A Quasi-Experimental Study to Assess the Effectiveness of foot Reflexology on Intensity of Labour Pain among Primigravida Mothers admitted at selected Hospitals of Mohali, Punjab

 

Shilpa Bhatt¹, Mrs. Shivani Sharma², Ms. Vijayasanthalakshmi³

¹M.Sc (N) in OBG, Mata Sahib Kaur College of Nursing, Balongy, Mohali, Punjab 

²Guide and Professor (OBG), Mata Sahib Kaur College of Nursing, Balongy, Mohali, Punjab   

³Co-guide and Professor (OBG) , Mata Sahib Kaur College of Nursing, Balongy, Mohali, Punjab 

 

ABSTRACT:

Introduction: Pain is a physiological component of labour and birth. Pain is an unpleasant sensation of distress resulting from stimulation of sensory nerves. During the first stage of labour, pain results primarily from cervical dilatation and secondarily from the uterine contractions themselves. Painful sensations travel from the uterus via visceral afferent (sympathetic) nerves that enter the spinal cord through the posterior segments of thoracic spinal nerves. Human body can bear only up to 45 Del of pain. But at the time of giving birth, a woman feels up to 57 Del of pain. Aim of the study: The aim of the study is to assess the effect of foot reflexology on intensity of labour pain among primigravida mothers with view to promote the comfort of the primigravida mothers. Material and methods: A quantitative approach with quasi-experimental design was adopted. By purposive sampling Technique 60 primigravida mothers were selected. Data was collected by structured interview schedule and observation method. Analysis and interpretation was done by descriptive and inferential statistics. Results: In pre-test intensity of labour pain among primigravida mothers in experimental and control group In control group majority of the women had moderate pain 23(76.7%). In experimental group 20 (66.7%) had moderate pain.  In post- test intensity of labour pain among primigravida mothers in experimental and control group. In control group majority of women had severe pain 27(90%). In experimental group most of the women had moderate pain 28(93.3%). Conclusion: It shows that after foot reflexology in experimental group most of the women were had moderate pain 28(93.3%), 2(6.7%) had severe pain and there was no woman in mild pain. In control group majority of women in post test had severe pain 27(90%), 3 (10%) had moderate pain no woman was in mild pain. Behavioural response was good in the reflexology group as compared to control group. In the present study, it was found that the primigravida mothers of experimental group had moderate intensity of labour pain after the intervention, but intensity of labour pain was more in control group. Behavioural response was good in experimental group as compared to control group. So it is concluded that foot reflexology was effective on intensity of labour pain among primigravida mothers. Though labour pain increases with increase in dilatation.

 

 

 

 

 

INTRODUCTION AND BACKGROUND OF THE STUDY:

According to the definition of the International Association of Pain, pain is an unpleasant and mental emotional experience, which is accompanied with tissue damage8. One of the most severe pain known to woman is labour pain, which is synonymous with parturition⁹. During delivery, excessive pain lead to fear and anxiety. This stimulates the sympathetic nervous system to increase catecholamine secretion leading to increased blood levels of hormones such as epinephrine. This will further intensify the pain and potentially prolong the first stage of labour, thus resulting in a very unpleasant experience of childbirth especially among primigravida mothers.¹

 

Labour Pain can be classified as acute pain, but differs from pain experienced in other conditions. It is part of the normal process of childbearing. The sources are known (uterine contractions and dilatation of the cervix) and is necessary to propel the baby through the birth canal.² Pain gives the woman time to prepare herself for birth. Labour pain is generally referred to the abdominal wall, sacrum during the first stage of labour. During contractions, the blood vessels constrict and reduce the blood supply to the uterine and cervical cells, resulting in anoxia and ischaemia of the muscle fibres. As the contractions become longer and more intense, the ischaemia to the cells increases and the labour pain intensifies.²

 

Foot Reflexology is one of the non-pharmacological pain relief method. It is a noninvasive, inexpensive and applicable technique that can be used by a skilled and trained midwife.13Foot Reflexology massage is a type of massage that uses the thumb and the forefinger to stimulate some focal points on the foot. It is said that the foot has more than 7000 nerve endings, which are linked to various organs in the body.³

 

OBJECTIVES OF THE STUDY:

1.     To assess the pre-test intensity of labour pain among primigravida mothers in experimental and control group.

2.     To administer foot reflexology among primigravida mothers in experimental group.

3.     To assess the post test intensity of labour pain among primigravida mothers in experimental and control group.

4.     To evaluate the effectiveness of foot reflexology by comparing intensity of labour pain in experimental and control group.

5.     To associate the post test findings with selected socio-demographic variables.

 

 

HYPOTHESIS:

H₁: There will be significant difference in the post test on intensity of labour pain in experimental group and control group.

H₂: There will be significant association between the intensity of labour pain with the selected socio-demographic variables.

 

MATERIAL AND METHODS:

In present study, a quantitative approach with quasi-experimental research design was adopted. By Purposive sampling technique 60 primigravida mothers (30 in experimental group 30 in control group) were selected. Data was collected by structured interview schedule and observation method to assess the intensity of labour pain among primigravida mothers. Analysis of data was done using descriptive and inferential statistics. A study was conducted in the month of January 2017 Formal written permission was obtained obtained from the SMO of civil hospitals of Mohali and Kharar. After discussing the purpose and objectives of the study. Analysis and interpretation of data was done according to objectives of the study by using descriptive and inferential statistics.

 

ETHICAL CONSIDERATION:

With the view of ethical consideration the researcher has taken permission from Principal of Mata Sahib Kaur college of nursing Mohali. After that the researcher has discussed the type and purpose of the study with the SMO of civil hospitals of Mohali and Kharar and written permission were obtained. Also the primigravida mothers were explained about the purpose of the study and written consent was taken from them for their participation in study. They were explained about the right to refuse from participating in the study. The primigravida mothers were assured that the information given by them will be kept as confidential and will be purely used for research purpose.

 

RESULTS:

Table:1 depicts the frequency and percentage distribution of the primigravida mothers according to socio demographic variables such as age, educational status, occupation status, preoccupied idea about severity of labour pain and any idea about labour pain relieving measures. 

 

According to age in control group, majority of the women 13(43.3%) were in the age group of 26-30 years followed by 10 (33.3%) who were in the age group of 21-25 years, 7(23.4%) were in 31-35years. In experimental group majority of the women 15(50%) were in age group 26-30 years followed by 9 (30%) who were in 21-25 years and 6 (20%) were in the age group of 31-35 years. Calculated chi square value (χ2=.272, 2, .873) was found non significant thus, there was homogeneity in the groups. 

According to educational status majority of women 13(43.3%) were up to matric level followed by 8 (26.4%) who were graduate, 5(16.9%) were up to senior secondary level and 4 (13.4%) were having no formal education. In experimental group majority of women 11(36.6%) were graduate and above followed by 11(36.6%) who were up to senior secondary level, 4(13.4%) were up to matric level and 4 (13.4%) were having no formal education. Calculated chi square value (χ2 =21.383, 3, .315) was found non significant, thus there was homogeneity in the groups. 

 

According to occupation status in control group majority of the women 23(76.6%) were housewives and 7(23.4%) were working. In experimental group 16(53.3%) were housewives and 14(46.7%) were working. Calculated chi square value (χ2=12.381,1,.058) was found non significant, thus there was homogeneity in the groups. 

 

According to preoccupied idea about severity of labour pain majority of women 15(50%) were in severe category, 15(50%), were in moderate category and there was no women having preoccupied idea of mild pain. In experimental group majority of the women 16((53.3%) were in severe category followed by 14(46.7%) who were in moderate category, there was no women having preoccupied idea of mild pain. Calculated chi square value (χ2=.067, 2, .796) was found non significant, thus there was homogeneity in the groups.

 

 According to any idea about labour pain relieving measures majority of women 10(33.3%) were having idea of music therapy followed by 8(26.4%) who had no idea about pain relieving measures,7 (23.4%) had idea of acupressure/ foot reflexology and 5(16.9%) had idea of massage therapy. In experimental group, 10(33.3%) of women had no idea about pain relieving measure followed by 9(30%) who had idea of acupressure /foot reflexology, 7(23.4%) had idea of music therapy and 4(13.4%) had idea about of massage therapy. Calculated chi square value was (χ2=1.881, 3, 0.758) found non significant, thus there was homogeneity in the groups. 

 

 

Table – 1 Frequency and percentage distribution of primigravida mothers according to socio demographic variables     N=60

Socio-demographic variables	Control       n =30		Experimental   n =30		Chi-square, df, p-value
Age (in years)	n	%	n	%
21-25 26-30 31-35	10 13 07	33.3 43.3 23.4	09 15 06	30 50 20	272,2,.873
Educational Status
No formal education Up to matric Senior secondary Graduate $ Above	04 13 05 08	13.4 43.3 16.9 26.4	04 04 11 11	13.4 13.4 36.6 36.6	21.383,3,.315
Occupation status
Working housewife	07 23	23.4 76.6	14 16	46.7 53.3	12.381,1,.058
Preoccupied idea about severity of labour pain
Mild pain Moderate pain Severe pain	0 15 15	0 50 50	00 14 16	0 46.7 53.3	.0672,2,.796
Any idea about labour pain relieving measures Music therapy Acupressure/Foot reflexology Massage therapy No idea	10 07 05 08	33.3 23.4 16.9 26.4	07 09 04 10	23.4 30 13.4 33.3	1.881,3,0.758

p <0.05

SECTION B:

Table- 2: Pre-test intensity of labour pain among primigravida mothers in experimental and control group                           N=60 

 

Table –3 Post-test intensity of labour pain among primigravida mothers in experimental and control group                N=60

Table 4: Effectiveness of foot reflexology by comparing intensity of labour pain in experimental and control group     N=60

NS=Non significant;  *significant p<0.05

 

Table 2 depicts frequency and percentage based on pretest intensity of labour pain such as mild, moderate and severe pain. In control group most of the women in pretest were in moderate pain 23(76.7%), 6 (20%) were in severe pain and 1(3.3%) was in mild pain. In experimental group 20 (66.7%) were in moderate pain, 9(30%) were in severe pain and 1 was in mild pain. 

Hence, it shows that in both the groups most of the primigravida mothers had moderate intensity of labour pain before therapy.

 

Table 3: depicts frequency and percentage based on posttest intensity of labour pain such as mild pain, moderate pain and severe pain. In control group most of the women in post test had severe pain 27(90%), 3(10%) had moderate pain no woman was in mild pain. In experimental group most of women had moderate pain 28(93.3%), 2 (6.7%) had severe pain and there was no woman in mild pain.

 

Thus, it shows that most of 28 (93.3%) primigravida mothers had moderate pain, in experimental group after getting foot reflexology. But in control group, majority of the 27 (90%) primigravida mothers had severe intensity of labour pain.

 

Table 5: Association between post test score of the intensity of labour pain among control group mothers with selected sociodemoraphic variables                                                                                                                                                                                                             N=30

p<0.05

 

Table 4, depicts that pretest mean score and SD at 3-4cm cervical dilatation in experimental group was 5.6±1.25 and in control group mean score and SD was 5.4± 1.10 which was statistically non significant. Post test mean score and SD at 6-7cm of experimental group was 4.83±.817 and in control group mean score and SD was 8.20±1.32 which was highly significant at the level of 0.05.  

 

Thus, there was significant difference in experimental and control group in the post test. Hence, research hypothesis (H₁) was accepted.

 

Table 5, depicts that Fisher’s exact test value for the association between post test findings of control group with education status (11.317, 3, 0.00*), occupation status (F21.667,1,0.008*), was found significant at p<0.05 level. 

 

Fisher’s exact test value for the association between post test findings of control group with age (F.2841,2,0.305), preoccupied idea about severity of labour pain (F.0001,1,100) and any idea about labour pain relieving measures F(4.386, 3, 0.224) were found non significant at p<0.05 level 

 

Thus, there was statistically significant association between post test findings of control group with education status (F11.317, 3, 0.00*), occupation status (F21.667,1,0.008*), at p<0.05 level. Hence, hypothesis H₂ was accepted in these cases.

 

SECTION –B Part-II

Table 6: Frequency and percentage distribution of primigravida mothers according to their behavioural response to intensity of labour pain

Behavioural response to intensity of labour pain	Experimental Group             n =30				Control Group                n =30
	Pretest		posttest		Pretest		posttest
	3-4cm		6-7cm		3-4cm		6-7cm
	n	%	N	%	n	%	n	%
Facial expression Relaxed Partially tightened Fully tightened Grimacing	1 15 14 0	3.3 50 46.7 -	0 10 18 2	- 33.4 60 6.6	2 14 14 0	6.6 46.7 46.7 -	0 10 14 6	- 33.3 46.7 20
Activity Quite Slightly restless Moderate restless Very restless	5 23 2 0	16.6 76.8 6.6 -	0 18 6 6	- 60 20 20	4 24 2 0	13.3 81 6.6 -	0 8 12 10	- 26.7 40 33.3
Verbalization Talking in normal tone or no sound Sigh, gross, moan softly Groan, moans loudly Cries out or sobs	3 27 0 0	10 90 - -	0 20 8 2	- 66.7 26.7 6.6	4 26 0 0	13.3 86.7 - 0	0 8 12 10	- 26.7 40 33.3

 

Table 6 depicts frequency and percentage distribution of primigravida mothers according to their behavioural response to the intensity of labour pain such as facial expression, activity and verbalization. 

 

According to facial expression in pretest of experimental group, majority of the primigravida mothers 15(50%) had partially tightened followed by 14(46.7%) had fully tightened and 1(3.3%) had relaxed facial expression. No women having grimacing facial expression. In post test of experimental group 18 (60%) had fully tightened followed by 10(33.3%) had partially tightened and 2(6.6%) had grimacing facial expression in experimental group. In control group majority of primigravida mothers 14(46.7%) had partially tightened, 14(46.7%) had fully tightened and 2 (6.6%) primigravida mothers had relaxed facial expression in pretest. In post test 14(46.7%) had fully tightened, 10(33.3%) had partially tightened, and 6(20%) had grimacing. Facial expression. No primigravida mothers had relaxed facial expression in post test. There were more women having painful facial expression in control group as compared to experimental group. 

 

According to activity, in pretest of experimental group majority of the primigravida mothers 23 (76.8%) were slightly restless followed by 5 (16.6%) who were quite, 2(6.6%) were moderate restless. No women were in very restless activity. In post test 18(60%) were slightly restless, 6(20%) were moderate restless and 6(20%) were very restless. No primigravida mother had quite activity. In control group pretest majority of primigravida mothers 24(80%) had slightly restless, 4(13.3%) had quiet activity, 2 (6.7%) were moderate restless. Where in posttest of control group 12(40%) had moderate restless followed by 10(33.3%) were very restless and 8(26.7%) had slightly restless. activity. It shows that women in control group during post-test having more restless activity as compared to control group. 

 

According to verbalization, in pretest of experimental group majority of the primigravida mothers 27(90%) had sighing, grossing, moaning softly, 3(10%) were talking in normal tone. No mothers were groaning, moaning loudly and crying out verbalization. In post test of experimental group majority of primigravida mothers 20 (66.7%) who were sighing grossing, moaning softly followed 8(26.7%) were groaning 38 moaning loudly and 2(6.6%) were crying out. No women had talking in normal tone verbalization. 

 

In control group, pretest most of primigravida mothers that is 26(86.7%) had sighing grossing moaning softly, 4(13.3%) who were talking in normal sound and no woman were in groaning moaning loudly, crying out verbalization. In post test 12(40%) who were groaning, moaning loudly, 10(33.3%) who were crying out, 8(26.7%) who were sighing, grossing moaning softly. No primigravida mothers were talking in normal sound verbalization. Verbalization of pain was more in control group during post-test as compared to experimental group

 

DISCUSSION:

The results revealed that socio demographically, according to age in control group, majority of the women 13(43.3%) were in the age group of 26-30, In experimental group majority of the women 15(50%) were in age group 26-30 years. According to educational status in control group majority of women 13(43.3%) were up to matric level. In experimental group majority of women 11(36.6%) were graduate and above According to occupation status in control group majority of the women 23(76.6%) were housewives. In experimental group 16(53.3%) were housewives. According to preoccupied idea about severity of labour pain majority of women 15(50%) were in severe category, 15(50%) were in moderate category. In experimental group majority of the women 16 (53.3%) were in severe category followed by 14(46.7%) who were in moderate category. According to any idea about labour pain relieving measures majority of women 10 (33.3%) were having idea of music therapy. In experimental group majority of women 10 (33.3%) had no idea about labour pain relieving measures. 

 

To evaluate the effectiveness of foot reflexology by comparing intensity of labour pain in experimental and control group. During pretest at 3-4 cervical dilatation  in experimental group mean score and SD was 5.6± 1.25 and in control group mean score  and SD was 5.4±1.10  which was  statistically non significant. In post test at 6-7cm in experimental group mean score and SD was 4.83±.817 and in control group mean score and SD was 8.20±1.32 was significant at the level of 0.05. 

 

CONCLUSION:

In the present study. it was found that the primigravida mothers of experimental group had moderate intensity of labour pain after the intervention, but intensity of labour pain was more in control group.

 

Behavioural response was good in experimental group as compared to control group. So it is concluded that foot reflexology was effective on intensity of labour pain among primigravida mothers. Though labour pain increases with increase in dilatation.

 

REFERENCES:

1.      Goweily Eman. Efficacy of foot reflexology on first stage labor pains.  Journal of Health, Medicine and Nursing. vol 18, 2015.

2.      Basbarm H. Endorphin mediated analgesia system AND Text Book of pain Edinburgh Churchill Livingstone.8thed. W.B Saunders Company.1984

3.      Pillitteri Adele. Maternal and child health Nursing.2nded. W.B Saunders Company. 2012. 

4.      Briggs, E. Adrienne Dubin. Nociceptors: the sensors of the pain pathway. Journal of clinical investigation Nov2010; 120 (11)3760-3772.

5.      Annamma, Jacob. A comprehensive textbook of midwifery and gynaecological nussrsing.3rd ed. Jaypee publishers, 2012.

 

 

 

 

Received on 03.12.2018         Modified on 29.12.2018

Accepted on 25.01.2019      ©A&V Publications All right reserved