A study to assess the Level of anxiety related to labour process among primigravidas in a selected hospital, perinthalmanna, Kerala.
Mrs. Nirmala V1*, Ms. Abi P2, Ms. Aditya KS2, Ms. Alfi SS2, Ms. Amala KS2, Ms. Anju Joseph2
1Vice Principal, MES College of Nursing, Palachode (Po), Kolathur Via, Perinthalmanna, Kerala-679338
2III Year B.Sc Nursing, MES College of Nursing, Palachode (Po), Kolathur Via, Perinthalmanna, Kerala-679338
Corresponding Author Email: suninirmala@gmail.com
ABSTRACT:
Pregnancy and childbirth are special event in a woman’s life and indeed in the life of their family. Though pregnancy is special and joyful, the expectant mother may feel anxious about the outcome of pregnancy. Hence, the researchers aimed to assess the level of anxiety among the primigravidas. A quantitative research approach with non experimental descriptive design was adopted. Data was collected from 50 samples, by purposive sampling technique. Structured interview schedule was used to collect the data from primigravidas. Descriptive and inferential statistics was used to analyze the data. Study findings revealed that 28% belonged to 24-27 years, 44% studied upto higher secondary, 86% of marriages were consanguineous,74% were working, 62% belonged to nuclear family, 56% were in 12-28 weeks of gestation, 27 (54%) had mild anxiety, 22 (44%) had moderate anxiety and only 1(2%) had severe anxiety. Study findings denoted that there is significant association between the level of anxiety and type of family.
KEY WORDS: Pregnancy, Primigravida, Hamilton rating scale, anxiety, labour process.
INTRODUCTION:
Pregnancy is a vital event in the life of women. It needs special attention and care from the time of conception to the postnatal stage. As labour process is a new experience for the primigravida, anxiety is inevitable. It includes fear of injury to self or newborn, fear of effects in labour and their traumas and symptoms, fear of complications during delivery, fear of feeling to be helpless, fear of missing control of coping with labour and the fear of unknown.
A descriptive study by Nisha et al (2013) to assess the level of anxiety related to labour process among primigravida revealed that majority of the primigravida (79%) had moderate level of anxiety14% and 7% mild and severe anxiety respectively. Likewise findings from a study by another researcher Sayl M, Gure A et al (2006) revealed that prenatal period low income, self esteem and self efficacy were significantly associated with prenatal maternal anxiety. Findings indicated that prenatal high anxiety is an adverse risk factor for postnatal wellbeing of mothers. Anderson et al (2004) found that there was a significant association between depression and anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrics and planned caesarean delivery. Their investigation revealed that there is an association between antenatal depression and anxiety disorder and increased health care use during pregnancy and delivery.
Hence mental preparation is as important as physical and maternal preparation. Sufficient opportunity and time must be given to the expectant mothers to have a free and frank talk on all aspects of pregnancy and delivery. It ensures
good health throughout purperium, and that every pregnancy may culminate in a healthy mother and healthy baby. Therefore assessing the level of anxiety at a very early stage and initiating measures to reduce anxiety is essential to make pregnancy not only safe but special too.
STATEMENT OF THE PROBLEM:
A study to assess the level of anxiety related to labor process among primigravidas in a selected hospital, Perinthalmanna, Kerala.
OBJECTIVES:
· To assess the level of anxiety regarding labor process among primigravidas.
· To associate the level of anxiety regarding labor process among primigravidas with selected demographic variables.
ASSUMPTIONS:
· Primigravidas may experience anxiety related to labour process.
· Anxiety may vary from one individual to another.
MATERIAL AND METHODS:
Research approach: Quantitative approach.
Research design: Non experimental descriptive design.
Setting of the study: Present study was conducted in OPD, of MES Medical College Hospital, Perinthalmanna.
Population: Target population consists of primigravida mothers attending OPD.
Sample: Primigravidas who fulfilled the inclusion criteria.
Sample size: 50 primigravida mothers.
Sampling technique: simple random technique was used to select a hospital at perinthalmanna. Non probability purposive sampling was used to select the subjects for study.
Criteria for the selection of samples:
Inclusion criteria:
· Primigravidas who attended OPD.
· Primigravidas who were willing to participate in the study.
· Primigravidas who knew and could understand Malayalam.
Exclusion criteria:
· Primigravidas who were not available on the day of data collection.
· Primigravidas who were not willing to participate in the study.
Description of the tool:
Section A: Demographic Variables: It consisted of 12 items which included age, educational status, marital status, type of marriage, occupational status, and occupational status of their spouse, monthly income of the family, religion, type of family, source of information regarding the labor process for the antenatal, period of gestation, and support system in the family.
Section B: It consisted of Hamilton Rating Scale. It was used to assess the level of anxiety among primigravidas related to the labor process. It consisted of 14 items. Each item of the tool was scored in 5 point rating scale (0- Not found, 1- Mild, 2- Moderate, 3- Severe, 4- Very severe). Minimum and maximum scores were 0 and 56 respectively.
The scores were arbitrated and classified as below:
· If the score is < or = 17 it indicates mild anxiety.
· If the score is 18 – 24 it indicates moderate anxiety.
· If the score is 25 – 30 it indicates severe anxiety.
· If the score is > / = 31 it indicates very severe anxiety.
Validity and reliability of the tool:
The content validity of the tool was assessed by obtaining opinion from experts. HARS exhibited good construct validity showing statistically significant relationship with independent self report measures of generalized anxiety and other anxiety variables. The reliability of the rating scale was found to be (r = 0.79) significant.
Data collection:
Ethical consideration:
Permission was obtained from the concerned authorities of obstetrics department in selected hospital. Informed consent was taken from primigravidas who were willing to participate in the study.
Data collection procedure:
Data collection was carried out from 11.08.14 to 30.08.14. After explaining the purpose of the study and ensuring the confidentiality of data, the data was collected from 50 samples by using Hamilton Rating Scale.
Data analysis and interpretation:
The collected data was tabulated, organized and analyzed by using descriptive and inferential statistics.
RESULTS:
Table 1 shows that among 50 samples 33 (66%) were in the age group of < / = 23 years, 44% studied upto higher secondary, all 50 (100%) were married , 86% of marriages were consanguineous, 74% were working, 72% were having a family income of < 10000 per month, 60% were Muslims 62% belonged to nuclear family, 76% got information about labour process from family members, 56% belonged to 12-28 weeks of gestation, and 56% were getting support from their husband.
Table:1 frequency and percentage distribution of primigravidas according to their socio-demographic variable N=50
|
S. No |
Socio- demographic variables |
|
Frequency (f) |
Percentage (%) |
|
1. |
Age in years |
<=23 |
33 |
66 |
|
|
|
24-27 |
14 |
28 |
|
|
|
>=28 |
3 |
6 |
|
2. |
Educational status |
Primary |
4 |
8 |
|
|
|
High school |
7 |
14 |
|
|
|
Higher secondary |
22 |
44 |
|
|
|
Graduates |
16 |
32 |
|
|
|
Post graduates |
1 |
2 |
|
3. |
Marital status |
Married |
50 |
100 |
|
4. |
Type of marriage |
Consanguineous |
43 |
86 |
|
|
|
Non consanguineous |
7 |
14 |
|
5. |
Occupational status |
Working |
37 |
74 |
|
|
|
Non working |
13 |
26 |
|
6. |
Occupational status of the spouse |
Business |
11 |
22 |
|
|
|
coolie |
13 |
26 |
|
|
|
Any other |
26 |
52 |
|
7. |
Family monthly income |
<=10000 |
36 |
72 |
|
|
|
10001-25000 |
14 |
28 |
|
|
|
>25000 |
0 |
0 |
|
8. |
Religion |
Hindu |
13 |
26 |
|
|
|
Muslim |
30 |
60 |
|
|
|
Christian |
7 |
14 |
|
9. |
Type of family |
Nuclear |
31 |
62 |
|
|
|
Joint |
19 |
38 |
|
10. |
Source of information on labour process |
Family |
38 |
76 |
|
|
|
Friends |
11 |
22 |
|
|
|
Mass media |
1 |
2 |
|
11. |
Period of gestation |
<12 weeks |
9 |
18 |
|
|
|
12-28 weeks |
28 |
56 |
|
|
|
29-37 weeks |
13 |
26 |
|
12. |
Support systems in the family |
parents |
21 |
42 |
|
|
|
Husband |
29 |
58 |
|
|
|
|
|
|
Figure 1Distribution of samples according to the level of anxiety.
Figure 1 shows that majority 54% of primigravidas had mild anxiety, 44% had moderate anxiety and 2% had severe anxiety.
Table 2: Association between anxiety and their Socio - demographic variables. N=50
|
S.No |
Demographic variables. |
df |
Calculated value |
Table value |
|
1. |
Age in years |
8 |
0.8069 |
15.51 |
|
2. |
Educational status |
16 |
91.97 |
27.59* |
|
3. |
Type of marriage |
4 |
2.526 |
9.49 |
|
4. |
Occupational status |
4 |
1.0485 |
9.49 |
|
5. |
Occupational status of the spouse |
8 |
3.7878 |
15.51 |
|
6. |
Family monthly income |
12 |
1.398 |
21.03 |
|
7. |
Religion |
12 |
5.928 |
21.03 |
|
8. |
Type of family |
4 |
15.33 |
9.49* |
|
9. |
Source of information on labour process |
20 |
1.3948 |
31.41 |
|
10. |
Period of gestation |
12 |
5.3724 |
21.03 |
|
11. |
Support system in the family |
8 |
2.7359 |
15.51 |
*= Significance at 5% level
Data presented in the above table 2 reveals that there is a significant association between level of anxiety with their educational level and type of family. There is no association between level of anxiety with their age, type of marriage, occupational status, occupational status of the spouse, family monthly income, religion, source of information, period of gestation, and support system in the family
CONCLUSION:
A study was conducted to assess the level of anxiety related to labor process among primigravidas at a selected hospital, perinthalmanna, Kerala. The findings revealed that 27 (54%) had mild anxiety, 22 (44%) had moderate anxiety and only 1(2%) had severe anxiety. Some anxiety during pregnancy is inevitable and normal, while excessive indicates the need for treatment. It is essential for the nurses to understand anxiety producing factors and situations in primigravida mothers in organizing health education programmes and management interventions to reduce the anxiety.
REFERENCES:
Books:
· Mudaliar and Menon’s, “Clinical Obstetrics”, 10th edition, orient Longman publication.
· DC dutta, “Text Book of Obstetrics”, 6th edition, New centeral book agency private limited.
· ShirishN Daftary, Sudip Chakravarti, “Manual of obstetrics”, 2nd edition, Elsevier publication.
Journals:
· Nisha et al, “A Descriptive Study to Assess the Level of Anxiety Related to Labour Process among Primigravida in Selected Hospitals of Punjab and Haryana” International journal of Nursing Education and research, vol (1), October to December 2013.
Website:
· www.medline
· www.pubmed
Received on 30.11.2014 Modified on 05.12.2014
Accepted on 15.12.2014 © A&V Publication all right reserved
Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 396-399