INTRODUCTION:

Pregnancy is such an exciting time and the changes that accompany pregnancy affect the women’s emotions. Hence the pregnant woman needs the support very much from the caregiver (Bryanton, 1994). Last decade, a number of studies have acknowledged and validated the importance of the presence of supporting persons with women during labour (Madi, Sandall and Bennet, 2004).

Childbirth preparation became popular because it identified the need of most expectant mothers and their support people as they began to reclaim their right to take an active part in their experience and demanded a change in their care from their health care providers (Moondragon, 2007). A good child birth preparation helps couple to develop stress management techniques to deal with fear and pain as well as good grounding in the risks and benefits of various obstetric choices. This preparation helps them to empower women and their partners so they may be able to stand up for the clinics they want and be able to decline the choices they don’t want from the medical community (Rowlands, 1998).

Gagon, et al (1990) explained that childbirth preparation tends to allow women to cope, to remain in control and thus able to describe pain more manageable, even though it may be as intense as experienced by an unprepared woman.

Husband and antenatal women both can be comfortable with the idea of husband coached labour. Husband can be the most significant source of emotional support and comfort. Loving partners are one of the strongest tranquilizers and the most effective pain relievers. Their nurturing presence may also encourage the flow of oxytocin, a hormone which helps labour to progress more quickly (Green, 2003). For many fathers, the involvement in birth gives them a chance to nurture and care of their new baby. Women who nurtured by their male partners during pregnancy had few childbirth complications and they will adjust easily in the postpartum period.

Robert Bradley developed this method in the late 1940’s. This method emphasizes an extremely natural approach with few or no drugs and little medical help during labour. Fundamental philosophy of Bradley birth is that, with adequate preparation and support from a loving, supportive coach, most women can naturally deliver their babies. In the Bradley course of study, mates are trained to coach mothers through childbirth using hands-on-techniques like massage and praise. Husband coached labour is the main concept where husband is allowed to remain inside the labour room to participate actively in the labour process.

The Cochrane group conducted several reviews of published trials regarding pregnancy and childbirth. In one review of 15 trials involving over 12,000 women, the continuous presence of husband coach reduced the likelihood of analgesia for pain relief, reduced operative delivery and reduced dissatisfaction of women with their birth experiences (Hodnett, Gates, Hofmeyr and Sakala, 2006).

Combined five randomized trials involving 1,252 primiparous women at term with singleton uncomplicated pregnancies. Researcher found that when continuous labour support was provided for women, the caesarean birth rate decreased by 50%, length of labour was decreased by 40% and the request for pain medication dropped by 60%. This research concluded that continuous support in primiparous women enhances maternal and fetal well being reduces medical interventions and saves money for individuals and hospitals (Klein, et al., 1998).

The continuous presence of a supportive companion during labour and delivery in Guatemala shortened labour and reduced the need for caesarean section and the other interventions. 412 healthy nulli parous women in labour were randomly assigned to a supported group (n=212) that was monitored by an inconspicuous observer. Continuous labour support significantly reduced the duration of labour, oxytocin use, forceps deliveries, rate of caesarean section deliveries, maternal fever and prolonged infant hospitalization (Kennell and Klaus, 2003).

Since, a father can participate in labour and birth in different ways; nurses need to encourage him to adapt the role most comfortable for him and for the woman, rather than an artificial role. Supporting both the father and the mother in labour elevates the nurse’s role. It is another step forward from merely providing custodial care to enacting a therapeutic role. Nurse plays many professional roles in day to day activities. Among all, the role as a comforter is very important in speaking soothing words to antenatal women. They are the professionals available with the women all the time. Nurse’s master mind utilized for childbirth preparation helps to alleviate fear, anxiety and tension and promote quality in birthing.

OBJECTIVES:

· To implement Bradley method of child birth to women and their husband.

· To assess the outcome of labour among women undergone Bradley method of Childbirth.

hypotheses:

(i) Bradley method will facilitate high coping ability among parturient.

(ii) Bradley method will facilitate high satisfaction level on child birth experiences among parturient.

METHODOLOGY:

The conceptual framework in this study was based on Roy’s adaptation model. The study was conducted for 30 days. Quasi experimental one group post test design was adopted. The antenatal women who were between 36-38 weeks of gestational age were considered as accessible population. Convenient sample of 7 antenatal women and their husband were drawn as sample for the study.

Description of tools

Ø Demographic profile and obstetric history

Ø Partogram to assess the progress of labour

Ø Modified Alice Chacko coping response scale (Esther John, 2009) to assess the coping response of the parturient during labour. It was a structured observational checklist, consists of 48 items.

Ø Modified Esther john’s structured Opinionnaire to assess the mother’s satisfaction level on childbirth experiences. It was a structured questionnaire consists of 9 items.

Description of intervention

Phase I

The purpose of the present study was explained to the couple. The demographic and obstetric history was collected by personal interview. The couples were taught about Bradley method by using booklet and demonstration on breathing techniques, relaxation and massage techniques were done in five different sessions. The couples were encouraged to re-demonstrate these techniques.

The content of the teaching module was,

v Introduction to female reproductive system

v Introduction to Labour

v Concept of Bradley method and role of husband in childbirth.

v Breathing exercices

v Massage technique

v Relaxations techniques

Phase II

During first stage, parturient was shifted to labour room, where researcher allowed the husband to be with his wife to provide emotional support and physical comfort by performing massage. The progress of labour was informed to the husband now and then by the researcher and obstetrician. The partner was encouraged to give continuous support to his wife who was in labour. Progress of labour was monitored through Partogram and coping responses was assessed through questionnaire. After assessing the outcome of labour in the first stage, the researcher permitted the husband to remain in the labour room till the crowning of the presenting part. After the delivery, the mother’s satisfaction level on child birth experiences was assessed by using an Opinionnaire.

DISCUSSION:

Demographic variables of antenatal women

In this study, 7 antenatal women comprising of age ranged from 20 – 30 years were studied. Among that, 57% of the antenatal women belong to the age group of 29 – 32 years, 29% of them belongs to the age group of 25 – 28 years and 14% of them were between the age group of 21 – 24 years. Out of 7 antenatal women, 57% of women were Under Graduates, 29% of them were Post Graduates and 14% of them completed their higher secondary.

Demographic variables of husband

Among 7 husbands, 57% of the husbands belong to the age group of 30-34 years. 29% of them belong to the age group of 35-40 years and 14% of them were between age group of 25-29 years. Out of 7 husbands, 42% of them were Post Graduates, 29% of them were Under Graduates and 29% of them completed their higher secondary.

Distribution of obstetrical data

Most of the antenatal women (57%) were multigravida and 43% of them were primigravida. Present study revealed that, multigravida mothers were shown high coping ability when compared to primigravida mothers. Among 7 antenatal women, 71% of the antenatal women were between 35 – 36 weeks of gestational age, 29% of them belong to 37 – 38 weeks of gestational age. Among 7 antenatal women, 57% of them had 8-10 hours duration of labour. 29% of them had 5-7 hours duration of labour. 14% of them had 11-13 hours duration of labour. Out of 7 antenatal women, all of them undergone normal vaginal delivery. Among 7 husbands, 57% of them were present during first stage up to 4-6 hours and 43% of them were present upto 7-10 hours. Present study revealed that more the duration of presence of husband more coping ability was noted among parturient.

Distribution of parturients based on score of Modified Alice Chacko coping response scale (Esther john, 2009)

The result reveals that, 86% of mothers who have practiced Bradley method during labour were shown high coping ability during first stage of labour. 14% of mothers were shown moderate coping ability during first stage of labour. Hence, the hypothesis, “Bradley method of childbirth preparation increase the coping ability of the parturients” is accepted.

Distribution of satisfaction level of the mother based on Modified Esther john Opinionnaire

Most of the mothers were expressed (57%) high satisfaction level on Bradley Method of childbirth. 43% of them were expressed moderate level of satisfaction on Bradley method of childbirth which was achieved through the presence of their husbands and psychological support provided by them.

Major findings of the study:

1. Bradley method was effective in increasing the coping ability of parturients during first stage of labour.

2. 86% of the parturients were shown high coping ability during first sage of labour.

3. 57% of the parturients had high level of satisfaction and 43% of the parturients had moderate level of satisfaction in childbirth experience.

4. Progression of labour was accelerated with the help of Bradley method.

5. Husbands were actively participated in labour process.

6. All the mothers underwent normal vaginal delivery with the use of Bradley method.

Recommendations:

1. Bradley method can be implemented from third trimester onwards and results obtained to evaluate the quality of early preparation.

2. A similar study can be conducted as a true experimental study comprising of a control group.

3. A structured teaching programme can be conducted to the staff nurses working in obstetric department about Bradley method.

4. A comparative study can be conducted on various childbirth preparation methods.

5. The study can be replicated with a larger size for wider generalization of findings.

Nursing Implications:

The concept of Bradley method encourages the role of husband in providing comfort measures in terms of relaxation exercises and measure to cope up during first stage. It is one of the child birth preparation methods aiming to improve the labour outcome and its implications needs wide knowledge and practice. The practice of Bradley method can be included in the nursing curriculum. Bradley method facilitates the mother to cope with pain and increase the coping ability of mother during first stage of labour. The midwife can practice Bradley method to promote the labour outcome.

Conclusion:

The study was conducted to find the effect of Bradley method among pregnant women. Most of the women (86%) were shown high coping ability during first stage of labour and 57% of women showed high satisfaction level on child birth experiences. Hence, the intervention was found to be effective in promoting labour outcome.

REFERENCES:

1. Adele Pilliteri. (2007). Maternal and Child Health Nursing. (5^th Ed.), Philadelphia: J.P. Lippincott Company, 523-526.

2. Bradley, R. (1981). Husband Coached Childbirth. (3^rd Ed.), New York: Harper Collins, 332.

3. Bradley. (1981). Bradley Method of Child Birth. Retrieved from http://www.exortment.com/all/bradleymethod.html on Nov 28, 2009.

4. Bryanton, J., Fraser-Davie, H. and Sullivan, P. (1994). Women’s Perception of Nursing Support during Labour. Journal of Obstetric, Gynaecologic and Neonatal Nursing, 23, 638-644.

5. Gagnon, et al., (1990). A Randomized Trial of One – To – One Nurse Support of Women in Labour. Birth, 24, 2, 71 – 77.

6. Green. (2003). Positive Effects of Presence of Partner. Retrieved from http://www.birthpsychology.com/prep.html on Dec 10, 2009.

7. Hodnett, E. D., Gater, S., Hofmeyr, G. J. and Sakala. (2006). Continuous Support for Women During Child Birth. Cochrane Library, 4, Oxford, UK: Update Software.

8. Hodnett, E. and Osborn, R. (1998). A Randomized Trial Of The Effects Of Support During labour. Journal of Obstetric and Gynecology and Neonatal Nursing 16, 177 – 183.

9. John, E. (2009). A Comparative Study to Assess the Effectiveness of Selected Child Birth Preparation Methods. An Unpublished Doctoral Thesis submitted to Annamalai University, Chidambaram.

10. Kennel. M. and Klaus. (2003). Continuous Presence of Supportive Companion during labour, Retrieved from http://pal.dec.org/PNACY760.pdf on July 11,2010.

11. Klein, R. P., et al. (1998). A Study of Father in Child Birth. Birth Family Journal, 8, 161-164.

12. Madi, B. C., Sandall. J. and Bennet, R. (2004). Effects of Continuous Support in Labour. Birth, 26, 1, 5-8.

13. Moondragon. (2007). Child Birth Preparation Classes. Retrieved from http://www.moondragon.org/pregnancy/childbirthclasstype.html on July 13, 2010.

14. Rowland. (1998). Birthing Classes. Retrieved from http://www.kidshealth.org.pregnancy/birth-class.html on July 10, 2010.

15. Sosa, et al., (1998). Continuous Supports during Labour. Retrieved from http://pdf.dec.org/PNACY760.pdf on July 11, 2010.

Received on 27.07.2012 Modified on 12.08.2012

Asian J. Nur. Edu. and Research 2(3): July-Sept. 2012; Page 109-112