Effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected Hospital, Mysuru.
Neethu Thomas1, Mrs. Bhavya S. V2, Prof. Sheela Williams3
1M.Sc Nursing Student, JSS College of Nursing, Mysuru
2Assistant Professor, Obstetrics and Gynaecological Nursing, JSS College of Nursing, Mysuru
3Principal, JSS College of Nursing, Mysuru
*Corresponding Author E-mail: neethuchirayath7@gmail.com
ABSTRACT:
Background: Daily fetal movement counting is a simple and invasive method that can be carried out by the mother in order to improve the maternal fetal attachment and reduce the maternal worries for the healthy pregnancy outcome. Aim: The aim of this study was to assess the effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected hospital, Mysuru. Methods: In this study, one group pre-test post-test pre- experimental design was used and nonprobability purposive sampling technique was adopted to select 60 primigravida mothers attending Out Patient Department of JSS Hospital, Mysuru. Pilot study was conducted, the tool and study design were found to be feasible. Personal variable proforma was used to assess the sample characteristics, Modified Prenatal Attachment Inventory was used to assess the Prenatal attachment and Modified Cambridge Worry Scale was used to assess the maternal worries. The tools were validated by experts and reliability was established. The data were collected and analyzed using descriptive and inferential statistics. Result: The study results revealed that majority 33(55%) of the primigravida mothers were in the age group of 26-30 years, majority 33(55%) had completed PUC. Majority 35(58.3%) were daily wagers and majority 32(53.3%) had monthly income of 10,001-15,000. Majority 30(50%) primigravida mothers were between 32-34 weeks of gestation and 30 (50%) were living in joint family and 30(50%) were in nuclear family. Majority 34(56.6%) were 1-3 years of their married life. The mean difference between prenatal attachment pre-test score and post test score was 2.32. The obtained value of paired‘t’= 6.3, p<0.05 was found to be significant. The mean difference between the pre-test scores of maternal worries and post test scores of maternal worries was 6.48. The obtained value of paired‘t’= 6.47, p<0.05 was found to be significant. The correlation co-efficient between prenatal attachment and maternal worries was -0.259 and the study findings were inferred that there was significant negative relationship between prenatal attachment and maternal worries among primigravida mothers. The study findings showed significant association between educational level and level of prenatal attachment of primigravida mothers and the findings depicted significant association between occupation and level of maternal worries among primigravida mothers. Conclusion: The study concluded that, fetal movement counting was effective in increasing the prenatal attachment and reducing the maternal worries among primigravida mothers. Through this study, fetal movement counting is proved to be the paramount measure to improve maternal fetal attachment and reduce maternal worries.
KEYWORDS: Fetal movement counting; Prenatal attachment; Maternal worries.
INTRODUCTION:
Woman is having special role in procreation by being the important part in reproduction. It is her special gift from the god to become mother. Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. Pregnancy is considered as a very precious event in every woman's life1. There are various measures to assess the fetal wellbeing includes fetal movement counting, non-stress test, biophysical profile etc. 2 Fetal movement counting is a method by which a woman quantifies the movements she feels to assess the condition of the baby. Fetal movement counting is a simple and non invasive method to assess the fetal well being. The purpose is to reduce perinatal mortality by alerting care givers when the fetal condition is in danger. Normally the fetus is expected to move at least ten times inside the uterus within every two hours.3 Maternal Fetal Attachment has been defined as “the emotional tie or bond which normally develops between the pregnant woman and her unborn child” Quality of attachment directly affects maternal and fetal health. Women may become excessively anxious about their pregnancies since it is considered as the major role for a woman to deliver a healthy baby4. Mother who is anxious and negative during pregnancy might tend to provide less nurturing and stimulating care for the baby during pregnancy and after birth5. There are certain interventions that focus to boost the maternal fetal bonding and reduction of maternal worries. As these interactions like interacting fetus, massaging her belly and paying attention to baby’s movements and following fetal development are believed to have an effect in improving the attachment between the mother and the fetus and reducing the maternal worries and anxiety.
NEED FOR STUDY:
The ultimate dream of every woman is to become a mother, as motherhood gives the completeness of a woman. The earliest relationship does not begin with the birth. Pregnant women construct mental representations of the fetus, and feelings of affiliation or maternal fetal attachment generally increase over the course of gestation. Every pregnant woman experience a variety of physical, emotional and hormonal changes that may trigger anxiety which would make them feel overwhelmed. Elevated anxiety can affect mother-infant interaction and cause adverse outcomes for mother and fetus. Pregnancy and worries go hand in hand. Some women start worrying as soon as they discover their pregnancy. Such worries are more common in woman pregnant for the first time.6
As soon as the mother perceives fetal movement, maternal bonding is developed with the unborn baby. Fetal movement counting is a method used by the mother to quantify her baby’s movements. Researcher concluded that there is a bidirectional relationship between maternal and emotional wellbeing and level of fetal activity. Hence there is need for further investigation.7
A true experimental study was conducted to assess the effectiveness of fetal movement counting on prenatal attachment and maternal worries among primigarvida mothers. This study was conducted in the antenatal outpatient department of Sri Ramachandra hospital, TamilNadu. The sample was 100 primigravida mothers. Consecutive non probability sampling was used in this study. Tools consist of demographic, clinical and social variables; prenatal attachment inventory and Cambridge worry scale. The results of the study showed that a significant level of improvement in prenatal attachment was seen in the study group mothers. Researcher concluded that there is a relationship between daily fetal movement counting, prenatal attachment and maternal worries.8
With the above mentioned facts and studies investigator felt that there is a need to enhance fetal movement counting among pregnant mothers as it is helpful in reducing maternal worries and promoting bonding between the mother and fetus. Daily fetal movement counting is an inexpensive, non invasive, easy and simple technique that can be used to assess the foetal wellbeing by the mother. It promotes prenatal attachment thus by it is an ideal method to encourage parenting process. It is essential to implement the research based findings in Indian setting since it is important to safe guard the life of both the mother and the fetus.
OBJECTIVES:
1. To assess the prenatal attachment and maternal worries among primigravida mothers using Modified Prenatal Attachment Inventory and Modified Cambridge Worry Scale.
2. To evaluate the effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers.
3. To find the relationship between prenatal attachment and maternal worries among primigravida mothers.
4. To find the association between level of prenatal attachment and level of maternal worries among primigravida mothers with their selected personal variables.
HYPOTHESES:
The following hypotheses are formulated for the study and will be tested at 0.05 level of significance.
H1: There will be significant difference between the pretest score and post test score of prenatal attachment and maternal worries among primigravida mothers.
H2: There will be significant relationship between prenatal attachment and maternal worries among primigravida mothers.
H3: There will be significant association between level of prenatal attachment and level of maternal worries among primigravida mothers with their selected personal variables.
METHODOLOGY:
RESEARCH APPROACH/DESIGN:
One group pre-test post-test pre- experimental design is used in this study
VARIABLES UNDER STUDY:
Study variables:
Dependent variable- maternal worries, prenatal attachment. Independent variable- fetal movement counting
Personal variables-:
Age, education, occupation, family income per month, weeks of gestation, type of family, duration of marital life in years.
SETTING OF THE STUDY:
The study conducted in antenatal Outpatient Department at JSS hospital Mysuru.
POPULATION:
In the present study population comprises of primigravida mothers who are attending the Outpatient department of hospital.
SAMPLE AND SAMPLING:
The sample of the present study comprises of primigravida mothers who are attending the antenatal Outpatient department at JSS hospital. In the present study sample size is 60 primigravida mothers.
SAMPLING TECHNIQUE:
Sampling is the process of selecting a portion of the population to represent the entire population. Non-probability purposive sampling is used in this study.
SAMPLING CRITERIA:
Inclusion criteria:
Primigravida mothers who are;
· With gestational age of 32-38 weeks.
· available at the time of data collection
· Able to read and write English or Kannada.
Exclusion Criteria:
Primigravida mothers with high risk conditions.
RESULTS:
Table 1. Frequency and percentage distribution of primigravida mothers according to their selected personal variables n=60
Sl.No |
Sample characteristics |
Frequency (f) |
Percentage (%) |
1 |
Age(in years) 20-25 26-30 |
27 33 |
45 55 |
2 |
Education 2.1 Degree and above 2.2 PUC 2.3 High school 2.4 No formal education |
20 33 07 - |
33.3 55 14.2 - |
3 |
Occupation 3.1 Home maker 3.2 Daily wager 3.3 Government employee 3.4 Private employee |
16 35 09 - |
26.6 58.3 15 - |
4
|
Family income per month in rupees 4.1 5000-10,000 4.2 10,001-15,000 4.3 Above 15,000 |
23 32 05 |
38.3 53.3 8.33 |
5 |
Weeks of gestation 5.1 32-34 5.2 35-36 5.3 37-38 |
30 27 03 |
50 45 05 |
6 |
Type of family 6.1 Nuclear family 6.2 Joint family 6.3 Extended family |
30 30 - |
50 50 - |
7 |
Duration of marital life in years 7.1 1-3 7.2 4-6 7.3 >6 |
34 22 04 |
56.6 36.6 06.6 |
Table 2. Frequency and percentage distribution of level of prenatal attachment of primigravida mothers according to their pre-test and post-test scores. n = 60
Level of Prenatal attachment |
Pre test f (%) |
Post test F (%) |
Poor attachment(24--72) |
26(43.3%) |
12(20%) |
Good attachment (73-120) |
34 (56.6%) |
48(80%) |
Table 3. Frequency and percentage distribution of level of maternal worries of primigravida mothers according to their pre-test and post-test scores. n= 60
Level of maternal worries |
Pre test f (%) |
Post test F (%) |
Minor worry (17--34) |
20(33.3%) |
47(78.3%) |
Major worry (35-51) |
40(66.6%) |
13(21.6%) |
Table 4. Mean, Median, Standard deviation and Range of pre-test and post-test scores of prenatal attachment of primigravida mothers. n=60
Test |
Mean |
Median |
Range |
SD |
Pre test |
73.18 |
75 |
38-98 |
±13.41 |
Post test |
81 |
75.5 |
43-116 |
±15.07 |
Table 5. Mean, Median, Standard deviation and Range of pre-test and post-test scores of maternal worries of primigravida mothers. n=60
Test |
Mean |
Median |
Range |
SD |
Pre test |
36.13 |
36.5 |
24-47 |
±5.02 |
Post test |
29.65 |
29 |
18-43 |
±6.2 |
Table 6. Mean, mean difference, standard deviation difference, standard error and paired ‘t’ value of pre-test and post test scores of prenatal attachment of primigravida mothers. n=60
Prenatal attachment scores |
Mean |
Mean Difference |
S.D. Difference |
Standard Error |
Paired ‘t’ test value |
Pre-test |
73.18 |
2.32 |
±1.66 |
1.73 |
6.3* |
Post-test |
75.5 |
t(59)=2.0; p<0.05* significant.
Table 7. Mean, mean difference, standard deviation difference, standard error and paired‘t’ value of pre-test and post test scores of maternal worries of primigravida mothers. n=60
Maternal worry scores |
Mean |
Mean Difference |
S.D. Difference |
Standard Error |
Paired ‘t’ test value |
Pre-test |
36.13 |
6.48
|
-1.18
|
0.64
|
6.47* |
Post-test |
29.65 |
t(59)=2.0; p<0.05* significant.
The data presented in the Table 6 shows that the mean difference between prenatal attachment pre-test score and post test score is 2.32. To find the significance of difference in mean prenatal attachment level, a paired‘t’ test was computed and obtained value of paired ‘t’= 6.3, p<0.05 is found to be significant. Hence the null hypothesis H01 was not accepted. It was inferred that there was significant improvement of prenatal attachment after daily fetal movement counting.
The data presented in the Table 7 shows that the mean difference between the pre test scores of maternal worries and post test scores of maternal worries is 6.48. To find the significance of difference in mean maternal worry level, a paired ‘t’ test was computed and obtained value of paired‘t’= 6.47, p<0.05 is found to be significant. Hence the null hypothesis H02 was not accepted. It was inferred that there was significant reduction of maternal worries after daily fetal movement counting.
Table 8 Correlation coefficient of prenatal attachment and maternal worries among primigravida mothers. n=60
Variables |
Mean score |
Correlation co-effficient |
Prenatal attachment |
73.18 |
-0.259 |
Maternal worries |
36.13 |
|
t(58):0.250; p<0.05* significant.
Data presented in table 8 shows that, the correlation co-efficient between prenatal attachment and maternal worries is -0.259 and it is equal to the table value t(58): 0.2500. Hence the null hypothesis was not accepted, it was inferred that there was significant negative relationship between prenatal attachment and maternal worries among primigravida mothers.
Table-9. Chi-square values between level of prenatal attachment of primigravida mothers with their selected personal variables. n=60
Sl.No |
Sample characteristics |
Good attachment |
Poor attachment |
Chi square |
1 |
Age in years 1.1 20-25 1.2 26-30 |
16 18 |
11 15 |
0.11 |
2 |
Education 2.1 Degree 2.2 PUC 2.3 High school |
15 17 02 |
05 16 05 |
11.98*# |
3 |
Occupation 3.1 Home maker 3.2 Daily wager 3.3Govt.employee |
10 18 06 |
06 17 03 |
3.348# |
4 |
Family income per month 4.1 5000-10000 4.2 10001-15000 4.3 >15,000 |
11 19 04 |
12 13 01 |
2.601# |
5 |
Weeks of gestation 5.1 32-34 5.235-36 5.337-38 |
18 14 02 |
12 13 01 |
0.967#
|
6 |
Type of family 6.1 Nuclear 6.2 Joint |
19 15 |
11 15 |
1.08 |
7 |
Duration of marital life in years 7.1 1-3 7.2 4-6 7.3 >6 |
22 10 02 |
12 12 02 |
2.74# |
χ2(2) = 5.99, χ2(1) = 3.84 ; P<0.05,P>0.05; # -Yates correction; *-Significant
Table-10. Chi-square values between level of maternal worries of primigravida mothers with their selected personal variables. n=60
Sl.No |
Sample characteristics |
Minor worry |
Major worry |
Chi square |
1 |
Age in years 1.1 20-25 1.2 26-30 |
10 10 |
17 23 |
0.412 |
2 |
Education 2.1 Degree 2.2 PUC 2.3 High school |
10 8 2 |
10 25 5 |
3.77# |
3 |
Occupation 3.1 Home maker 3.2 Daily wager 3.3 Govt.employee |
5 10 5 |
11 22 7 |
7.67* |
4 |
Family income per month 4.1 5000-10000 4.210001-15000 4.3 >15,000 |
8 11 1 |
15 21 5 |
0.841#
|
5 |
Weeks of gestation 5.1 32-34 5.2 35-36 |
9 11 |
21 19 |
0.30 |
6 |
Type of family 6.1 Nuclear 6.2 Joint |
10 10 |
20 20 |
00 |
7 |
Duration of marital life in years 7.1 1-3 7.2 4-6 |
13 7 |
21 19 |
0.848 |
χ2(2) = 5.99, χ2(1) = 3.84 ; P<0.05,P>0.05; # - Yates correction;*-Significant
LIMITATIONS:
The limitations of the present study were,
1. The Non-probability purposive sampling technique adopted, limits the generalization of the findings.
2. Study conducted at selected hospital, it may differ from community setup and other hospitals.
RECOMMENDATIONS:
1. An explorative study can be conducted to assess the barriers in maintenance of daily fetal movement counting
3. A similar study can be conducted with experimental and control group and on larger samples for wider generalization
4. A study may be conducted to assess the effectiveness of fetal movement counting in rural areas.
5. A study can be conducted with mothers in first and second trimesters or high risk and low risk mothers.
6. A similar study can be conducted by utilizing other interventions to assess the prenatal attachment.
CONCLUSION:
The fetal movement counting was effective in increasing the Prenatal Attachment and reducing the Maternal worries among primigravida mothers as the computed‘t’ values were found significant at 0.05 level of significance. There was significant negative relationship between the prenatal attachment and maternal worries. There was significant association found between educational level and pre test level of Prenatal Attachment and occupation with pre test level of maternal worries among primigravida mothers.
Thus, it was concluded that, the fetal movement counting was effective in enhancing Prenatal Attachment and reducing Maternal worries among primigravida mothers. Through this study, fetal movement counting is proved to be the paramount measure to improve maternal fetal attachment and reduce maternal worries.
REFERENCE:
1. Dutta DC. Textbook of Obstetrics. 6th ed. Calcutta: new central book agency private ltd; 2004.
2. Lowdermilk LD. Maternity and women’s health care. 10th ed. London: Mosby publications; 2007.
3. Yogev Y, Ben-Haroush A, Horowitz ER, Chen R, Hod M, Kaplan B. PGE2 Induction of labor for consistent decreased perception of fetal movements at term. Int J GynaecolObstet 2003; 82: 173-8.
4. Anna R., Sandra Pitts., Wayne, H., Allen stringer and Evans. A history of the theory of prenatal attachment. Journal of prenatal perinatal and psychological health, 23(4);(2009) : 201-222
5. Cannella, B.L. Maternal-foetal attachment: an integrative review. Journal of advanced Nursing. 50 (1);(2005): 60-68
6. Nierenberg C. Mood Swings & Mommy Brain. The Emotional Challenges of Pregnancy.Live Science Contributor [online] [cited June 02, 2015]. Available from http://www.livescience.com/51043-pregnancy-emotions.html
7. Mangesi l, Hofmeyr GJ. Fetal Movement Counting or Assessment of Foetal Wellbeing. [Online]. 2007.Available from:URL:http//www.cochrane.org/reviews/en/aboo4909.html.
8. Rincy K, Nalini S. J. Effect of foetal movement counting on prenatal attachment and maternal worries among primigravidae. Available from: http:// www. Anvpublication.org. ISSN-2331-1149
Received on 04.11.2017 Modified on 18.02.2018
Accepted on 20.03.2018 © A&V Publications all right reserved
Int. J. Nur. Edu. and Research. 2018; 6(2): 200-204.
DOI: 10.5958/2454-2660.2018.00045.5