PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

(AS PER RGUHS- BANGALORE)

SUBMITTED BY:-Mrs.PACKIA ANNA PRISCILLA .PIst YEAR NURSINGObstetrics and Gynecological Nursing(2009-2011)ORIENTAL COLLEGE OFNURSING, BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKAPERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE AND ADDRESS MS.P.PACKIA ANNA PRISCILLA,1st Year MSc nursing,(Obstetrics and Gynaecological Nursing),Oriental College of Nursing,43/52, 2 nd Main , Industrial town,West of Chord road, Rajajinagar,Bangalore-44.

NAME OF THE INSTITUTION Oriental College of Nursing,Bangalore-44.

COURSE OF STUDY AND SUBJECT 1st Year M.Sc. nursing,Obstetrics and Gynaecological Nursing

DATE OF ADMISSION TO THE COURSE 16-06-2009

TITLE OF THE TOPIC “ A STUDY TO ASSESS THE EFFECTIVENESS OFINTERVENTION PACKAGE ON KNOWLEDGEREGARDING LAMAZE TECHNIQUE AMONGMIDWIVES IN SELECTED HOSPITALS,BANGALORE.”

BRIEF RESUME OF THE INTENDED WORK6.0 Introduction6.1 Need for the study6.1.1 Statement of the problem6.2 Review of literature6.3 Objectives6.3.1 Operational definitions6.3.2 Assumptions6.3.3 Hypothesis6.3.4 Sampling criteria (inclusion & exclusion criteria)

Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed EnclosedEnclosed

MATERIALS AND METHODS7.1 Source of data: Enclosed

7.2 Method of data collection: Enclosed

7.3 Does the study require and investigation or interventions to be conducted on the patients or other human being or animals ?

NO

7.4 Has ethical clearance been obtained from your institutions?

YES, ethical committee's report is here with enclosed.

8.0 List of References: Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE KARNATAKA.

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE AND ADDRESS MS.P.PACKIA ANNA PRISCILLA1st Year MSc nursing,(Obstetrics and Gynaecologic Nursing),Oriental College of Nursing,43/52, 2 nd Main , Industrial town,West of Chord road, Rajajinagar,Bangalore-44.

COURSE OF STUDY AND SUBJECT 1st YEAR M.SC.NURSING,OBSTETRICS&GYNAECOLOGIC NURSING.

DATE OF ADMISSION TO THE COURSE 16-06-2009

TITLE OF THE TOPIC “A Study To Assess The effectiveness Of Intervention Package On Knowledge Regarding Lamaze Technique Among Midwives In Selected Hospitals, Bangalore.

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-19 th 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 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 and delivery women need to be educated on all

the different type of pain management by talking to the health care providers 9.

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

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 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 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".20

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.9

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 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.22

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 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.

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 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 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

argumentation 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 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.

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-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.

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.17

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 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

1. To assess the knowledge regarding Lamaze technique among midwives before

intervention package

2. To assess the knowledge regarding Lamaze technique among midwives after

intervention package.

3. To evaluate the effectiveness of intervention package on Lamaze technique

4. 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.

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 the 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 to assist women during labor.

6.3.2) ASSUMPTION

Midwives may have some knowledge regarding breathing techniques in

labor.

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 working in maternity unit of the selected

hospitals Bangalore.

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   : Maternity unit in Selected hospitals, Bangalore

d) Population : All the midwives working in maternity unit                         of 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,

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 of

information.

l) Projected outcomes:

This study will enable midwives to gain knowledge regarding Lamaze

technique. There by midwives can adequately support 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.

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