INTRODUCTION:

“Pain is inevitable, suffering is optional”

Haruki Murakami

Burroughs (2011) stated that pregnancy is a special event not only in the life of a woman but also in the entire family. The labour and birth process is an exciting, anxiety provoking but rewarding time for the women and her family. Normal labour is spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy.

McKinney (2018) stated that Labour pain was part of a normal process. Although expected during labour process, it is considered as the most undesirable and unpleasant aspect of the labour experience during childbirth. Labouring women often experience intense pain due to uterine contractions. During descent, the fetus head exerts pressure on the mother’s pelvic floor, vagina and perineum causing somatic pain transmitted to the pudendal nerve. As woman’s labour progresses, labour pain also increases especially in primiparas. Pain during birth involves two components; the physiologic component which includes reception by sensory nerves and transmission to the central nervous system and the psychological component which involves recognizing the sensation, interpreting it as painful, and reacting to the interpretation.

According to World Health Statistics (2016) 9% of all births in India were by cesarean section.1 in 10 women in India had gone under surgical knife. Fear of labour pain is one of the most important reasons that make women go for cesarean section.

Kristine Burneko (2012) pointed that the goal of Lamaze is to increase mother’s confidence in her ability to give birth and to help pregnant women understand how to cope with pain in ways that facilitate labour. The Lamaze technique is not evidence based medical therapy. Its effectiveness could be explained by the placebo effect.

In India (2013) total population was estimated as 1,220,800,359 and annual number of births as 27,098. The total population of Tamil Nadu is 74,319,357 and the birth rate is 1.64 lakhs.

WHO (2016) reported that, 800 women were dying every day due to complications related to pregnancy and childbirth. They are dying because they have no access or limited access to health care, or because the quality of care is poor.

Mikal Rose (2009) pointed out that the Lamaze educators continue to teach body awareness and tension release, but the goal is not to expect total relaxation during labour. Rather, women are encouraged to be in the moment, not fearful, but actively relaxed, rhythmically working with labour. The main Lamaze technique that has migrated to other birthing philosophies is controlled breathing. There are five different types of controlled breathing outlined by Lamaze. They are baseline breathing, slow breathing, blowing exercise, patterned breathing and cleansing breath. The purpose of Lamaze breathing is to keep a mother’s attention focused on the breathing so that she cannot focus on her pain.

According to Lamaze International, the philosophy of Lamaze is that the experience of birth is meant to be normal and natural, and that women have an inherent ability to give birth. Women who use this method often praise the rewarding results. Benefits of Lamaze are largely emotional and psychological as it focuses on providing a positive environment and well-being during delivery

MATERIAL AND METHODS:

Research approach and design:

Quantitative Research approach was selected to assess the effectiveness of Lamaze breathing technique on reduction of labour pain among primigravida mothers at primary health centre, Coimbatore.

One group pretest post test design, a subtype of pre experimental research design was adopted in this study. The researcher took experimental group. Treatment (X), i.e., Lamaze breathing exercise was performed (experimental group) during first stage of labour.

Setting of the study:

The study was conducted among primigravida mothers in primary health centres, Coimbatore

Population:

The population of the study includes primigravida mothers who were in first stage of labour and completed 37 weeks of gestation.

Sample Size:

The sample size for the study was 30 primigravida mothers who were in first stage of labour.

Sampling Technique:

Convenient sampling technique, a subtype of non probability sampling method adopted for the present study

Inclusive Criteria:

· Primigravida mothers who were in first stage of labour

· Primigravida mothers who have completed 37 weeks of gestation

· Primigravida mothers who were willing to participate in the study

· Primigravida mothers who were able to communicate in English or Tamil

Exclusion Criteria:

· Mothers who were multigravida

· Mothers who were <37 weeks of gestation

· Mothers who were having medical complications during pregnancy Mothers who were not cooperative

Instrument and tools of data collection:

Tool 1:

Section A: Demographic Variables:

Demographic variables which include age, educational level, occupation, type of family, habitation, monthly income.

Section B: Obstetric Variables:

Obstetric variables include gestational age in weeks, age at marriage, duration of marriage, nature of conception, nature of labour, analgesia given.

Tool 2:

Numerical Pain Intensity Scale:

Numerical rating scale was a standard tool invented by Mc Caffery (1999) measured from 0-10 equal divisions. Divisions expressed the pain level in ascending order that is at the division of ‘0’ the pain level is at lowest point, at’10’ the pain level is at its worst point. The mother will be asked to indicate the pain intensity as she experienced at the moment by marking at the point. The reading will be noted based on the point at which the mother marked. The values on the pain scale correspond to pain levels as follows:

0	: None
1-3	: Mild Pain
4-6	: Moderate Pain
7-10	: Severe Pain

Data Collection Procedure:

The study was conducted for a period of four weeks. The researcher obtained written permission from the primary health centre comibatore to conduct the research study on primigravida mothers who are in first stage of labour. The researcher met the subjects and explained the benefits of the study and obtained consent from them.

Samples who met the inclusion criteria were selected by using non probability convenient sampling technique. The investigator had done the pre-test to assess the level of pain before giving Lamaze breathing technique by using the numerical pain intensity scale and collected the demographic and obstetrical data by using a baseline Proforma. As contraction starts, slow paced breathing was initiated for two minutes followed by modified paced breathing until the change in contractions. As the contraction increases, patterned breathing was initiated until the contraction has passed off. Then take the big, deep breath through the nose and then exhale slowly through the mouth. After giving breathing techniques the post test was conducted.

Table 1: Distribution of Pain Scores among Primigravida Mothers at primary health centre, Coimbatore (n=30)

S. No.	Level of Pain	Experimental group
		Pre test		Post Test
		f	%	f	%
1.	Mild pain	0	0	20	66.7
2.	Moderate pain	12	40	10	33.3
3.	Severe pain	18	60	0	0

Table 1 shows distribution of pain scores among primigravida mothers. While considering the pre test none of them had mild pain and 20 (66.7%) primigravida mothers were having mild pain during post test, 12(40%) of primigravida mothers had moderate pain in pretest and 10(33.3%) were having moderate pain during post test, 18(60%) of primigravida mothers had severe pain in pretest and none of them were having severe pain during post test.

Table 2: Comparison of Pretest and Post Test Pain Scores among Primigravida Mothers at primary health centre, Coimbatore (n=30)

S. No.	Mean Pain Level	Mean	SD	Paired ‘t’ Value
1.	Pre test	7	1.26	12.80*
2.	Post test	3.1	1.13	12.80*

*at significant level

Table 2 shows the pre test mean score was 7 and post test mean score was 3.1. The calculated paired ‘t’ value was 12.80 at 29 degrees of freedom and 0.05 level of significance which is greater than the table value (2.045), hence it is significant. It showed that the practice of Lamaze breathing technique has significant effect on minimizing labour pain among primigravida mothers during first stage of labour

RESULT AND DISCUSSION:

Lamaze breathing is a deep-breathing pain-management technique used by women who want to experience natural labour and childbirth. During pregnancy, a mother-to-be practices Lamaze breathing exercises so that during labour, she will be familiar with important breathing techniques to help ease and transfer the focus off the pain of natural childbirth.

The purpose of the study was to provide knowledge regarding importance of performing Lamaze breathing technique in reducing pain in women in first stage of labour. This awareness will keep a women comfortable, focused and in control during labour during first stage of labour.

· The pretest mean score of pain level among promigravida mothers was 7

· The post test mean score of pain level among promigravida mothers was 3.1

· The obtained ‘t’ value for promigravida mothers was 12.80 at 29 degrees of freedom is significant at 0.05 level.

CONCLUSION:

The study shows significant effectiveness of Lamaze breathing technique in reducing labour pain during first stage of labour among primigravida mothers and study reveals that primigravida mothers have positive attitude towards Lamaze breathing technique as evidenced by greater acceptance.

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Received on 08.02.2021 Modified on 28.02.2021

Asian J. Nursing Education and Research. 2021; 11(3):361-364.

DOI: 10.52711/2349-2996.2021.00087