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

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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.

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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

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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

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