraction in the various parts in a certain order. The large muscle

groups are attended to first, because the sensation from them is most conspicuous.

;hen an individual rela! a given part, they simultaneously rela! all parts that have

previously received practice5. "fter they master rela!ation while lying down, they

are taught how to rela! muscles in reallife situations, which re/uires ??differential

rela!ation,## minimi$ing tension in the muscles needed for some activity while

completely rela!ing muscles not being used. @lassical +M was timeconsuming.

9nitially suggested & to A& min treatments several times a week for up to more

than a year .8

+rogressive muscle rela!ation is especially helpful for people whose an!iety is

strongly associated with muscle tension. 3ther symptoms that respond well to

progressive muscle rela!ation include tension headaches, backaches, tightness in

the 0aw, tightness around the eyes, muscle spasms, high blood pressure, and

insomnia. 2ystematically rela!ing your muscles tends to help slow down your

mind.

The immediate effects of progressive muscle rela!ation include all the benefits of

the rela!ation response described above. ongterm effects of regular practice of

progressive muscle rela!ation include:8

• " decrease in depression.

• " decrease in anticipatory an!iety related to phobias.

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• eduction in the fre/uency and duration of panic attacks.

• 9mproved ability to face phobic situations through graded e!posure.

• 9mproved concentration.

• "n increased sense of control over moods.

• 9ncreased selfesteem.

• 9ncreased spontaneity and creativity.

Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is

the name given to a techni/ue of rela!ing the whole, or part, of your body,

thus relieving the muscle tendons produced by stress. 9t can be applied

rapidly, either as full rela!ation of your whole body or rela!ation of selected

parts of body not in use at any given moment. 9n this way rest can be

obtained in one part of body, while activity may be going on in another .2

This method utili$es knowledge of the typical stressCtension posture and

reciprocal rela!ation of muscle whereby one muscle group rela!es as

opposing group contract. 2tress induced tension in the muscle that work to

create the typical posture may be released by voluntary contraction of the

opposing muscle groups. +ropioreceptive receptor in 0oints and muscle

tendons record the resulting position of ease and this is relayed to and

registered in the cerebrum.2

Mitchell#s method involves adopting body positions that are opposite to

those associated with an!iety (fingers spread rather than hands clenched, for

e!ample). 9n autogenic training, patients concentrate on e!periencing

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physical sensations, such as warmth and heaviness, in different parts of their

bodies in a learned se/uence.9

CHAPTER-2

NEED OF STUDY

NEED OF STUDY

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CHAPTER-3

OBJECTIVES

OBJECTIVES

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• To study the effects of Mitchell#s rela!ation techni/ue in maternity blues.

• To study the effects of progressive rela!ation techni/ue in maternity blues.

•

To compare the effects of +rogressive rela!ation techni/ue and Mitchellrela!ation techni/ue on maternity blues.

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CHAPTER-4

HYPOTHESIS

HYPOTHESIS

• A!"#$%&"'(# )*+,")#': The progressive rela!ation techni/ue would be more

effective than Mitchell#s rela!ation techni/ue in the management of maternity

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blue.

• N!! )*+,")#' The progressive rela!ation techni/ue would not be more

effective than Mitchell#s rela!ation techni/ue in the management of maternity

blue.

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CHAPTER-5

OPERATIONA/ DEFINITIONS

OPERATIONA/ DEFINITIONS:

M"T>D9TE B1>

Maternity blues, or baby blues is a transient condition with a comple!

mi!ture of physical, emotional, and behavioral changes that mothers could

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e!perience shortly after childbirth with a wide variety of symptoms which

generally involve mood liability, tearfulness, and some mild an!iety and

depressive symptoms. Baby blues is not postpartum depression, unless it is

abnormally severe 2 .The maternity, baby or third day blues occur in the first

two to three weeks after delivery. The depression often follows a latent

period of three or four day.

+3>229F> >"G"T93D T>@7D9H1>

+rogressive muscle rela!ation was described by dmund 6acobson .9t is a

systematic techni/ue for achieving a deep state of rela!ation. Tensing and

releasing various muscle groups throughout the body.6

M9T@7> >"G"T93D T>@7D9H1>

Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is the name given to a

techni/ue of rela!ing the whole, or part, of your body, thus relieving the muscle tendons

produced by stress. 9t can be applied rapidly, either as full rela!ation of your whole body or

rela!ation of selected parts of body.IJ

>2293D 2@">

>


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CHAPTER-6

REVIE0 OF /ITERATURE

REVIE0 OF /ITERATURE

• #%&!! #" &!:The maternity ,baby or third day blues occur in the first two to

three weeks after delivery. The depression often follows a latent period of

three or four day ,is usually mild and transitory but can be more intense

.Ma!imum tearfulness and depression occur on fifth postpartum day. This

condition is often aggravated by a sore perineum, breast, fatigue from

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broken nights and endless visitor ." women#s sense of success or failure

about her labour, delivery and baby, as well as thoughts comments from

staff can be triggering factors too.2

• O’ H&$& #" &! : +ostpartum blues is the most common observed puerperal

mood disturbance, with estimates of prevalence ranging from &-*' 3.The

symptoms begin within a few days of delivery, usually on day or , and

persist for hours up to several days. The symptoms include mood lability

irritability, tearfulness, generali$ed an!iety, and sleep and appetite

disturbance. +ostnatal blues are be definition timelimited and mild and do

not re/uire treatment other than reassurance, the symptoms remit within

days.4 The propensity to develop blues is unrelated to psychiatric history,

environmental stressors, cultural conte!t, breastfeeding, or parity (7apgoodet al.,8K%%) ,8, however, those factors may influence whether the blues lead

to ma0or depression (Miller, &&). 1p to &' of women with blues will go

on to develop ma0or depression in the first year postpartum.31

• S"#'% 198 :Lound that postnatal blues peaked on days *.


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stressors, () discussion of postpartum stressors, and () a control discussion

about their awareness of postpartum stress. They found that the groups

receiving rela!ation training were significantly less distressed than the non

rela!ation training groups during the first K weeks postpartum. They also

found that the groups that discussed possible postpartum stressors were lesselated after delivery than the groups not e!posed. The authors recommended

the use of e!tended, nonspecific rela!ation training both before and after

delivery as a way of reducing postpartum emotional distress.24

• ')! 0.O H&$& 2tudies of the prevalence of the blues have reported a

wide range (A' to %*'). 2tudies reporting relatively high prevalence rates

have used criteria such as the presence of crying at some time during thefirst week after delivery. ower prevalence rates have been obtained in

studies using more stringent criteria for the blues, such as high scores on

standard depression or mood scales.11

• E% J&,:,% trained his patients to voluntarily rela! the muscles in

their body whenever they are not being used to perform a particular task. 7e

found that the rela!ation procedure is effective against a number of ailments

including ulcers, insomnia, and hypertension.6

• P$,;$#'(# $#!&dmund

6acobson in the early 8K&s.12 6acobson did not ever fully understand how by

shutting down ones responses to e!ternal and internal stimulants one could

not only reduce an!iety, but actually reduce such problems as skin allergies

and rashes. 9t is not at all clear how shutting down our physical responses

can be so effective in curing various disorders.12

•O’H&$& = S>&'% 1996): 9n a meta analysis of *K studies from Dorth"merica, >urope, "ustralasia and 6apan (nN8,%8& sub0ects), found an

overall prevalence rate of postpartum depression of 8'. This was based on

studies that assessed symptoms after at least two weeks postpartum. (to

avoid confounding of postpartum blues) and used a validated or standardi$ed

measure to assess depression.1

17

http://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Insomniahttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Insomniahttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Edmund_Jacobson


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• B""%#$ O?H&$& 0 0&",% D. 212 The structure of women=s

mood in the early postpartum. 2tates that Opostpartum bluesO is a mild,

predictable mood disturbance occurring within the first several days

following childbirth. +revious analyses of the ObluesO symptom structure

yielded inconclusive findings, making reliable assessment a significant

methodological limitation. The current study aimed to e!plicate the

symptom structure of women=s mood following childbirth, and to e!amine

psychometric properties of the !periences Huestionnaire (H), an

adapted version of the ennerly Blues Huestionnaire that included

additional items from the +ositive and Degative "ffect 2chedule. Mothers

who recently delivered (D N 8A) were recruited from a university hospital

and asked to complete mood ratings on si! consecutive days using the H.

>!ploratory factor analysis yielded an interpretable twofactor solution

identified as Degative "ffect and +ositive "ffect. 2cale reliability indices

were e!cellent, with a high level of agreement in factor structure over time.This twofactor model provides reliable assessment of women=s mood in the

early postpartum, informing the study of reproductiverelated mood

disorders.13

• N&$&')&'&) @ &%%&") @'$'*&++& V#%&"#) R&&%%& 211:

+ostpartum blue is common in socially and economically insecure mothers ,

"mong the 8& women screened, 8 mothers fulfilled the inclusion criteria

and were recruited in this study. 3f the 8 women screened, - werediagnosed to have ++B, accounting for *%.*' prevalence rate. Most of the

mothers were literate (K8') and housewives (--'). "bout K' of the

mothers had previous history of miscarriage and %' had a history of

psychiatric illness. Two mothers had marked suicidal tendency (by >+stimated the prevalence and

track the risk factors associated with, Maternity blues (MB). " transversal

study was performed with 88 women, on the tenth day of puerperium. +itt2cale (8KA%), 2tein (8K%&), and a /uestionnaire with socio demographic and

obstetric data were used for assessment. esults of study showed the

prevalence of Maternity Blue was .-' according to the 2tein scale221. 9n

the univariated analysis, civil status and tobacco use were associated with

MB. egally married women and nonsmokers showed a risk appro!imately

times lower of e!periencing the problem.15

18

http://www.ncbi.nlm.nih.gov/pubmed?term=Buttner%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=O%27Hara%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Watson%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Menezes%20PR%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Tedesco%20JJ%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Kahalle%20S%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Zugaib%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Buttner%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=O%27Hara%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Watson%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Menezes%20PR%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Tedesco%20JJ%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Kahalle%20S%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Zugaib%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18988444


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•

1

• P#"$,' A @&;!'&$' /.213 "n!ious and depressive components of

>dinburgh +ostnatal dinburgh +ostnatal ++


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7eart rate was measured using a pulse o!imeter , at baseline, and before and

after intervention .The supine position showed reduction in heart rate

significantly in all groups.


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a firstline treatment in a stepped care approach to managing depression,

especially in younger populations and populations with sub threshold or

first episodes of depression.2

• V'",$'& / S&!" &")!##% #$$ 1997 : Mitchell=s 2imple +hysiological

ela!ation and 6acobson=s +rogressive ela!ation Techni/ues: "

comparison. This study was aimed to compare the shortterm physiological

effects of Mitchell=s simple physiological rela!ation and 6acobson=s

progressive rela!ation. Twentyfour nor motensive sub0ects, 8 men and ten

women, participated in the si!week study. 2ystolic blood pressure (2B+)

and diastolic blood pressure (


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forgetfulness Cmuddled thinking. +rimary blues emerged as a separate

cluster from depression and was more fre/uent (A' versus 8A',

respectively). The final /uestionnaire was validated on a further sample of

%- newly delivered women, comparing prenatal scores to the mean of

scores obtained on days 8to 8& postpartum. The scores for the primary blues

cluster significantly increased postpartum, while scores for depression did

not change. These findings may indicate that changes in depression are not

characteristic in the early puerperium. " second study by ennerly and ath

(ennerly 8K%K) on88 women compared maternal blue /uestionnaire

scores with the women# s social environment and personality type (>ysenck

+ersonality 9nventory).+ostnatal blues was significantly associated with

neuroticism, poor social ad0ustment with the role as a house worker, and a

poor relationship in either the family unit, e!tended family or marriage.4131

• H&+;,, #" &!.1988 The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural conte!t, breastfeeding,

or parity . 7owever, those factors may influence whether the blues lead to

ma0or depression (Miller, &&). 1p to &' of women with blues will go on

to develop ma0or depression in the first year postpartum (@ampbell et al.,

8KKP 3=7ara et al., 8KK8b).31

"mong the 8& women screened, 8 mothers fulfilled the inclusion criteria

and were recruited in this study. 3f the 8 women screened, - were

diagnosed to have ++B, accounting for *%.*' prevalence rate. Two mothers

had marked with suicidal tendency (by >+


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CHAPTER-7

ATERIA/S AND ETHOD

ETHODS

• NUBER OF SUBJECTSA& 21B6>@T2

• SOURCE OF SUBJECTS

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8.


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SAP/IN@

•SAP/E SIE The sample si$e consists of A& sub0ects in maternity blues.

• SAP/E CRITERIA: 2ystematic random sampling method is used to

divide the patient in to two groups.

roup " M9T@7>#2 >"G"T93D T>@7D9H1> (nN&)

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roup B 6"@3B23D#2 >"G"T93D T>@7D9H1> (nN&)

• VARIAB/E OF THE STUDY

I%#+#%#%" (&$'&:!#

+rogressive rela!ation techni/ue

Mitchell#s rela!ation techni/ue

D#+#%#%" (&$'&:!#dinburgh +ostnatal 2cale (>


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nsure the legs are not straight. 3pen (A& degree) angle behind knee

A. +oint the toes, then release. ;iggle toes to and fro to ensure no cramping

occurs.

-. +ush yourself into the support. elease.

%. +ush your head into the head rest (or cupped hands).

K. Breath using the diaphragm. +ush tummy out as you breathe in. Lour

seconds in and hold for four seconds then breathe out for four seconds.


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8.;ith eyes still closed imagine a calm place and put yourself in a deck chair

in the scene. Meditate on that scene.

emember that you should never drive away in a car after work without doing this

sort of e!ercise first to ensure that neckC0aw tension is not creating tunnel vision for

you.

@ROUP B-PRO@RESSIVE RE/AGATION TECHNIUE %3

The system comprises8*& basic e!ercises, which have been found to be

effective, if practiced regularly.8

There are no contraindications for progressive muscle rela!ation unless the musclegroups to be tensed and rela!ed have been in0ured. 9f you take tran/uili$ers, you

may find that regular practice of progressive muscle rela!ation will enable you to

lower your dosage.

@'#!'%# ,$ P$&"''%; P$,;$#'(# !# R#!&


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ways of supporting your body most completely. (;hen lying down, you may want

to place a pillow beneath your knees for further support.) 2itting up is preferable to

lying down if you are feeling tired and sleepy. 9t=s advantageous to e!perience the

full depth of the rela!ation response consciously without going to sleep.

A. oosen any tight clothing and take off shoes, watch, glasses, contact lenses,

0ewelry, and so on.

-. Make a decision not to worry about anything. ive yourself permission to put a

side the concerns of the day. "llow taking care of yourself and having peace of

mind to take precedence over any of your worries.

%. "ssume a passive, detached attitude. This is probably the most important

element. Eou want to adopt a Olet it happenO attitude and be free of any worry

about how well you are performing the techni/ue.


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. @lench your fists. 7old for -8& seconds and then release for 8*&

seconds. 1se these same time intervals for all other muscle groups .(fig no.)

. Tighten your biceps by drawing your forearms up toward your shoulders and

Omaking a muscleO with both arms. 7old... and then rela!.

. Tighten your tricepsthe muscles on the undersides of your upper armsby

e!tending your arms out straight and locking your elbows. 7old ... and then rela!.

*. Tense the muscles in your forehead by raising your eyebrows as far as you can.

7old ... and then rela!. 9magine your forehead muscles becoming smooth and

limp as they rela!.

A. Tense the muscles around your eyes by clenching your eyelids tightly shut.7old... and then rela!. 9magine sensations of deep rela!ation spreading all

around them.

-. Tighten your 0aws by opening your mouth so widely that you stretch the muscles

around the hinges of your 0aw. 7old ... and then rela!. et your lips part and allow

your 0aw to hang loose.

%. Tighten the muscles in the back of your neck by pulling your head way back, as

if you were going to touch your head to your back (be gentle with this muscle

group to avoid in0ury). Locus only on tensing the muscles in your neck. 7old ...

and then rela!. 2ince this area is often especially tight, it=s good to do the tense

rela! cycle twice.

K. Take a few deep breaths and tune in to the weight of your head sinking into

whatever surface it is resting on.

8&. Tighten your shoulders by raising them up as if you were going to touch your

ears. 7old ... and then rela!.

88. Tighten the muscles around your shoulder blades by pushing your shoulder

blades back as if you were going to touch them together. 7old the tension in your

shoulder blades ... and then rela!. 2ince this area is often especially tense, you

might repeat the tenserela! se/uence twice.

8. Tighten the muscles of your chest by taking in a deep breath. 7old for up to 8&

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seconds ... and then release slowly. 9magine any e!cess tension in your chest

flowing away with the e!halation.

8. Tighten your stomach muscles by sucking your stomach in. 7old ... and then

release. 9magine a wave of rela!ation spreading through your abdomen.

8. Tighten your lower back by arching it up. (Eou should omit this e!ercise if you

have lower back pain.) 7old ... and then rela!.

8*. Tighten your buttocks by pulling them together. 7old ... and then rela!.

9magine the muscles in your hips going loose and limp.

8A. 2/uee$e the muscles in your thighs all the way down to your knees. Eou will probably have to tighten your hips along with your thighs, since the thigh muscles

attach at the pelvis. 7old ... and then rela!. Leel your thigh muscles smoothing

out and rela!ing completely.

8-. Tighten your calf muscles bypulling your toes toward you (fle! carefully to

avoid cramps). 7old ... and then rela!. (fig no.)

8%. Tighten your feet by curling your toes downward. 7old ... and then rela!.

8K. Mentally scan your body for any residual tension. 9f a particular area remains

tense, repeat one or two tenserela! cycles for that group of muscles.

&. Dow imagine a wave of rela!ation slowly spreading throughout your body,

starting at your head and gradually penetrating every muscle group all the way

down to your toes.

E% , $#!&


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first day of the commencement of the treatment. Then they were given respective

treatment as decided per group. The sub0ects were reassessed on the last day of the

treatment.

Lig no8 M9T@7>#s >"G"T93D T>@7D9H1> 9D 21+9D> E9D

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Lig no M9T@7>#s >"G"T93D T>@7D9H1> 9D 29 E9D

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Lig. no 6"@3B23D#2 >"G"T93D T>@7D9H1>-

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"sk the patient to clenched your fist and hold for-8& seconds than rela!.

Lig no. 6"@3B23D#2 >"G"T93D T>@7D9H1>

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"sk the patient . Tighten your calf muscles bypulling your toes toward you (fle!

carefully to avoid cramps). 7old ... and then rela!.

O",# #&$#

EASUREENT OF DEPRESSION

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CHAPTER-8

DATA ANA/YSIS

STASTICA/ ANA/YSIS

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I%"$& ;$,+ ,+&$',%

RT-+$# " "#" , @ROUP A

JRT-+$#-+," "-"#" , @ROUP B

40

"ssessment>


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I%"#$ ;$,+ ,+&$',% :* EDPS

41

A##%" S)#!#

,&##%"

N:#$

,:#"

#&% S"&%&$

#('&"',%

"-

(&!#

+-

(&!#

P$# T#"

,+&$',%

RT 3 15.33 3.325 .374 .71

JRT 3 15.66 3.575

P," "#"

,+&$',%

RT 3 8.2 2.28 1.95 .55

JRT 3 7.1 2.73


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CHAPTER-9

RESU/T

RESU/T

This chapter deals with the most important and crucial aspect of investigating the

data to answer the research /uestion through suitable statistical treatment.

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" sample of A& patients were selected and allotted randomly into two groups of

e/ual si$e of & sub0ects using systematic random sampling method .roup "

received Mitchell#s rela!ation techni/ue and roup B received 6acobson rela!ation

techni/ue. The assessment was done by >dinburgh postnatal depression scale. The

collected data was statistically analy$ed.

The score were following:

8.MT 2cores:roup"

• +re test mean 8*. and standard deviation .*

• +ost test mean %.& and standard deviation .%&

.6T 2cores:roupB

• +re test mean 8*.AA and standard deviation was .*-*

• +ost test mean -.8&& and standard deviation was .&-

• .@omparison within the groups before and after treatment : BE >


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• +ost test comparison: tN 8.K*P pN&.&**

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@RAPH

INTER @ROUP COPARISON BET0EEN @ROUP A AND @ROUP-B

BY EDINBUR@H POSTNATA/ DEPRESSION SCA/E

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CHAPTER -1

DISCUSSION

DISCUSSION

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9n this study the effectiveness of progressive rela!ation techni/ue Fs Mitchell

rela!ation techni/ue on maternity blues was assessed.

A& sub0ects of the age group between 8%Kyears were taken for the study .The

sub0ect who met the inclusion criteria were included in the study .+ermission for

the study was taken from the above hospitals and ethical committee of career

institute of medical sciences . "n informed and written consent form was also

taken from the females , where the patient agreed to participate in the study and

the data was collected from females by using evaluation tools. The participant

were divided into two groups. roup " (&) and roup B (&) using the systematic

random sampling.

dinburgh +ostnatal +dinburgh +ostnatal +


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were taking part in +M treatment from 8&CK% to KC&&, were /uestioned

about their e!periences.7

• J&'# A!&% B#!! J,#""#B#""&%* S&!"',( 2 Mitchell=2 ela!ation

Techni/ue: 9s 9t >ffectiveQ 2howed effectiveness of Mitchell=s rela!ation

techni/ues including diaphragmatic breathing, compared with diaphragmatic

breathing alone and supine lying.1.

• "s maternity blues is postpartum depressive condition. Maternal blues is a

common condition in most of the +ostpartum women and left untreated.27.

• "mong the rela!ation techni/ues, we emphasi$e that of +rogressive Muscle

ela!ation, which is used in this study. 9t is mainly based on the premise

that an!iety and rela!ation are e!cluding situations. The procedures used are

simple: the individual retracts a specific set of muscles as much as possible

and e!periences as tension sensation. The muscles are then rela!ed as much

as possible and the individual focuses on the rela!ation sensations. 9t is,

therefore, a participant e!ercise in which the individual herself seeks a state

of rela!ation and physical wellbeing.;hen +rogressive Muscle ela!ation

is practiced and incorporated to the mother#s life style, it can help to

neutrali$e some of the effects of stress reaction.24

The distinction in the current study is that both techni/ues either 6acobson

progressive rela!ation techni/ue or Mitchell#s rela!ation techni/ue were used to

produce rela!ation in maternal blues rather than physiological effects on cardiac

components. "lthough the current study does not provide information about the

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mechanism of action or change, however it suggests that both methods were found

effective significantly.

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CHAPTER-11

CONC/USION

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CONC/USION

9n this study we found that both the techni/ue Mitchell#s rela!ation and 6acobson#s

rela!ation techni/ue are effective in the management of maternity blues but

6acobson#s rela!ation was found to be more effective than Mitchell#s rela!ation

techni/ue. esult of this study suggest that a gradual improvement was seen

throughout the session. The pre and post treatment score of >dinburgh +ostnatal

+


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CHAPTER-12

/IITATIONS

/IITATIONS

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• This study was conducted on a small sample si$e of A& patients.

+opulation of the both groups was smallP only & patients in each group

might not represent the ma0ority of the maternal blues population.

• The study was not consent and concluded with appropriate interval

follow ups. 2ome follow ups should be conducted to strengthen the

conclusion.

• 3nly one scale was used to assess the maternal blues. The >


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CHAPTER -13

BIB/IO@RAPHY

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BIB/IO@RAPHY

1. obertson, >., @elasun, D., and 2tewart, . (&&). isk factors for

postpartumdepression. 9n 2tewart, ., obertson, >., 6: +rospective study of

postpartum blues: Biologic and psychosocial factors. "rch en +sychiatry %: %&8,

8KK8 .

4. ennerly 7, ath


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13. +ost partum depression literature review of risk factor and interventions

:Buttner MM, 3=7ara M;, ;atson


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21.Fictoria 2alt, athleen M err Mitchell=s 2imple +hysiological ela!ation

and 6acobson=s +rogressive ela!ation Techni/ues: " comparison +hysiotherapy

Folume %, 9ssue , "pril 8KK-, +ages &&U&-http:CCd!.doi.orgC8&.8&8AC2&&8

K&A(&*)AA&%8A.

22. +itt B: 4Maternity blues.5 Br 6 +sychiatry 8: 8, 8K-.

23. 2tein : The pattern of mental change and body weight change in the first post

partum week. 6 +sychosom es : 8A*, 8K%& 8. 7andley 2, nfermagem && setembrooutubroP 8&(*):A*K.

25. B9@> +9TTV @onsultant +sychiatrist, .8

26. 2tefanie aers8 , Melanie ;aschke8 and 1lrike >hlert8 81niversity of Wrich, 2wit$erland

X@orrespondence: 1lrike >hlert, .,


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CHAPTER-14

ANNEGURE

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ANNEGURE- I

INFORED CONSENT FOR

T'"!# , ")# "*

4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue

on maternity blues5

I%(#"';&",$ "nkita upta

9, ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ, freely and voluntarily agree to participate

in her research pro0ect.

P$+,# , "*

9 have been informed that this study is going to help me in maternity blues .

ela!ation techni/ue is an acceptable management to treat maternity blues and will

help the healthcare professionals to predict better treatment in future.

P$,#$#

9 understand that i will be treated with either 6acobson rela!ation techni/ue or

Mitchell#s rela!ation techni/ue. 9 also understand that this would be done under

the physiotherapist#s supervision. 9 am aware that 9 will have to follow therapist#s

instructions.

B#%#'"

This treatment will help to improve /uality of life, and will reduce depression. 9twould also help in detecting better choice of treatment for maternity blues.

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C,%'#%"'&!*

9 understand that the medical information produced by this study will be

confidential. 9f the data are used for publication in the medical literature or

teaching purpose, no names will be used and other literature such as photographs

or audio or visual tapes will be used only with permission.

R##" ,$ ,$# '%,$&"',%

9 understand that 9 am free to ask /uestions about the study at any time. The

therapist will be available to answer my /uestion. @opy of this consent form will

be given to me to keep for my careful reading.

R#&! ,$ >'")$&>&! , +&$"''+&"',%

9 understand that my participation is voluntary and 9 may refuse to withdraw

consent and discontinue participation at any time. 9 also understand that she may

terminate my participation in the study at any time after she has e!plained the

reason to doing so.

2ign of 9nvestigator 2ign. 3f +articipant

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ANNEGURE- II

CASE PRO-FORA=ASSESSENT CHART

T'"!#

4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue

on maternity blues5

N&# , ")# ),!&$ : "nkita upta

@'# :


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T$#&"#%" )'",$*

F&'!* )'",$*

#%"$&! )'",$*

O:"#"$' )'",$*' &%*

P#$,%&! )'",$*

"ppetite: oodC+oorC9mpaired

Bowel: DormalC@onstipated

Micturition:

2leep: oodC


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S*"#' #


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ANNEGURE- III

H'%' "$&%!&"# E'%:$;) P,"%&"&! D#+$#',% S&!# EPDS)

ननन : ननन:

नननन नननन नननन :

ननननन नन नननन नननन : ननन ननननन :

नन नननन ननननन ननन नन ननननन न ननननन ननन नन नननन

ननननन नननन नन ?

1. नननन नन नननन नन ननननन नननन ननननन नन ननननन नननन

नननन नन ?

□ नननन नननन ननननन नननननन नन ननन

□ ननन नननन नननननन नननन

□ नननन नननननन नननन

□ नननननन नननन

2. नननन नन ननननन / ननननन ननन ननननन ननननन नननन ननन ?

□ ननननन नननन नननन नन

□ ननन ननन नननन नन नन

□ ननन, नननन नन नन

□ नननननन नन

3. नननन ननन ननन ननननन नन नननन नन ननननन ननन नननन नन

नन नननन नननन ननन ? *

□ ननन , नननन

□ ननन , ननन ननन



4. नननन नन नननन नननन नननननननन नननन नन ननननननन नननन नन

?

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□ नननन नन ननन

□ ननन ननन ननन

□ ननन नननन नननननन

5. नननन नन नननन नननन नननननननन नननन नन नन नन नन ननननन

नननन नन ? *

□ ननन, नननन नननननन




6. नननन नननन ननननन नन नननन ननन न ननननन नन *

□ ननन, नननननननन ननन ननन ननन ननन नननननन ननन ननननन

नननन नन नननन

□ ननन, ननन ननन ननन ननन ननन नननननन ननन ननननन नननन

नन नननन

□ नननननननन ननन ननन ननन ननन नननननन ननन ननननन नननन

ननन

□ नननन नननन ननन ननन ननन नननननन ननन ननननन ननन

7. नननन नन नन ननन नन नननन ननन नन नननन नननन ननन

ननननननन नन ? *





8. नननन नन नननन नन नननन ननननन नननन ननन ? *



□

नननन नननननन नननन□ नननन नननननन नननन

9. नननन नन नननन नननन ननन नन नन नननन नननन ननन ? *




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10.नननन नननन नन ननन नननन नन नन ननन नननननननन नन

ननननन ननन नन ? *





SCORING

• QUESTIONS 1, 2, & 4 (without an *) are scored 0, 1, 2 or 3 with top boxscored as 0 and the bottom box scored as 3.

• QUESTIONS 3, 5-1 (!a"#$% with an *) are reverse scored, with the top boxscored as a 3 and the bottom box scored as 0.

• Maximum score: 30

• Possible Depression: 10 or greater

• lwa!s loo" at item 10 #suicidal thoughts$

ANNEGURE-IV

FEEDBAC FOR

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Sl.no Students Name Class Contact No Feedback & Remark Signature

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CHAPTER-15

ASTER CHART

ASTER CHART

Sl. No GROUP-A GROUP-B

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MRT-PRE

TREATMENT

MRT-POST

TREATMENT

JRT-PRE

TREATMENT

JRT-POST

TREATMENT

1 15 9 11 9

2 14 11 20 5

3 16 12 15 6

4 12 6 21 7

5 15 10 16 8

6 18 7 17 5

7 16 9 20 4

8 12 6 12 5

9 11 7 15 10

10 19 11 10 4

11 13 10 12 6

12 17 8 20 12

13 16 7 12 5

14 15 9 15 6

15 21 9 17 10

16 11 6 12 517 20 10 17 6

18 17 6 16 7

19 15 7 10 5

20 23 15 20 8

21 18 8 13 7

22 13 9 15 8

23 15 7 15 9

24 15 6 12 5

25 22 10 14 9

26 14 8 13 9

27 13 6 20 7

28 12 7 23 10

29 11 5 19 7

30 11 5 18 9

Total

Mea 15.33 8.20 15.66 7.100

S! 3.325 2.280 3.575 2.073

Maternity Blue Final Thesis

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