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RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, KARNATAKA, BANGALORE
ANNEXURE-11
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
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NAME OF THE CANDIDATE AND
ADDRESS(IN BLOCK LETTERS)
CELINE THOMAS V.T
1ST YEAR MSc.NURSING
DR. M.V SHETTY INSTITUTE OF
HEALTH SCIENCES,
VIDYANAGAR,
MANGALORE-575013
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NAME OF THE INSTITUTION
DR. M.V SHETTY INSTITUTE OF
HEALTH SCIENCES
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COURSE OF STUDY AND SUBJECT
MSc NURSING
OBSTETRIC AND
GYNAECOLOGIC NURSING
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DATE OF ADMISSION
12-5-2007
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TITLE OF THE TOPIC
EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON
PROCESS OF CHILDBIRTH
AMONG PRIMIGRAVIDA
MOTHERS IN A SELECTED RURAL
AREA AT MANGALORE,
DAKSHINA KANNADA,
KARNATAKA STATE.
INTRODUCTION
“Childbirth is more admirable than conquest, more amazing than self-defence, and as courageous as
either one”
Gloria Steinen
Our civilization is an epitome of knowledge and memories accumulated by generations of the past and
present. The horizons of knowledge are expanding at a terrific speed and the present era can be aptly
called as the era of ‘knowledge explosion’, with the advancement in information technology and recent
programs in mass media which broadcast more programs on maternal and child health; women of this
country are expanding their own health specially during pregnancy and childbirth.1
Childbirth is the culmination of a human pregnancy or gestation period with the delivery of one or more
newborn infant from the mothers’ uterus. The process of childbirth is categorised in three stages of
labour. In this first stage of labour, the uterus begins rhythmic contractions, gradually widening and
thinning the cervix. During the stage, the infant passes from the uterus through the cervix and birth
canal. In the third stage, the placenta pulls from the uterine wall and is expelled through the birth canal.1
Childbirth is a new experience for the primigravida. It is said that mother builds up in a state of tension
because of inadequate knowledge of childbirth process. The primigravidas experience of childbirth is
influenced by the knowledge and expectation. Her expectation of childbirth are based on the information
she has got from the antenatal clinic, the staff nurse, her mother, friends and family and it remarks that
support during labour and delivery has a positive impact on childbirth out come.2
Every one minute, in the world, a woman dies due to complications from pregnancy and childbirth.
According to WHO estimates, every year approximately 600,000 women die pregnancy related
complications globally and 99%of these occur in developing countries. Of these deaths about 231,000
occurred in African countries, 17,000 in Americas, 68,000 in Eastern Mediterranean, 3000 in European,
171,000 in South East Asia, and 21,000 in Western Pacific countries.3
India is among those countries which have a very high maternal mortality rate. According to Govt. of
India, Annual Report estimates for the year 2000, maternal mortality rate in India is 407 per 1,00,000
live births. Forty thousand women die every year of childbirth and related complications in UttarPradesh which has the highest mortality rate in the world. In Karnataka maternal mortality rate is 195
per 1,00,000 live births.4
Accurate assessment of mothers and foetus requires knowledge of expected adaptation to pregnancy
helps the nature anticipates and meet the woman’s requirement during childbirth. From the above
mentioned facts identified, it is obvious that to educate the primigravida mothers to eliminate the
complications during childbirth process. So the researcher felt the necessity to impart knowledge to the
primigravida mothers regarding the process of childbirth. An understanding of the process holds the
possibility that more women will experience childbirth as a joyous experience.5
6. BRIEF RESUME OF THE INTENDED STUDY
6.1 Need for the study
Childbirth is a natural biological process and there the emotions associated with it ought to be normal
and natural. It is a new experience to the primigravida mothers which includes stress among them. The
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woman expecting her first child is faced with many unknowns. As the time for labour and delivery
approaches there is essentially heightened sense of impending disaster.2
The Cochrane review study on continuous support for women during childbirth was conducted in 11
countries among 12791 women to assess the effectiveness of supportive care which included emotional
support, information about labour process and advice regarding coping techniques, comfort measures
and advocacy. The study showed that during labour 71% of women were uniquely vulnerable to
environmental influences and it may have an adverse effect on the progress of labour and the
development of confidence. The investigator concluded that the provision of support and companionship
during labour can overcome environmental influences.6
The Cochrane study of the relationship among fear and anxiety, the stress response and pregnancy
complications was conducted in Canada among antenatal mothers. The study revealed that anxiety
during labour is associated with high levels of the stress hormone epinephrine in the blood which may in
turn leads to abnormal fetal heart rate pattern in labour, decreased uterine contractibility, longer active
phase of labour and low Apgarscores among 27% of mothers. The researcher summarized that
emotional support, information and advice, comfort measures and advocacy may reduce anxiety and
fear.6
An exploratory study on opportunities to improve maternal health literacy through antenatal education,
in university of Sydney among healthcare providers, pregnant woman and new mothers to obtain
different perspectives on the issue surrounding antenatal education and parenting. A series of focus
groups and interviews was conducted among the samples. The results from interviews and discussion
described the similarities and differences in perceptions of the antenatal education from the sample.
Antenatal education is engaging the women in understanding factors influencing successful childbirth
and their capacity to navigate the early period of parenthood successfully. Here the investigator
predicted the scope to develop the delivery of antenatal education better reflect the health literacy
concept among the antenatal mothers.7
Most of the mothers do not know about what changes takes place and their role in the presence of
childbirth. Due to fear of pain, many of them start bearing down in the first stage itself. Therefore
assessment of knowledge of mothers on childbirth process can contribute to the improvement of
maternal health. Hence every mother has to be made aware of childbirth process which is a safety ladder
to ensure that both the mother and the baby are active and healthy.2
The expectant mother depends on professional help and guidance for most of the activities surrounding
pregnancy and childbirth. It has been reported that fear concerning labour pain can be reduced with
providing prenatal education about childbirth process.5
Nurses are the principal care giver during childbirth, play major role in structuring the social context of
the childbirth. Childbirth educators and care givers must prepare women more realistically for the
childbirth. Thus the investigator felt that a planned teaching programme is most effective means of
providing knowledge to the primigravida mothers on the process of childbirth.8
6.2 Review of literature
A prospective cohort study on factors related to genital tract trauma in normal spontaneous vaginal
birth, conducted in Netherlands among 1176 midwives revealed that physiologic pushing, birth of head
between contractions reduced genital trauma at birth. The researcher analysed that spontaneous vaginal
births were episiotomy was not performed and genital tract trauma were identified among 58% of
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primiparous and 18% multiparous women. Directed pushing while the woman holds her breath and
higher infant birth weight increased the risk of trauma requiring suturing in primiparous woman. In
mutiparous women prior sutured trauma and higher infant weight increased the likelihood of trauma
requiring suturing, however the researcher assumed that birthing the infants head between contractions
reduced the risk of trauma in the genital tract.9
A descriptive study on mothers expectation of childbirth process in Sweden among all Swedish
speaking women in a large city, who gave birth during a two- week period were given a questionnaire
one after the birth, and 295(91%) of questionnaires returned. The overall experience was assessed as
positive by 77% of women and negative by 10%. The study showed that negative and positive feelings
can co-exist in birth experience. The researcher concluded that women’s assessment of childbirth is
influenced by both physical and psychological factors.10
An experimental study to determine the effect of relaxation techniques on pain relief during labour
conducted in Hamadan, Iran among 62 pregnant women during labour. They were selected using
convenience sampling and were divided randomly in two groups. The first group (control) received
routine way of ward during labour and second group (test) went through the relaxation techniques after
training. The statistical analysis of data showed significant difference in intensity of pain between two
groups (p= 0.0001) and behavioural reaction between the two groups (p= <0.0001). In latent phase
12.9% of subjects in test group had severe pain, but in control group 54.16% of cases had the same
grade of pain. Similarly in active phase of labour only 9.7% of cases in test group had very severe pain
compared to 78.8% of cases in control group. Since the relaxation technique is easy to perform and with
out any risk and also has low expenses, it is recommended for pain relief during labour and can reduce
stress during labour; therefore, it can be recommended for pregnant women.11
Cochrane review study on continuous support for women during childbirth conducted in 11 countries
among over 13000 women in a wide range of setting and circumstances. The result showed that 86% of
women who received continuous labour support were more likely to give birth spontaneously and
women were less likely to use pain medications were more likely to be satisfied and had slightly shorter
labours. The investigator concluded that the continuous support during child birth can make drastic
changes.12
6.3 Statement of the problem
Effectiveness of planned teaching programme on process of childbirth among primigravida
mothers in a selected rural area at Mangalore, Dakshina Kannada, Karnataka state.
6.4 Objectives of the study
The objectives of the study are to:
1. determine the pre- existing knowledge on the process of childbirth among primigravida mothers as
measured by the structured questionnaire.
2. design and provide health education on the process of childbirth to primigravida mothers by using
media.
3. find the effectiveness of planned teaching programme on process of
mothers as measured by the same structured questionnaire.
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childbirth among primigravida
6.5 Operational definitions
1. Effectiveness: In this study it refers to the difference in the percentage of
mean knowledge scores of pre-test and post- test conducted for the sample.
correct responses and
2. Planned teaching programme: In this study planned teaching programme refers to a systematically
organised teaching plan on stages of childbirth, nutrition, relaxation technique, support and care during
childbirth.
3. Childbirth: In this study it refers to the entire process of birth as the baby makes its way from the
womb through the birth canal to the outside world. It starts naturally between 37 and 42 weeks. It ends
in the delivery of a live, healthy baby.
4. Primigravida mother: In this study it refers to one who is pregnant for the first time, not having any
complication during the pregnancy period and primigravida mothers are residing in the selected rural
area.
5. Selected rural area: In this study it refers to the area which is coming under the Surathkal PHC. It
is the sum total of he villages under the study. The rural area is easily reachable and 10km away from
the mangalore city.
6.6 Assumptions
The investigator assumes that
1. The selected rural area primigravida mothers will have some knowledge regarding the process of
childbirth.
2. Planned teaching programme will increase the knowledge of primigravida mothers regarding the
process of childbirth.
6.7 Delimitation
The study is delimited to primigravida mothers
1. Residing in selected rural area at Mangalore.
2. Who all are not having the history of high risk pregnancy.
6.8 Hypothesis
H1: The mean post-test knowledge scores of selected primigravida mothers in rural area regarding the
process of childbirth will be significantly higher than their mean pre-test scores.
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7. MATERIAL AND METHODS
7.1 Source of data
Data will be collected from primigravida mothers who fulfil the inclusion criteria and will be willing
to participate in the study.
7.1.1 Research design
The research design for the study will be one group pre-test- post- test design
7.1.2 Setting
The study will be conducted in a selected rural area at Mangalore. The PHC selected for the study
on the basis of geographical proximity, feasibility of conducting study and availability of sample.
7.1.3 Population
In this present study, the population consists of the primigravida mothers in the selected rural
area at Mangalore.
7.2
METHOD OF DATA COLLECTION
7.2.1Sampling procedure
Non probability sampling using purposive sampling technique will be appropriate to select 30
primigravida mothers from selected rural area are the sample for the study.
7.2.2 Sample size
It is planned to collect data from a sample of 30 primigravida mothers who resides in rural area.
7.2.3 Inclusion criteria
1. Primigravida mothers reside in the selected rural area at Mangalore.
2. Primigravida mothers available at the time of the data collection.
3. Primigravida mothers willing to participate in the study.
7.2.4 Exclusion criteria
The primigravida mothers who all are not residing in the selected rural area.
7.2.5 Instrument used
A closed ended structured questionnaire about process of childbirth will be used to collect data.
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7.2.6 Data collection method
The researcher will obtain permission from the concerned authority. The purpose of the study
will be explained to all the primigravida mothers and informed consent will be obtained from them. The
structured interview schedule will be using to determine the knowledge of the primigravida mothers.
Pre-test will be conducted on the first day followed by planned teaching programme administration. It
will be conduct on 1st and 3rd day, which will be based on the knowledge of the subjects. After
administering the planned teaching programme, post-test will be conducted on 7th day by using the same
structured questionnaire to evaluate the effectiveness.
7.2.7 Data analysis plan
Descriptive statistics are useful for summarising empirical information. Inferential statistics are
which are based on the laws of probability provide a means of drawing conclusion about the population
from which data will be obtained for the sample.
Collected data will be analysed by using descriptive and inferential statistics. First of all the data
will be arranged in master sheet. Description of the subjects with respect to demographic variables will
be presented using frequency and percentages. Mean, standard deviation and mean percentages will be
used to evaluate effectiveness of planned teaching programme. Further statistical significance of the
effectiveness of planned teaching programme will be analysed using paired‘t’ test. Data will be
presented in the form of tables, graphs and diagrams.
7.3 Does the study require any investigation or intervention to be conducted on patients or other
human or animals? If so please describe briefly.
Yes, the study requires a planned teaching programme to be conducted among the primigravida
mothers on process of childbirth.
7.4
Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Ethical clearance has been obtained from the ethical committee of the institution. Consent
from the sample will be taken at the time data collection.
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8. REFERENCES:
1. Wikipidia the free encyclopaedia, Wikipidia contributors Inc. U.S September 2007; 02:43
2. Constance J Adams, “Nurse midwifery health care for woman’s health and newborn”, Newyork
Chalton publications; 1983.
3. WHO, UNICEF, UNFPA Maternal mortality in 2000. Estimates Developed by WHO, UNICEF
and UNFPA Geneva, 2004
4. Park K, Preventive and social medicine, 18th edition, Banarsidas bhanot publishers, Jabalpur,
2005.
5. Avenshine Martha Ann, Martha Gunther Enriquez, Comprehensive maternity nursing, Boston:
Jones and Barlette publishers; 1990
6. www.Cbbhihsprod.nic.inPROD75/Note%20on%20birth20 companionship% 20 programme.doc.
7. Renkert Susan, Nutbeam Don, Opprtunities to improve maternal health literacy through
antenatal education, Department of public health and community medicine,A27, University of
Sydney, NSW 2006.
8. Boback Irene, Maternity nursing, Mosby year book ,Philadelphia;1994.
9. Albers,L A, etal, Factors related to genital tract trauma in noral spontaneous vaginal births.
Birth, 33(2), 94-100.
10. Waldenstorm u, etal, The child birth experience, Birth, 1996sep; 23 (3): 144-53.
11. Bagharpoosh M, etal, Effect of progressive mussle relaxation technique on pain relief during
labour, Department of nursing, Hamadan University of Medical sciences, Iran: 187-190;2006.
12. Hodnet ED, etal, Continous support for woman childbirth, Cochrane data base of systematic
reviews 2003, Issue3,July21:2003.
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9.
SIGNATURE OF CANDIDATE
10.
REMARKS OF THE GUIDE
RESEARCHABLE, FEASIBLE AND
SIGNIFICANT TO NURSING
11.
NAME AND DESIGNATION OF
PROF. (MRS). K. SHANTHAKUMARI
11.1 GUIDE
HEAD OF THE DEPARTMENT OF OBSTETRIC
AND GYNAECOLOGIC NURSING,
DR. M.V. SHETTY INSTITUTE OF HEALTH
SCIENCES, MANGALORE
11.2 SIGNATURE
11.3 HEAD OF DEPARTMENT
PROF. (MRS). K. SHANTHAKUMARI
HEAD OF THE DEPARTMENT OF OBSTETRIC
AND GYNAECOLOGIC NURSING,
DR. M.V. SHETTY INSTITUTE OF HEALTH
SCIENCES, MANGALORE.
11.4 SIGNATURE
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12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
RECOMMENDED
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