ORIENTAL COLLEGE OF NURSING – BANGALORErguhs.ac.in/cdc/onlinecdc/uploads/05__13242.doc · Web...
Transcript of ORIENTAL COLLEGE OF NURSING – BANGALORErguhs.ac.in/cdc/onlinecdc/uploads/05__13242.doc · Web...
6. Brief Resume Of The Intended Work
6.0 INTRODUCTION:
Child birth is a sweet memory that a mother should
always cherish it. Labour is an experience of delivering
the baby and placenta from the uterus through the vagina to
the outside world1.Labor is often thought of as one of the
more painful events in human experience it ranges widely
from woman to woman and even from pregnancy to
pregnancy. Pain depends on many factors, such as parity,
size and shape of the pelvis, presentation &position of the
fetus and the strength of contraction2.
In New Delhi, Jan 15: Due to the complications during
the child birth around 78,000 women die each year in India.
This means that on an average every seven minutes, one
woman dies during birth or giving birth to a child. There are
many ways to handle pain during labor. It includes Breathing
technique, Hypnosis, Yoga, Meditation ,Walking, Massage
or counter pressure, Changing position, Taking a bath or
shower, Medication such as Analgesics, Tranquilizers,
regional anesthesia. Medications have been used for labor
and delivery pain relief since the mid-19th century. Today,
there are several drugs available to help mothers endure the
pain of childbirth. Most can be classified as analgesics or
anesthetics. Analgesics relieve but do not completely stop
1
pain. Any medication a woman takes can affect her baby. In
most of cases, women report the sensation of breathing
difficulties, and some of the medication’s effect on the chest
muscles, although it produces no real danger, it can provoke
anxiety.Breathing during labor is not meant to be a
distractive technique such
as visualization or massage. Instead you will learn to be
more in tune with and in control of your body. Breathing
patterns can benefit during a different phase of
contractions3.
An Indian Council of Medical research study
conducted in 2008 submitted a report that 25% of babies in
India are born through cessarian sections in that 18% of the
surgeries are elective. There has been atleast a 25% rise in
the number of woman opting for cesareans in the last few
year in Delhi, as don’t want to go through pain like all
expectant mothers opt for a caesarian section in hospitals6.
Many women make the decision before going
to the labor to have natural child birth and later change their
mind, others plan to get pain medication and then arrive at
the hospital as the baby is about to be born and birth
happens before they have a chance to get medicine. It is
always best to know mothers options before they enter into
labour. Weighing the options about pain relief during labour
2
and delivery women need to be educated on all the different
type of pain management by talking to the health care
providers9. Dr Lamaze introduced natural child birth in
France in 1951. Lamaze was a sympathizer ran a maternity
clinic, during a trip to Russia in 1951 he discovered a new
method to relieve pain in labor through a Lamaze technique.
The Lamaze method is a technique designed
to help expectant mothers focus attention away from the
pain of delivery, because the relaxation and breathing
techniques will help a woman in labor stay focused,
comfortable, and in control of the delivery process. It also
helps women to overcome the fears that are often
associated with childbirth. Many women who practice
Lamaze breathing during their deliveries are able to avoid
pain medication – and the side effects that come with it –
altogether. Both the mother-to-be and her support partner
use these methods to help decrease the mother's
perception of pain.
According to Linda Harmon, Executive Director
of Lamaze International, Lamaze technique promotes a
natural, healthy and safe approach to pregnancy, childbirth
and early parenting practices. Knowing that pregnancy and
childbirth can be demanding on a woman’s body and mind,
Lamaze
3
serves as a resource for information about what to
expect and what choices are available during the
childbearing years. This helps to simplify and clarify the
childbirth process, alleviate a woman’s fears and, most
importantly, helps a woman feel more informed and repared
so they can achieve a safe and healthy pregnancy and
birth18.
Lamaze education and practices are based on
the best, most current medical evidence available, and can
help reduce the overuse of unnecessary interventions while
improving overall outcomes for mothers and babies.
Working closely with families, health care providers and
Lamaze educators, millions of pregnant women have
achieved their desired childbirth outcomes using Lamaze
practices. Word of mouth spread in the United States during
the late 1950s, after Marjorie Karmel gave birth assisted by
Dr. Lamaze and she wrote of her childbirth experience in
Thank You, Dr. Lamaze. The book inspired many women to
approach childbirth as a shared event for both mother and
father21.
The Lamaze breathing exercises includes,
Baseline breathing, Slow breathing, Blowing breathing,
Patterned breathing , Cleansing breathing exercise. The
baseline breathing exercise consists of monitoring normal
breathing pattern for one minute to determine how many
4
breaths normally breathe per minute. The slow breathing
exercise consists of inhaling as count to 3, 4 or 5 and
exhaling as count to the same. The blowing breathing
exercise in done by inhaling through nose and then exhaling
by blowing out of mouth. The patterned breathing exercise is
the familiar "he, he, hoo" technique that is often associated
with Lamaze. This is done by exhaling with two short
breaths followed by blowing out the rest of the air through
mouth. The cleaning breath exercise that consists of taking
a deep, slow breath in through nose then exhaling with a
deep, slow breath out of mouth.
Many mind–body interventions are applied to
chronic illness, but this technique also appears to be
applicable to the acute situation of delivery.
The Lamaze method encouraged expectant
mothers to use the breathing training to learn how to cope
with the labor pains without drugs and to give birth at home
or in birthing centers with a birthing partner and/or midwife9.
6.1) NEED FOR THE STUDY
The intensity of the labour pain isn’t always the
determining factors that drives woman to seek pain
management of a repetitive nature and length of time the
pain persists with each contraction. It should not be turned it
a thing that she should fight to forget. Child birth
5
preparation, enhance their self awareness, trusting their
body9.
A survey of several investigations, which
included both primiparas and multiparas; revealed that the
incidence of intolerable pain ranged from 35% to 58% during
labour.Another found that 77% of primiparas reported that
their pain during child birth was severe or intolerable5.
A recent survey of American women who gave
birth between 2000 and 2002 found that 61% of the
respondents used breathing techniques, and of those, 69%
rated them as "very helpful".
The Lamaze technique offers parents wishing
to have a natural birthing experience the knowledge and
skills to fulfill that dream. It gives them more confidence and
control over the birth process. Methods used in Lamaze
have been proven to lead to faster and easier deliveries with
fewer complications. Parents using Lamaze generally have
a more positive and relaxed attitude toward the birth of their
baby.
Lamaze classes educate the midwife to
prepare the women about the way they can decrease their
perception of pain such as through relaxation techniques
and breathing exercises, Lamaze approach takes a neutral
position wards pain medication encouraging women to make
an informed decision about its right for them.
6
The quasi-experimental study was conducted
to explore the effectiveness of the video-based Lamaze
method on pre-natal mothers' knowledge and attitudes,
compared with that of traditional nursing guidelines two
experimental groups E (1): issued with traditional nursing
guidelines and instructed in video-based Lamaze method;
and E (2): instructed in video-based Lamaze method), and
two control groups C (1): issued with traditional nursing
guidelines and C (2): issued with no guidelines). Before the
intervention, E (1) had the highest score for knowledge.
Scores for attitude showed no significant difference between
the four groups. This study showed that the video-based
Lamaze method is likely to promote more effectively than
traditional guidelines the knowledge, attitudes, and practice
of prenatal mothers in relation to giving birth. The use of this
method in conjunction with traditional nursing guidelines
may be even more effective in relation to maternal attitude23.
According to Lamaze International, the goal of
Lamaze classes is to "increase women's confidence in their
ability to give birth." Toward that end, women learn a variety
of simple coping strategies, of which breathing is only one.
The classes aim to help women "learn how to respond to
pain in ways that both facilitate labor and increase comfort.
The study was conducted to explore in belief about personal
7
control through Lamaze child birth training by using modes
(Lamaze classes, red cross classes, no classes)the findings
are discussed and suggested Lamaze training helps to
improve and better meet the immediate needs of expectant
and new parents.
This study was conducted in a public general
hospital in Mexico City to evaluate efficacy of the support
during labor to reduce cesarean rate. From March 1997 to
February 1998, a group of 100 pregnant women were
studied. These women were at term, engaged in an active
phase of labor, exhibited 3 cm. or more cervical dilatation,
were nuliparous, had no previous uterine incision, and
possessed adequate pelvises. The group was randomly
divided into two subgroups comprising 50 women,
each:Results confirmed that support during labor was
associated with a significant reduction in cesarean birth and
pitocin administration.
The results of this study showed support
during labor is associated with positive outcomes that have
physical, emotional, and economic implications.As per the
college of literature,science and arts university of
Michigan,USA. There are multiple models of child birth
education for both with in health care settings, including
centering pregnancy,and external programs,such as
8
Lamaze. As a component of child birth preparation , a birth
plan can be a medium to improve patient provider
communication regarding a desired labor and birth
experience and improve satisfaction with care.A wide variety
of childbirth preparation classes is currently available to
expectant parents in most communities14.
The Lamaze approach to prenatal education
has had dramatic gains in popularity resulting mainly from
the satisfaction of those using the training and their
encouragement of friends to do likewise.As with every
service, it is the consumer who determines what is or is not
effective with the increasing numbers of Lamaze-trained
couples in labor units, it is important that the nurse
understand the differences between Lamaze and other
approaches, especially that of "natural" childbirth.Analgesics
and narcotics sometimes cause sleepiness and lower the
mother’s attention and strength to push. The drugs can also
decrease a woman’s memory of her birth experience. In
addition, they may temporarily depress respiration in the
mother and baby. Child birth preparation usually Lamaze
technique enhance women self awareness trust in their
body. It will make the body to produce it own endorphins,
natural relaxant and pain killers to help ease labour pain13.
9
6.1.1) STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of intervention
package on knowledge regarding lamaze technique among
midwives in selected hospitals,Bangalore”
6.2) REVIEW OF LITERATURE
Review of literature is the selection of available
documents on the topic, which contain information, ideas,
data, and evidence return from a particular stand point to
fulfill certain aims or express certain views on the nature of
the topics and how it is to be investigated, and effective
evaluation of this document in relation to the research being
proposed.
1) Studies related to negative experience on labor pain:
A descriptive study was conducted to assess
the negative experience of labour pain among 53 postnatal
mothers by in depth interview technique.The finding of the
study were all woman who expressed labour pain were
severe and intolerable , unable to cope with the pain during
contraction , some of them said that they were panicked and
felt they might died in pain , Most of the woman told that
they did not want any more children.The study review the
increased perception of pain might be due to lack of
10
knowledge of the process of child birth an education
regarding the birth process and coping with pain10.
This project was conducted to improve
perinatal care effectiveness. The data analysis were to
identify the lasck of completeness of perinatal care process ,
a dearth of education tools in the Vietnamese language and
poor communication , which resulted in poor nursing
education outcomes. After providing communication cards ,
nursing education pamphlets, video- CDs,proper practice of
Lamaze during labor rose from 43% to80.6%. These
improvement acheieved project
aims. This project not only improved the effectiveness of
perinatal care for Vietnamese women , but also improved
their satisfaction with nursing services21.
A discussion regarding child birth education
and birth plans was considered a key component to
perinatal care, although many women did not receive any
formalized preparation. There are multiple models of child
birth for both with in health care settings, including child birth
preparation like Lamaze technique. As a component of child
11
birth preparation a desired labor and satisfied birth
experience were held21.
A longitudinal Cohorts study conducted for
woman on negative birth experience
due to unexpected medical problem operative delivery,
induction of aggumentation of labour pain, lack of control
during delivery and administration of analgesia. The above
said studies indicates, the need for some intervention to
avoid or reduce the negative experience of the child birth
and labour.
A study conducted to determine whether
women's attitudes and concerns, confidence in ability to
control pain, and practice of pain-control techniques would
predict pain and coping or distress-related thought during
labor. During the third trimester of their pregnancies, 115
women completed the prenatal self-evaluation inventory and
measures of confidence and practice of pain-control
techniques, interviews were conducted to assess levels of
pain and the content of women's cognitive activity on a
continuum that ranged from coping-related thought to
distress-related thought. The results suggest that, with the
shift from latent to active labor, women's fundamental
concerns and anxieties become manifest, and may take
12
precedence over the skills acquired through childbirth
education in moderating experienced pain and distress16.
2) Study related to pharmacological intervention in
reduction of negative experience of labor:
A study conducted to evaluate the
effectiveness and acceptability of a lidocaine spray in
reducing perineal pain during spontaneous vaginal delivery
among 185 woman with out epidural analgesia using
randomized controlled trial were 93 woman received
topically applied Lidocaine anesthetic spray and 92 woman
received placebo spray8.
The severity of perineal pain was assessedby
using McGill pain questionnaire. Which is an (0-100) scale?
The statistical analysis reveals that the means pain score
among experimental group (Lidocaine group) was 76.9 the
mean pain score among control group (placebo group) was
72.1 the main difference is 4.8 at P-value 0.14. This
indicates there is increase in pain for Lidocaine spray
compared with placebo spray. Accompanied by 30% of
neonatal resuscitation among experimental (Lidocaine)
group and 23% of neonatal resuscitation in a control
placebo group8.
13
This study significantly explores that the
pharmacological intervention is in effective in reducing the
negative experience of the mother related to child birth &
labour as well as having ill effect on the neonates too, which
stress the use of non-pharmacological intervention to over
come the untoward incidence8.
3) Studies related to effectiveness of non
pharmacological intervention to reduce negative
experience of pregnancy and labor:
A quasi-experimental study done to evaluate
the effectiveness of non-pharmacological strategies on pain
relief during labor among 30 parturient at Humanizew labor
unit of a School maternity hospital in Nafal in Brazil by
assessing pain by using analogous visual scale. The
collected data were subjected to analysis using Mann-
Whitney’s U test which reveals there is statistical
significance level of P=<0.05 with acceptance of respiratory
exercise up to 80%. There fore through
application of these strategies the labor process may be less
painful, less tense. Since they need attention, counseling &
communication skills aimed at better onducting child birth. In
this context, this research support, the need to select non-
14
pharmacological strategies for parturient relief pf pain &
anxiety in the labor process11.
4) Studies related to effectiveness of Lamaze technique:
A method of child birth in which, the expectant
mother is prepared psychologically and physically to give
birth without the use of pain relieving drugs. The advantages
of the method include the need for little or no analgesia for
relief of pain and participation in the labour by the mother
giving her a guess about sense of self satisfaction at
delivery. The father of the baby also benefits by participating
in the birth of his child. A study was conducted to discuss
the effect of Lamaze practice on the outcome of pregnancy
and labour among 70 primipara women by controlled semi-
experimental clinical trial.The subjects were divided into
control and study group.Study group receieved Lamaze
technique included a training programme for the study group
cointaining 6 session.The study group was more satisfied
with their labour. The finding shows Lamaze practices can
increase satisfaction of labour process and it can decrease
the length of second stage of delivery. Inclusion of Lamaze
technique in maternal care program is highly suggested12.
15
This study was conducted to explore the
effectiveness of the video-based Lamaze method on Pre-
natal mothers' knowledge and attitudes, compared with that
of traditional nursing guidelines. Using a quasi-experimental
design, women in labor with gestations of 32 weeks or more
were divided into four study groups, including two
experimental groups (E(1): issued with traditional nursing
guidelines and instructed in video-based Lamaze method;
and E(2): instructed in video-based Lamaze method), and
two control groups (C(1): issued with traditional nursing
guidelines and C(2): issued with no guidelines). Before the
intervention, E (1) had the highest score for knowledge.
Scores for attitude showed no significant difference between
the four groups. The experimental groups had higher scores
than the control groups in the posttest. This study showed
that the video-based Lamaze method is likely to promote
more effectively than traditional guidelines the knowledge,
attitudes, and practice of prenatal mothers in relation to
giving birth. The use of this method in conjunction with
traditional nursing guidelines may be even more effective in
relation to maternal attitude23.
The study was conducted plasma
concentration of beta-endorphin and adrenocorticotropic
16
hormone in women with and without child birth
preparation.25 women had received child birth preparation
with the Lamaze method, and 22 women had received no
preparation. Mean concentration of beta-EP from the
beginning of labor until puerperium were higher in women
who had received preparation. The researcher discussed
the role of childbirth preparation was a way to enhance beta-
EP secretion. Levels of adrenocorticotropic hormonal closely
related with behaviors during labor22.
6.3 OBJECTIVES
To assess the knowledge regarding Lamaze
technique among midwives before and after
the intervention package
To evaluate the effectiveness of intervention
package on Lamaze technique To
find out the association between knowledge on Lamaze
technique and selected variables.
6.3.1 OPERATIONAL DEFINITIONS
Effectiveness : Refers to the significant improvement in
the Knowledge of midwives on Lamaze
technique as assessed by response to
the structured questionnaire
17
Intervention package : Includes teaching programme
through lecture and
demonstration regarding
Lamaze technique.
Lamaze technique : A method that mother adopts
for easy and pain free child
birth which includes on the5
types of breathing exercises
like Baseline breathing, Slow
breathing, Blowing breathing
Patterned breathing, cleansing
breathing exercise as per the
Stages of labor with out the
use of any pain relieving drug.
Midwives : A nurse who is trained and
certified by to assist women
during labor.
6.3.2) ASSUMPTION
Midwives may have some knowledge
regarding breathing techniques in labor.
18
6.3.3) Hypothesis
There is a significant increase in knowledge on
Lamaze technique among midwives after the Intervention
package than before.
6.3.4) SAMPLING CRITERIA
1. Inclusion criteria
a) Midwives who have under gone GNM & Bsc
course
b) Those who are available at the time of study
c) Midwives who are interest to participate in the
study
2. Exclusion criteria
a) The nurse who have already undergone formal
training in Lamaze technique and Obtained
certification.
7. MATERIALS AND METHODS
7.1 Source of the data :
Data will be collected from midwives in
selected maternity hospitals Bangalore.
19
7.2 Method of data collection:
a) Research approach : Evaluative
b) Research design : Quasi experimental. One group pre test & post test design.
c) Research setting : Selected maternity hospital, Bangalore
d) Population : All the midwives working in selected hospitals.
e) Samples : Midwives fulfilling the inclusion criteria.
f) Sample size : 50
g) Sampling technique: The sampling technique adopted for the study is
simple random sampling.
h) Method of data collection: Self administered questionnaire.
i) Tool for data collection : Structured Questionnaire.
j) Method of data analysis and interpretation:
The researcher will use
appropriate statistical technique for data analysis and
present in the form of tables and diagrams. The data will be
analyzed by using descriptive and inferential statistical.
1) Demographical variable will be assessed by frequency
distribution and percentage.
2) Level of knowledge will be assessed by mean, standard
deviation,
20
3) Effectiveness of Intervention package will be assessed by
paired‘t’ test.
4) Association between level of knowledge and selected
variables will be determined by ‘chi’square test
k) Variables under study:
Independent variable - Intervention
package on Lamaze technique
Dependent variable - Knowledge on Lamaze technique.
Attribute variable - Age, education, income,
experience ,source information.
l) Projected outcomes:
This study will enable midwives to gain
knowledge regarding Lamaze technique.
There by midwives can improve support to the mothers
during the labor process.
7.3) Does the study require any investigation
or intervention to be conducted on patient
or other humans or animals? If so please describe briefly?
No
7.4) Has ethical clearance been obtained from
your institution?
Yes ethical committees report is here
with enclosed.
21
Bibliography1) Myles text .book for midwives.14th
edition .DianM.Fraser:Margaret A .Cooper 2003 pp 435-43.
2) Caron – leulliez M.Can bull med hist .child birth with out pain .politics in france during the cold war 2006;
3) Larissa Hirsch,MD,serdar H ,ural,MDKids health.org/parents/pregnancy…./childbirth-pain.html.Dealing with pain during child birth.2008feb. Available from:
URL:http://kidshealth.org/parents/pregnancynewborn//pregnancy/chidbirth-pain.html#4) Gayle L.Riedmann,CNM,MS education for
childbirth Riedmann,G,Glob.libr.women’s med, [ISSN;175-2228] October 2008;DOI 10.3843/GLOWN.10109, Available from :URL: http://www.glown.com/Index.html//P=glown.cml/section-view&articled=109
5) John David Loeser, John .j. bonica Bonica’s management 3rd edition.Steph
6) Preetha nair Intoday deliver us from pain August 10 ,2009 Available from URL: www.intoday.in/index.php?option=com...............task
7) Chang MY,chen CH ,Huang KF A comparison of massage effects on labour pain using the McGill pain questionnaire in National Tainan Institue of nursing ,ROC 2006sep;14(3) 190-197 Available from : URL: http://www.ncbi.nlm.nih.gov/pubmed.
8) Julia sanders , Tim J Peters , Rona Campbell, To assess the effectiveness and acceptability of Lidocain spray in reducing perineal pain during spontaneous vaginal delivery20032004Available from : URL: http://www.ncbi.nlm.nih.gov/articles/pmc.
9) Prism’s. Nursing practice, child birth methods- Lamaze method. Journal of clinical nursing education, training and career development October – December 2008 volume 3 no: 4. pp 152-153.
10)waldenstrom U Hildingsson I , Rubertson C, Radestad I . A negative birth experience prevalence and risk factors in a national sample birth .2004 mar; 31 (1):17-27
22
11)Rejane marie barbosa davim I ; Gilson de vascocelos Torres II ;Eva Saldanha de Melo III Riberrao preto Non pharmacological strategies on pain relief during labour. Rev.Latino-AM.Enfermagem vol.15 no.6 November /December 2007. Available from : URL: http:// www.scielo.br/pdf/recus/v43n2/en.pdf.
12)F. Fahami , S .Masoudfar , Sh. Davazdahemami. The effect of Lamaze practices on the out come of pregnancy and labour in primpara women “Iranian journal of nursing and midwifery research summer 2007 vol 12 , no 3.111.
13)K Hesson Variability in breathing patterns during latent labor linkinghub.elsevier.com/retrieve/pii/S0091218296001395 - Similar - 1997 - Cited by 5 - Related articles.
14)Trueba, Guadalupe; Contreras, Carlos, Velazco, Maria Teresa, Lara, Enrique García, Martínez, Hugo B. Journal of Perinatal Education Alternative Strategy to Decrease Cesarean Section: Support by Doulas During Labor , Lamaze International , Volume 9, Number 2, 1 April 2000 , pp. 8-13(6).
15)Normal Labor and Childbirth www.maqweb.org/maqslides/powerpoint/Maternal/nlc/nlc.ppt - Similar
16)Michael Wuitchik, Ph.D. 1 , Kathlyn Hesson, M.Sc. Donald A. Bakal, Ph.D. 1 Michael Wuitchik , Dr. Michael Wuitchik, Perinatal Predictors of Pain and Distress During labor. Volume 17 Issue 4, Pages 186 – 191 Published Online: 31 Mar 2007 Journal compilation © 2009, Wiley Periodicals, Inc
17)A basic text family centered maternity or new born care 3rd edition celste.R Phillips pp 168-169
18)J Obstet Gynecol Neonatal Nurs. 1986 Sep-Oct;15(5):412-8. The role of the nurse in labor and delivery as perceived by nurses and patients. Collins BA.
19) Journal of Obstetric, Gynecologic, & Neonatal Nursing Volume 6 Issue 2, Pages 53 – 54 Published Online: 28 Jul 2006 © 2009 AWHONN A
23
Clarification of the Lamaze Method JUDITH ANDERSEN, RN, MS
20)Tsai MN Kao LR ,Kang CM, Hu Li Za Zhi project to improve perinatal care effectiveness in Vietnamese women. Department of Nursing, Cathay General Hospital Sijhih Branch, ROC.2008 Dec
21)Bailey JM, Crane P, Nugent CE. College of literature, science and the arts, university of Michigan , F4835 Mott hospital SPC 5264 , Ann arbor , mi 48109- 5264, USA Child birth education and birth plans. 2008 September.
22)Florido J, Oltras CM, Fajardo MC , Gonzalez- Escanuela E, Villaverde C, Gonzalez-Gomez F. Department of Obstetrics and Gynecology , University of Granada , Spain Eur J Obstet Gynecol Reprod Biol. Plasma concentration of beta – endorphin and adrenocorticitropic hormone in women with or with out child birth preparation. 1997 June
24
9. Signature of the candidate:
10. Remarks of the guide:
11. Name and designation (in block letters):
11.1 Guide:
11.2 Signature:
11.3 Head of the department:
11.4 Signature:
12. Remarks of chairman / principal :
12.1 Signatures
25