RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

KARNATAKA

PERFOMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF CANDIDATE Ms. AMALA GEORGE.

2. NAME OF THE INSTITUTION AND

ADDRESS

UNIVERSAL COLLEGE OF NURSING,

NIRMALARAM CAMPUS, AREKERE,

MICOLAYOUT, IIMB POST,

BANERGHATTA MAIN ROAD,

BANGALORE. 560076.

3. COURSE OF STUDY AND SUBJECT M.Sc. NURSING 1ST YEAR IN

OBSTETRICAL & GYNAECOLOGICAL

NURSING.

4. DATE OF ADMISSION TO COURSE 13TH JULY2011

5. TITLE OF THE TOPIC

A COMPARATIVE STUDY TO ASSESS THE

SELF ESTEEM AND PARENTING

BEHAVIOUR BETWEEN PRIMI MOTHERS

WHO UNDERWENT CAESAREAN SECTION

AND NORMAL VAGINAL DELIVERY IN

SELECTED HOSPITALS, BANGALORE

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6. INTRODUCTION

Before you were conceived I wanted you. Before you were born I loved you. Before

you were here an hour I would die for you. This is the miracle of Mother's Love.1 

Every woman feels that becoming a mother is the most gifted position, a

woman could ever achieve at life time. Pregnancy also marks a time in which a great

number of changes and transitions occur. The memories and experiences of labour

and birth remain with women throughout their lives. Clearly, the support and care

they receive during this time is critical. The anticipated overall aim of caring for

women during labour and birth is to engender a positive experience for the woman

and her family, while maintaining their health, preventing complications, and

responding to emergencies. For primi parous women, or first-time mothers-to-be, the

experience of pregnancy in its entirety is new. This may lead to mixed feelings or

ambiguities about pregnancy-related changes as well as concerns about what to expect

at birth and post-birth.2

The addition of a newborn infant to the family brings about more profound

changes than any other developmental stage of the family life cycle. New roles need

to be learned, new relationships developed, and existing relationships realigned.

Raising a child is probably the most challenging responsibility faced by a new parent.

New parents cope with verity of concerns and issues during this period. For most

women and families, labour and birth is a time of excitement and anticipation, along

with uncertainty, anxiety, and fear3.

The attitudes of women who perceive their experience of giving birth by

caesarean section (CS) differ significantly from those of women who deliver

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vaginally. Labour, as a life event, is characterized by tremendous psychological

changes that require major behavioural adjustment in a short period of time.

Consequently, the labour process constitutes a unique set of “Stressors” that

challenges a woman’s ability to cope.

The former are often less satisfied with their experience, and with themselves.

The magnitude of the impact of caesarean delivery on the woman varies tremendously

according to the interplay of a number of variables, such as the integration of the

individual skills of the doctor, and ego strength. Most women who undergo caesarean

birth experience a feeling of resentment towards the physicians, profound

disappointment at treatment expectation, and the loss of the happy moment of natural

birth. This has been known to lead to depression postpartum in such women, and the

rejection of their babies. So there is need to investigate the effect self esteem of primi

mothers undergone caesarean and vaginal delivery.4

But in the post partum period after caesarean section the mother experience lot

of discomforts than mother undergone vaginal delivery. Sleep disturbances and

fatigue is more in mother undergone caesarean section. Most women who had a

caesarean did not breastfeed, quite different from today’s picture; however, “the

initiation of lactation cannot be the same as after a birth in physiological conditions.

After a caesarean, for obvious reasons, mother and baby need help.” Non-labour

caesareans seem to be associated with more breastfeeding problems as there has been

no opportunity for the release of hormones involved in childbirth and lactation. The

current study is related to compare the self esteem and parenting behaviour of primi

mothers who underwent caesarean section and normal vaginal delivery.

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6.1 NEED FOR THE STUDY

A caesarean section, is a surgical procedure in which one or more incisions are

made through a mother's abdomen and uterus to deliver one or more babies, or, rarely,

to remove a dead fetus. A Caesarean section is usually performed when a vaginal

delivery would put the baby's or mother's life or health at risk, although in recent

times it has been also performed upon request for childbirths that could otherwise

have been natural. In recent years the rate has risen to a record level of 46 percent in

China and to levels of 25 percent and above in many Asian and European countries,

Latin America, and the United States.

It was predicted that if age-specific caesarean rates continued at the steady

pattern of increase observed since 1970, 40 percent of births would be by caesarean in

the year 2000.Those predictions fell short, but not by much. The National Centre for

Health Statistics reported that the percentage of caesarean births in the United States

increased from 20.7 percent in 1996 to 32 percent in 2007. Caesarean rates increased

for women of all ages, races/ethnic groups, and gestational ages and in all states5.

Due to increase in the prevalence of caesarean section there is a study

conducted to assess the level of self-esteem of newly delivered mothers who had

caesarean section (CS) and evaluate the socio demographic and obstetrics correlates

of low self-esteem in them. Newly delivered mothers who had CS (n = 109) and who

had spontaneous vaginal delivery (SVD) (n = 97) completed questionnaires on socio

demographic and obstetrics variables within 1 week of delivery. They also completed

the Rosenberg self-esteem scale. Women with CS had statistically significant lower

scores on the self-esteem scale than women with SVD (p = 0.006). Thirty

(27.5percent) of the CS group were classified as having low self-esteem compared

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with 11 (11.3 percent) of the SVD group (p = 004). The correlates of low self-esteem

in the CS group included polygamy (odd ratio (OR) 4.99, 95percent confidence

interval (95 percent CI) 1.62-15.33) and emergency CS (OR 4.66, 95 percent CI 1.55-

16.75).CS in South-Western Nigerian women is associated with lowered self-esteem

in the mothers6.

A study conducted on subsequent obstetric performance related to primary

mode of delivery, in San Francisco, reported that the Women who gave birth by

Caesarean were more disappointed. Even after 5 years of birth, the mothers expressed

dominant feelings of fear and anxiety about their experiences and were more reluctant

to become pregnant again. Thus it reveals that the Caesarean section is a terrifying

experience for most of the women. Some women were expressed their feelings about

Caesarean section was bad impression7.

Women who deliver vaginally may be more responsive to their newborns in

the early postpartum period than those who deliver via caesarean section, new

research suggests. Using functional magnetic resonance imaging (FMRI) to measure

brain activity of women, found a significant difference in activity in certain cortical

and sub cortical areas of the brain in this group of mothers who delivered vaginally

compared with those who delivered by caesarean section. Broadly speaking, the

cortical brain regions are believed to be important for regulating emotions and

empathy8.

Nurses are often in ideal position to assess the health and its problems and to

offer education and support. Nurse need to be knowledgeable about signs and

symptoms of post partum period. When the nurse develops an effective plan for

nursing management, she should be considering appropriate referral resource. The

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above studies show that the caesarean delivery leads to some adjustment problem in

primi mothers during post partum period. So the investigator felt the importance of

comparison of primi mothers underwent caesarean section and normal vaginal

delivery. This study was not conducted till now in this area. Based on the above

considerations the investigator felt that there is a need to conduct a study regarding

comparison of self esteem and parenting behaviour between primimothers underwent

caesarean section and normal vaginal delivery.

6.2 REVIEW OF LITERATURE

The present study aimed to assess the self-esteem of newly delivered

primiparious mothers who had caesarean section (CS) in relation to their parenting

self-efficacy. A total of 115 primiparious women who delivered by CS were

compared with 97 matched controls who had vaginal delivery during the same period.

The mean score on the Rosenberg self-esteem scale was significantly lower for the

Caesarean group, both prior to discharge (p = 0.006) and at six weeks (p < 0.001),

than the vaginal delivery group. The mean score on the parent-child relationship

questionnaire was also lower in those who had CS compared with those who had

vaginal delivery (p < 0.001, OR 4.71, 95 percent CI 1.75-14.71).Caesarean in

Nigerian women is associated with lowered self-esteem and predicts poor parenting

self-efficacy in the postnatal period9.

The present study was designed to investigate possible differences in

psychological adjustment and satisfaction between women delivering vaginally and

those delivering by emergency caesarean section. 22 women who delivered vaginally

and 22 women who delivered by emergency caesarean section were selected

according to stringent criteria, to control for factors known to be associated with

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positive caesarean outcomes. Significant differences were found in level of

satisfaction, with caesarean mothers reporting less satisfaction with the delivery than

vaginal mothers10.

A comparative field study was done to collect both quantitative and qualitative

data to determine if women perceived their childbirth experience less positively when

they had caesarean deliveries and in what ways. The hypothesis, primiparas having an

emergency caesarean birth will have a less positive perception of their birth

experience than those who deliver vaginally, were supported at the .01 level of

significance (t test). Perceptions of 20 primiparas having an emergency caesarean

birth and 30 primiparas having a vaginal birth were measured by a 29 item

questionnaire within 48 hours postpartally. More caesarean delivered women had not

named their infants; this difference was significant at the 0.005 level. Caesarean

delivered mothers suffered a loss in self-esteem, possibly due to unfulfilled

expectations for a vaginal delivery and the physical trauma and corresponding loss of

control due to the surgery11.

The purpose of this study was to examine differences in psychosocial

outcomes between primiparas experiencing vaginal deliveries and primiparas

experiencing caesarean deliveries. One hundred and ninety-four vaginal delivery

primiparas and 81 caesarean delivery primiparas from the Kaohsiung city area in

Taiwan were recruited at 6 weeks postpartum to participate in this study. Using two-

sample tests, we found no significant differences in perceived stress, self-esteem, or

depression between vaginal and caesarean delivery primiparas. However, the

caesarean delivery primiparas showed a significantly higher level of perceived social

support than vaginal delivery primiparas. The lack of substantial differences between

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the groups may be a result of the normalizing effect of the high caesarean birth-rate

and greater social support given to this method of childbirth`12

The present study conducted to examine changes in personality from late

pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries.

A prospective, group-comparative cohort study including 314 healthy primiparas

having either ‘caesarean section on maternal request’ (n = 74) or ‘spontaneous vaginal

delivery group’ (n = 240). The self-report inventory Karolinska Personality Scales

was mailed to participants at 37–39 gestational weeks in pregnancy and 9 months

after delivery. There was a statistically significant increase in Impulsivity (P = 0·046)

and decrease in Socialization (P = 0·004). The scores developed differently depending

on mode of delivery. Thus, women in the vaginal delivery group increased their

scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery

group decreased their scores.13

To investigate contact between mothers and their newborn child and study if

there are differences between those who requested an elective caesarean section

compared to women who had a vaginal birth. The psychometric properties of a scale

that measure the contact between mother and child were also investigated. It was a

prospective cohort study. Setting was Danderyd Hospital, Stockholm, Sweden.510

primiparas from three groups: women undergoing caesarean section on maternal

request (n = 96), women undergoing caesarean section on obstetrical indication (n =

116) and women planning a vaginal delivery (n = 198). The later were further divided

into subgroups; women who underwent assisted vaginal delivery (n = 35) and women

who had an emergency caesarean section (n = 65).The instrument used was the

Alliance Scale. Mothers with a vaginal delivery experienced breastfeeding less

stressful than the mothers with a caesarean delivery. 14

8

The present study is to test the hypothesis that caesarean section delivery

mothers would be less responsive to own baby-cry stimuli than vaginal delivery

mothers in the immediate postpartum period, conducted functional magnetic

resonance imaging, 2–4 weeks after delivery, of the brains of six mothers who

delivered vaginally and six who had an elective caesarean section delivery.

Correlations between own baby-cry responses in the left and right reticular nuclei and

parental preoccupations (r = .64, p < .05 and .67, p < .05 respectively), as well as in

the superior frontal cortex and Beck depression inventory (r = .78, p < .01). This

suggests that vaginal delivery mothers are more sensitive to own baby-cry than

caesarean section delivery mothers in the early postpartum in sensory processing,

empathy, arousal, and motivation, reward and habit-regulation circuits15.

6.3 STATEMENT OF THE PROBLEM

A comparative study to assess the self esteem and parenting behaviour between primi

mothers who underwent caesarean section and normal vaginal delivery in selected

hospitals Bangalore

OBJECTIVES OF THE STUDY

1. To assess the self esteem and parenting behaviour of primi mothers who

underwent caesarean section

2. To assess the self esteem and parenting behaviour of primi mothers who

underwent normal vaginal delivery.

3. To compare the self esteem and parenting behaviour of primi mothers who

underwent caesarean section and normal vaginal delivery

9

4. To find out the association between self esteem and parenting behaviour and

selected demographic variables among primi mothers who underwent caesarean

section and normal vaginal delivery.

OPERATIONAL DEFINITON

Assess

In this study, it refers to an organized and systematic way of finding out the self

esteem and parenting behaviour of primi mothers who underwent caesarean section

and normal vaginal delivery.

Self esteem

In this study it refers to evaluation of the emotional, intellectual, and behavioural

aspects of the self-concept which will be assessed by using Rosenberg's self-esteem

scale.

Parenting behaviour

In this study it refers making strong emotional bond between mother and new born by

care and love of mother which will be assessed by using self structured questionnaire.

Primi mothers

In this study it refers to women those who are becoming a mother for the first time

either by caesarean section or vaginal delivery, within 48-72 hours of child birth.

Caesarean section

In this study it refers to the extraction of the fetus through an opening made in

abdominal and uterine wall

Normal vaginal delivery

In this study it refers to birth of fetus through vagina and delivery and no

complications to mother and baby

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6.4 ASSUMPTIONS

1. Primi mothers who underwent caesarean section may experiences low level self

esteem and parenting behaviour than normal vaginal delivery.

2. There may be a difference in level of self esteem and parenting behaviour

among primi mothers who underwent caesarean section and normal vaginal

delivery.

VARIABLES UNDER THE STUDY

Research variable

Self esteem

Parenting behaviour

Demographic variable

Age

Education

Religion `

Occupation

Socio economic status

DELIMITATIONS

The target population is limited to mothers who delivered by caesarean section and

normal vaginal delivery at selected hospitals, Bangalore

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7. MATERIAL AND METHODS:

7.1 SOURCE OF DATA

The data will be collected from primi mothers in post natal ward and post operative

ward in selected hospitals Bangalore.

RESEARCH APPROACH:

The investigator will use explorative research approach to conduct the study.

RESEARCH DESIGN:

The investigator will use descriptive research design to conduct the study

RESEARCH SETTINGS:

Study will be done in post operative and post natal ward of selected maternity

hospitals Bangalore

POPULATION

The target population of the study will be primi mothers underwent normal vaginal

delivery and caesarean section in selected hospitals, Bangalore

SAMPLING TECHNIQUE:

Primi mothers admitted in post natal and post operative ward will be selected by

purposive sampling technique

SAMPLE SIZE:

The sample size will be 100 post natal mothers (50 primi mothers undergone vaginal

delivery and 50 primi mothers underwent caesarean section.)

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SAMPLING CRITERIA

INCLUSION CRITERIA

Post natal mothers who delivered after 37 weeks of gestation.

Post natal mothers who are admitted in post natal ward and post operative ward

after caesarean section and vaginal delivery, within 48-72 hours of child birth.

Women who can speak and understand kannada and English

EXCLUSION CRITERIA:

Women who are suffering with psychiatric illness

Women who are suffering with medical problems like diabetes, heart disease

and hypertensive disorders.

METHODS OF DATA COLLECTION

Data will be collected after obtaining written permission from the hospital

administrator, and OBG ward in charge. In this study Rosenberg's self-esteem scale

for self esteem and self structured questionnaire for parenting behaviour will be used

to collect the data.

7.2 DESCRIPTION OF TOOL

It consist of three parts

Part 1: It consist of demographic variables like age, gender, religion, family type,

education, occupation and socio economic status

Part 2: Rosenberg's self-esteem scale will be used to assess the self esteem of primi

mothers underwent caesarean section and normal vaginal delivery.

13

Part 3: Self structured questionnaire will be used to assess the parenting behaviour of

primi mothers who underwent caesarean section and normal vaginal delivery.

DATA ANALYSIS METHOD

Descriptive

Mean, standard deviation, frequency distribution, percentage will be used to

describe demographic variables and self esteem and parenting behaviour.

Inferential

T test will be used to compare the self esteem and parenting behaviour of primi

mothers underwent caesarean section and vaginal delivery.

Chi square test is used to find out the association between self esteem and

parenting behaviour with selected demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN

OR ANIMAL? IF SO PLEASE DESCRIBE BRIEFLY.

No, this is a descriptive study; it does not require any investigation to be conducted

on patient or human or animal.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Yes, the ethical clearance certificate has been enclosed.

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8. REFERENCE

1. Maureen H. Motivational quotes for pregnant women. Available from: URL:

http://prettydarkhorse.hubpages.com/hub/

2. Susan C, William F, Family cantered maternity and new born care. Care during

labour and birth. 20I0 July 28; Available from: URL: http://www.phac-

aspc.gc.ca/hp-ps/dca-dea/publications/fcm-smp/fcmc-smpf-05-eng.php

3. Nystrom K. Parenthood experiences during the child’s first year. Literature

review. 2003 April 29. Available from: URL:

http://pure.ltu.se/portal/files/32603150/Parenthood experiences during the child

first year literature review.pdf

4. Lulu A, Nuaim A. Views of women regarding caesarean section. 2004 January; 25

(6): P. 707-710. Available from: URL:

http://ipac.kacst.edu.sa/edoc/2004/143877.1-20040300870.pdf

5. Joy S. Caesarean birth & how to support women pre- and post surgery. 2011 July

1; Available from: URL:

http://wellmother.org/projects/docs/pregnancyessaycaesarean.pdf

6. Loto O M, Adewuya A O, Ajenifuja O K, Orji E O, Owolabi A T, Ogunniyi SO.

Maternal fetal neonatal med. The effect of caesarean section on self-esteem

amongst primiparious women in South-Western Nigeria: a case-control study.

2009Sep; 22(9): P. 765-9.Availableat: URL:

http://www.ncbi.nlm.nih.gov/pubmed/19544153

7. Jolly J, Walker J, Bhabra K. An international journal of obstetrics & gynaecology.

Subsequent obstetric performance related to primary mode of delivery.2005

august 19; 106(3): P. 227-232. Available from: URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1999.tb08235.x/full

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8. Cassels C. Journal of child psychology and psychiatry. Vaginal delivery may

increase maternal responsiveness to newborns.2008 September 23; Available

from: URL: http://www.medscape.com/viewarticle/581065

9. Adewuya A O, Ajenifuja O K, Orji E O. Ayandiran E O, Owolabi A T.Cesarean

section in relation to self-esteem and parenting among new mothers in

southwestern Nigeria. Acta obstet gynecol Scand. 2010; 89(1): P. 35. Available

from: URL: http://www.ncbi.nlm.nih.gov/pubmed/19824868

10. Padawer J A , Fragan C, Bulman R J,Chorowski M. Women's psychological

adjustment following emergency caesarean versus vaginal delivery. Psychology of

women quarterly. 1987 August 14 .Available from: URL:

http://pwq.sagepub.com/content/12/1/25.abstract

11. Marut J S, Mercer R T. Birth Defects. The caesarean birth experience.

Implications for nursing. 1981;17(6): P. 129-52.Available from: URL:

http://www.ncbi.nlm.nih.gov/pubmed/7326369

12. Chen C H, Wang S W. Research in Nursing & Health. Psychosocial outcomes of

vaginal and caesarean births in Taiwanese primiparas. 2002 November 7; 25(6):

P.452. Available from: URL:

http://onlinelibrary.wiley.com/doi/10.1002/nur.10056/abstrat

13. Wicklund I, Edman G, Larsson C, Andolf E. Journal of advanced nursing. First-

time mothers and changes in personality in relation to mode of delivery. Journal

of advanced nursing. 2009 July 3; 65(8): P. 1636. Available at: URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2009.05018.x/abstract

14. Carlander A K K , Edman G, Christonson K, Andolf E, Wicklund I. Sexual &

Reproductive Healthcare. Contact between mother, child and partner and attitudes

towards breastfeeding in relation to mode of delivery. 2010 February; 1 I( 1): P.

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27-34. Available from: URL:

http://www.sciencedirect.com/science/article/pii/S1877575609000044

15. Swain J E, Asgin E T ,Mayes L C, Feldman R, Constable R T, Leckman J F.

Journal of child psychology and psychiatry. Maternal brain response to own baby-

cry is affected by caesarean section delivery.2008 October; 49(10): P. 1042-52.

Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-

7610.2008.01963.x/full

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9 SIGNATURE OF THE

CANDIDATE

10 REMARKS OF THE

GUIDE

This study is aimed to examine the relationship

between self esteem and parenting behaviour of

Primi mothers. The study may be approved.

11 NAME AND

DESIGNATION OF

a. GUIDE

b. CO-GUIDE (if any )

c. SIGNATURE

d. HEAD OF THE

DEPARTMENT

e. SIGNATURE

Asst. Prof. MRS. PRATHIMA. P

Asst. Prof .MRS.PRATHIMA. P

12 a. REMARKS OF THE

PRINCIPAL

b. SIGNATURE

Relevant study may be approved

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