Effectiveness of selected nursing intervention on maternal and newborn outcome among primigravida mothers at selected hospitals

Mrs. S. Shenbagavalli¹* , Dr. K. Menaka²

¹Principal, Dhanvantri College of Nursing, Ganapathypuram, No.1 Ranganoor Road, Muniyappan Kovil, Pallakkapalyam (PO), Sankagiri West Via, Thiruchengodu (TK), Namakkal Dist – 637303.

²Principal, Padmasree College of Nursing, No. 20 A, Masilamani Nagar, Walajabad, Kanchipuram District.

*Corresponding Author Email: shakthinilasri@gmail.com

ABSTRACT:

Back ground: Labour is one of the most common stressed and painful situations which adversely affect the maternal and new born outcome leads to many complications. Objective: To assess the effectiveness of selected nursing intervention on maternal and newborn outcome among primigravida mothers. Design: One group true experimental post test only design was adopted for the study. Setting: Government Hospital, Cheyyur, Participants: 20 primigravida mothers completed thirty six weeks of gestation fulfilling the inclusion criteria were selected by simple random sampling. Methods: Nursing interventions like Breathing exercise, massage, position changes implemented during intrapartum period and level of pain perception assessed with universal pain assessment tool during uterine contractions of first stage of labour. Followed by early initiation of breast feeding done through breast crawl technique. Maternal and newborn outcome assessed with ongoing assessment tool. Collected data was analyzed by using descriptive and inferential statistics. Results: In post test the mean score for the level of pain perception in experimental group was 6.5 (SD=1.58) and the control group was 9.1 (SD=0.88) with paired t’ value of 4.55. The mean score of experimental group maternal outcome was 23 (SD =3.13) and the control group outcome was 27.4(SD=4.62) with paired t’ value of 2.49. In experimental newborn outcome the mean score was 7.7 (SD=1.06) and control group newborn outcome score was 6.8(SD=0.92) with paired t value of 2.04. This showed that the selected nursing interventions were effective for good maternal and newborn outcome during labour. There was a statistically no significant association found between the post test score of the sample with their demographic variables. Conclusion: The findings imply the need for non pharmacological methods of nursing interventions were effective management during labour among primigravida mothers.

KEY WORDS: Effectiveness, Breathing exercise, Massage, Position changes, Breast crawl and Primigravida.

INTRODUCTION:

Save a mother educates women about pregnancy, nutrition, immunization, delivery and care of the child. We believe that one preventable death is one too many. Jabadi F (2010).

Modern Lamaze childbirth classes teach expectant mothers many ways to work with labor process to reduce the pain associated with child birth and promote normal (physiological) birth including the first moment after birth. Techniques include allowing labor to begin on its own, Movement and position, massage, aromatherapy, hot and cold packs, informed consent and informed refusal, breathing techniques, the use of a “birth ball” (yoga or exercise ball), spontaneous pushing, upright positions for labor and birth, breastfeeding techniques, and keeping mother and baby together after childbirth. Lamaze (2000).

The Lamaze technique, often referred to simply as Lamaze, is a prepared childbirth technique developed in the 1940’s by French obstetrician Dr.Fernand Lamaze as an alternative to the use of medical intervention during childbirth.

The goal of Lamaze is to increase a mother’s confidence in her ability to give birth; classes help pregnant women understand how to cope with pain in ways that both facilitate labor and promote comfort, including focused breathing, movement and massage.

Massage and breathing naturally helps to consciously relax the body, a skill that’s needed during the child birth. Early and active labor can especially benefit from massage. It relaxes the muscles and mind, allowing the body to take over. Letting can be the hardest thing to do, but it will bring control. Cunningham F. Gant N.F (2001)

NEED FOR THE STUDY:

According to WHO worldwide every minute of every day a women dies somewhere in the world as a result pregnancy or child birth globally, this is more than half a million a year worldwide.

Global maternal mortality estimate 400/1,00,000 live birth.

Maternal death worldwide is 25%.less than 1% maternal death in more developed region and 90% in developing countries. 13% countries account for 67% of all maternal deaths. Highest Estimated numbers are India, Nigeria, Pakistan, and Democratic republic of Tanzania Afghanistan, Bangladesh, Angola, China, Kenya, Indonesia and Uganda (WHO).

According to UNICEF, every year 78,000/1,00,0000 mothers die during child birth in India. According to UNICEF, India’s maternal mortality rate stands at 450/1,00,000 live births. Against 450 in 1998-1999 India’s millennium development goal is to reduce the maternal mortality rate to 109 by the Year 2015.

Geller in 2006 surveyed that in addition to maternal mortality, 7 million more women suffer serious health problems related to child bearing and 50 million suffer adverse health effects.

In Tamil Nadu, from the year 2001 to 2003 maternal mortality were 130/1,00,000. In the year 2007 to 2008 maternal mortality were 91/1,00,000. And in the year2009 maternal mortality were 79/1,00,000. From the year 2010 to 2011 maternal mortality were 68/1,00,000. From the year 2011 to 2012 maternal mortality were 58/1,00,000. From the year 2012 to 2013 maternal mortality are 49/1,00,000.

According to 2005 survey, the average crude birth rate the entire world was estimated to be 20.3 births per 1000 populations. As per 2001 census, the population of Tamilnadu was 6.24 crores with dedicated growth rate of 11.7% which was the second lowest in the country next to Kerala. Tamilnadu was the sixth most populous state in India. In accounts 6% of the country’s total population. The Tamilnadu as per government of India sample registration system 2002 furnished the birth rate to be 18.5/1000 population.

STATEMENT OF PROBLEM:

Effectiveness of selected nursing intervention on maternal and newborn outcome among primigravida mothers at selected hospitals.

OBJECTIVES:

Ø To assess the maternal and newborn outcome in experimental and control group.

Ø To evaluate the effectiveness of selected nursing intervention on maternal and newborn outcome.

Ø To find out the association between maternal and newborn outcome with their selected demographic variables.

HYPOTHESIS:

Ø There will be a significant difference in maternal and newborn outcome between experimental and control group.

Ø There will be significant correlation between maternal and newborn outcome.

Ø There will be significant association between maternal and newborn outcome in experimental and control group.

MATERIALS AND METHODS:

Research approach

An evaluate approach was considered as the appropriate measure to evaluate the effectiveness of selected nursing interventions on maternal and newborn outcome among primigravida mothers.

Research design

True experimental post test only design was used.

Research setting

The study was conducted in antenatal outpatient department at government hospital, cheyyur.

Sample

The sample consisted of 20 primigravida mothers completed 36 weeks of gestation. (10 control group and 10 experimental group)

Sampling technique

Simple random sampling technique was used to select the sample.

Development of tool

Section A: Demographic variables

Section B: Universal pain assessment tool

Section C: Ongoing assessment tool for maternal outcome

Section D: Ongoing assessment tool for newborn outcome

Data collection procedure

1. Ethical clearance obtained from hospital research committee

2. Followed by informed consent from 20 primigravida mothers completed 36 weeks of gestation 10 mothers from each group. Base line data was obtained from both the groups. Slow paced breathing exercise taught to experimental group and reinforces to practice 6 – 9 breaths/min for every day throughout pregnancy and every one hour during uterine contractions of first stage of labour. Followed by abdominal effleurage (light fingertip touching of 5 strokes in supine position.) and sacral pressure in lower thoracic to sacrococygeal region for 10 – 15 mts for every one hour, Simultaneously position changed from lateral to upright position alternatively for 20 – 30 mts during first stage of labour. After the delivery within half an hour early initiation of breast feeding through breast crawl technique is implemented to newborn after cutting the cord.

3. Participants in both groups received the same care except the selected nursing interventions of breathing exercise, massage, position changes and breast crawl technique.

Plan for data analysis

The data were analyzed by using both descriptive and inferential statistics. Back ground information of the subject were described by percentage distribution, Mean, Standard deviation, and‘t’ test were used to find the effectiveness of selected nursing intervention on maternal and newborn outcome among primigravida mothers.

Chi – square test was used to find out the relationship between selected variables of primigravida mothers with their post test scores.

RESULTS:

Section A:

The study findings showed that in control group ( 30% ) of primigravida mothers were in age group of 24 – 26 years, 40% were no formal education and homemakers, 40% of them were belongs to nuclear family. Majority 60% of them were Hindus, 80% of them were come to regular antenatal checkup. Highest percentage (70%) of them was in gestational age of 41 – 42 weeks.

The study findings showed that in experimental group 30% of primigravida mothers were in age group of 27 – 29 years, 30% were high school education, 30% of primigravida mothers were daily labour, 40% of them income were less than 5000/ month, 50 % of primigravida mothers were belongs to rural area, 60 % of them were in gestational age of 37 – 38 weeks.

Section B:

The level of pain perception in post test experimental group 60% of primigravida mothers were in moderate level of pain perception, 20% of them were in mild and severe level of pain perception, where as in control group100% of primigravida mothers were in severe level of pain perception.

Section C:

In experimental group the mean value for maternal outcome was 23( SD=3.13) where as in control group it was 27.4( SD=4.62) with the paired ‘t’ test value was 2.49 in newborn outcome, the experimental group mean value was 7.7(SD=1.06), where as in control group it was 9.1 (SD=0.88) with the paired ‘t’ test value was 2.04. It seems that the selected nursing interventions are breathing exercise, massage, position changes and breast crawl were effective during labour process.

Section D:

Chi square was computed to determine the association between post test scores of primigravida mothers with their demographic variables like age, education, occupation, income, family type, religion, living area, antenatal checkup and gestational weeks.

Table 1- Level of pain perception during first stage labour among primigravida mothers in experimental and Control group

Table.2-Comparison of Mean, SD of pain perception, Maternal and Newborn outcome among primigravida mothers in experimental and control group

Primigravida mothers	Post test score								t’ value
	Experimental group				Control group
	N	Mean	S.D	Std. Error mean	N	Mean	S.D	Std. Error mean
Pain perception	10	6.5	1.58	0.50	10	9.1	0.88	0.28	4.55*
Maternal outcome	10	23	3.13	0.99	10	27.4	4.62	1.46	2.49*
New born outcome	10	7.7	1.06	0.34	10	6.8	0.92	0.29	2.04*

Significant at P<0.05

DISCUSSION:

Ø Highly significant association was found between post test scores of pain perception, maternal and new born outcome among primigravida mothers in experimental and control group.

Ø No significant association was found between post test and their demographic variables of both the groups among primigravida mothers.

RECOMMENDATIONS:

Ø Non pharmacological pain management should be emphasized in nursing curriculum.

Ø Training programs for the nurses can be given on complementary therapies.

LIMITATIONS:

Ø The study was conducted only among primigravida mothers.

Ø Intervention was limited to labour process.

Ø Relatively small sample size.

CONCLUSION AND SUMMARY:

Ø Breathing exercise, massage, position changes and breast crawl technique significantly improved the maternal and newborn outcome during labour.

Ø Nurses interested in non pharmacological therapies should be encouraged to obtain training in alternative therapy especially Lamaze technique of selected nursing interventions like Breathing exercise ,massage, position changes and breast crawl technique and apply it in clinical settings if it is allowed.

REFERENCES

1. England P, and Horowitz R. Midwives as Teachers: The minute Curriculum in V.L. Walsh. (Ed), Midwifery community-Based care during the Childbirth Bearing Year, W.B. Sanders Company. 2002.

2. Cunningham F, Gant N.F, leveno Leveno K.J, Glistrap L. C, Hauth J.C, and Wenstrom L.D. Williams Obstetrics. 21th ed. Newyork: McGrawhill. Medival Publishing division. 2001.

3. Kinndy E.S. Maternal – Child Nurssing. 2th ed. United States of American: Elsevier

4. Hodnett E.D Pain and women's satisfaction with the experience of childbirth. A systematic review. American Journal of Obstetrics and Gynecology 2002: (5): 160-172.

5. Lamaze F. Painless Chilbirth. New York: 2002.6. Molby B, Scallan E, Fitzpatrick P, Keegan T, and Byrne. Community mothers program: seven year follow up of a randomized controlled trial of none Professional intervention in parenting. Journal of public health medicine 2000; 22(3): 337-342.

6. Ja'afari F, Khodakarami N. Guidelines of preparness classes for deliveryl Ministry of Health and medical education; 2004.

7. Moslemabadi FS. Effects of specialized midwifery care during labor on delivery out comes in referring women to one of the educational-treatment centers of Iran university of medical sciences. Ms thesis. Tehran: Iran University of nursing and midwifery. 2005.

8. Javadi F. Effect of continuous support during labor on the length of labor stages, cesarean using Exitocine and APGAR in primpara women referring to one of the hospitals of Iran medical sciences university. Ms thesis. Faculty of nursing and midwifery, Iran medical sciences university. 1998.

9. Chang M, Wang Sh, and Chen C. Effects of Massage on pain and anxiety during labor. Journal of advanced Nursing 2002; 38(1): 68-73.

10. Bryanton G, Fraraser H, and Sullivan. Woman’s Perceptions of Nursing Support During Labor. Gogan 1994; 23(8): 638-644.

11. Baker Rooks P.J. The Midwifery Model of Care. Journal of Nurse-Midwifery 1999; 44(4): 370-374.

Received on 21.04.2016 Modified on 18.05.2016

Asian J. Nur. Edu. and Research. 2016; 6(3): 407-410

DOI: 10.5958/2349-2996.2016.00072.0