A Quasi Experimental study to Assess the Effectiveness of Early Ambulation Technique on Biophysiological Health Parameters among Post Caesarean Mothers at selected Dr. Bhimrao Memorial Hospital Raipur (C.G.)

Anupama Masih¹, Payal Sharma²

¹Research Scholar, Department of Nursing, Malwanchal University, Indore, MP, India.

²Professor, Department of Nursing, Malwanchal University, Indore, MP, India.

*Corresponding Author E-mail: anupamahatsan@gmail.com

ABSTRACT

Motherhood is a profound and transformative journey that involves the care and nurturing of a child, presenting both immense joys and significant challenges. Mothers with C- section, involves complex physical and emotional recovery that varies for each individual. Early ambulation after caesarean section is to be encouraged in order to have fast recovery. After every surgery body takes time to heal. Early ambulation in the initial day can act as turning point in her life which can enhance recovery. The present quasi-experimental study aims to assess the effectiveness of the early ambulation technique on bio physiological health parameters among post-caesarean mothers at Dr. Bhimrao Memorial Hospital, Raipur (C.G.). Post-caesarean recovery is often challenged by delayed mobility, which can result in complications such as thrombophlebitis, constipation, and delayed wound healing. Objectives: To assess the biophysiological health parameters of post caesarean section mothers after early ambulation in interventional experimental group. To assess the biophysiological health parameters of post caesarean section mothers in non- interventional control group. To assess the effectiveness of early ambulation technique on biophysiological health parameters of post caesarean section mothers in interventional experimental group. To find out the association between socio demographic variable and biophysiological health parameters of post caesarean section mothers. Methods and Materials: a quasi-experimental approach with post-test only control group design was adopted for the study. The study included 60 subjects selected by non-probability purposive sampling technique; 30 in experimental and 30 in control group. The effectiveness of early ambulation is assessed by self-structured biophysiological health parameters. Findings: There was significant difference between biophysiological health score of post caesarean section mothers after early ambulation in interventional experiment group and non – interventional control group. Out of 30 samples in interventional group maximum (18) 60% had good score and (12) 40% had average score whereas in non-interventional control group maximum (22) 73.33% had average score and only (8) 26.67% had good score.; There was significant association between socio demographic variable with biophysiological health parameter of post caesarean section mothers. Thus providing early ambulation after C- section is effective to improve maternal outcome among post caesarean section mothers. Conclusion: The study concludes that early ambulation; after six hours of post caesarean section plays a vital and beneficial role in improving biophysiological health parameters of post caesarean mothers.

KEYWORDS: Assess, Effect, Early ambulation, post-caesarean mothers, bio physiological health parameters, Post cesarean mothers.

INTRODUCTION:

Childbirth is one of the most significant events in a woman’s life. It is a normal physiological phenomenon which add new experiences in women’s reproductive health, but in many cases, complications during delivery necessitate medical interventions such as caesarean sections.

A caesarean section (C-section) is a surgical procedure performed to deliver a baby through incisions made in the mother’s abdomen and uterus, usually performed when there is risk on life of mother or baby through vaginal delivery. Early ambulation is a key factor to re- establish the normal physiology of post caesarean mothers and helpful in preventing or minimizing post cesarean complications.²

Absolute Indications for caesarean section are failure to progress in labour, malpresentations, malpositions, antepartum hemorrhage, pregnancy induced hypertension, cephalopelvic disproportion, fetal distress and other fetomaternal high risk cases.³

Women after cesarean section must be cared immediately and care is not limited to specific recovery room. The care giver must record parameters like blood pressure, respiratory rate, rhythm and intensity of pain, drug administered, consciousness, temperature and urinary output for all women.⁴

Caesarean section is the most common and oldest obstetrical surgery and in recent years, the rate of caesarean deliveries has increased significantly While the caesarean procedure can be lifesaving for both mother and child, it is not without potential risks and postoperative complications. These may include pain, delayed wound healing, infection, deep venous thrombosis, respiratory complications, constipation and other complications associated with immobility or prolonged bed rest. The nurse play very crucial role in decreasing such complications and make the patient independent to carry out activities of daily life at the earliest, lead to fast recovery and shorter hospital stay.⁵

Early ambulation is very important factor in improving the health of postoperative women’s. Early mobilization helps in reducing postoperative complications and hospital stay periods. In spite of this validation, early mobilization as a great practice preferred is actualized conflictingly.^6,7-9

In the immediate postoperative period, mothers often experience physical discomfort, fatigue, and fear of movement due to pain at the incision site. These challenges can delay the initiation of ambulation, which in turn affects the normal functioning of various physiological systems. Protecting a women’s health as these challenges is important for preserving her future childbearing function and for ensuring that she is physically fit to incorporate her new child into her family.

Early ambulation does not mean resuming normal activities, mother should avoid strenuous work like lifting, staining and pushing heavy things and this should be restricted for atleast 6 weeks after delivery. The mother is encouraged to be out of bed as soon as possible following delivery unless there are contraindications.

Motherhood is the most sacred and greatest boon for a woman. During motherhood mothers experience various physiological and psychological changes in the body. Main changes occurs in mothers body during postnatal period is involution of the uterus and descent of the fundus. Early ambulation in post-partum period is the key to get rapid and maximum muscle function, fosters involution of uterus and restoration of mother’s health¹⁰

Prolonged immobility can lead to complications such as thrombophlebitis, infections, pneumonia, deep vein thrombosis, increased pain, delayed recovery and digestive problems like gas pain and constipation. Early ambulation helps counter these risks by promoting blood circulation, stimulating intestinal peristalsis, preventing venous stasis, and enhancing lung expansion. It also assists in improving muscle tone and strengthening the abdominal wall, which contributes to faster wound healing and overall recovery.¹¹

STATEMENT OF PROBLEM:

‘’An quasi experimental study to assess the effectiveness of early ambulation technique on Biophysiological health parameters among post caesarean section mothers at selected Dr. BhimRao Memorial Hospital Raipur (C.G)’’.

OBJECTIVES OF THE STUDY:

· To assess the biophysiological health parameters of post caesarean section mothers after early ambulation in interventional experimental group.

· To assess the biophysiological health parameters of postcaesarean section mothers in non- interventional control group.

· To assess the effectiveness of early ambulation technique on biophysiological health parameters of post caesarean section mothers in interventional experimental group.

· To find out the association between socio demographic variable and biophysiological health parameters of post caesarean section mothers.

Fig no. 1- Early ambulation technique

HYPOTHESIS:

NULL HYPOTHESIS:

· H₀1: there will be no significant difference between score of biophysiological health parameter of post caesarean section mothers after early ambulation in interventional experimental group and non- interventional control group.

· H_O2: there will be no significant association between socio demographic variable with biophysiological health parameter of post caesarean section mothers.

HYPOTHESIS:

· H1: there will be significant difference between score ofbiophysiological health parameter of post caesarean section mothers after early ambulation in interventional experimental group and non- interventional control group.

· H2: there will be significant association socio between demographic variable with biophysiological health parameter of post caesarean section mothers.

DELIMITATIONS:

· The study is limited only to post caesarean patients who had undergone spinal anesthesia, with minimum discomfort in post operative period.

· Who are present at the time of study

· Who are able and willing to participate in the study

· Who are able to follow instructions.

MATERIALS AND METHODS:

The present quasi-experimental study was conducted to assess the effectiveness of the early ambulation technique on bio physiological health parameters among post-caesarean mothers at Dr. Bhimrao Memorial Hospital, Raipur (C.G.).

The study adopted a quasi-experimental research design is selected to determine the impact of early ambulation on the recovery process of post-caesarean mothers. The research was conducted in the postnatal wards of Dr. Bhimrao Memorial Hospital, Raipur (C.G.), and a government tertiary care institution that caters to a large population of maternal health patients. The study setting was selected due to the availability of a sufficient number of caesarean mothers and cooperation from the hospital’s obstetrics and nursing staff.

The population for the study consisted of post-caesarean mothers admitted to the postnatal unit. The sample size included 60 participants, divided equally into an experimental group (30) and a control group (30). The sampling technique used was non-probability purposive sampling, which ensured that only those mothers who met the inclusion criteria-such as being hemodynamically stable, willing to participate, and free from postoperative complications-were selected for the study.

Data were collected using a structured observational checklist and bio physiological measurement sheet developed by the researcher. The intervention procedure involved initiating early ambulation for the experimental group within 6 to 8 hours after surgery under the supervision of trained nursing staff, while the control group followed standard hospital recovery protocols. Data analysis was performed using descriptive statistics (mean, standard deviation, percentage) and inferential statistics (unpaired t-tests) to determine the significance of the intervention.

Ethical clearance was obtained prior to data collection, and informed consent was secured from all participants. This methodological approach ensured reliability, validity, and ethical integrity throughout the study process.

Research Design:

A quasi-experimental research design with a post test only control group approach was adopted for the present study. This design was selected because it facilitated the observation of changes in bio physiological parameters after the intervention, thereby determining the effectiveness of the technique.

Research Setting:

The study was conducted at Dr. Bhimrao Memorial Hospital, located in Raipur, Chhattisgarh. The hospital is a government tertiary care institution equipped with obstetric and gynecological units providing maternal and child health services. The setting was chosen due to the availability of a sufficient number of post-caesarean mothers, accessibility to the researcher, and cooperation of hospital staff for the study.

Population:

The target population of this study comprised post-caesarean mothers admitted to the postnatal wards of Dr. Bhimrao Memorial Hospital, Raipur (C.G.). The accessible population included all post-caesarean mothers who met the inclusion criteria and were available during the data collection period.

Sample and Sampling Technique:

A total of 60 post-caesarean mothers were selected for the study using a non-probability purposive sampling technique. The participants were divided into two equal groups:

· Experimental Group (30 mothers): Received early ambulation intervention.

· Control Group (30 mothers): Received routine hospital postoperative care.

The sampling was carried out based on inclusion and exclusion criteria set by the researcher.

Inclusion Criteria:

· Patients who undergone caesarean section under spinal anesthesia, with minimum discomfort in post operative period.

· All full term and post term mothers

· Who are present at the time of study

· Who are able and willing to participate in the study

· Who are able to follow instructions.

Exclusion Criteria:

· Post caesarean patients who had undergone LSCS under general anesthesia.

· Who had developed major complications in post caesarean period.

· All preterm mothers

· Who were not willing to participate in the study.

Description of the Tool:

A structured observational checklist and data recording sheet were developed by the researcher after reviewing from literatures to assess the effectiveness of early ambulation. The tool consisted of three parts:

· Part I: Demographic Data – Information regarding age, occupation, residence, educational level and type of family.

· Part II: Obstetrical Data - type of caesarean section, duration of pregnancy, indication for caesarean section, gravida and type of previous labour.

· Part II: Biophysiological Parameters – Number of analgesics required, initiation of breast feeding, First flatus passed after ambulation on the first post operative day, Holding baby independently, Gastric tolerance, Assessment of breast, Presence of bowel persistalsis, Assessment for bowel function, Assessment for condition of abdomen, Assessment for bladder function, Observation of wound healing, Type of complications on 5^thpost operative day.

The content validity of the tool was established by a panel of nursing experts, obstetricians, and research methodologists. Reliability was tested through pilot study results, which showed the tool to be consistent and reliable for use.

Intervention Procedure:

After obtaining ethical clearance and informed consent, the study was carried out in the following manner:

1) Experimental group:

Implementation of Early Ambulation:

The experimental group received the early ambulation intervention under the supervision of the researcher and nursing staff. Safety measures such as monitoring blood pressure, pulse, and signs of dizziness were strictly followed during ambulation.

Techniques of Early Ambulation:

The subjects were taught the steps or techniques of early ambulation by demonstration cum lecture. The early ambulation technique was started 6 hours after caesarean section and were explained to repeat the exercise 2 – 3 times everyday.

· Exercise began by exercising in bed like breathing exercise and for the extremities after 6 hours of caesarean section.

· Check for headache, uneasiness and nausea, if the patient do not exhibit the above symptoms then proceed for the next.

· Then sitting up slowly and take the semi sitting position for 5 – 10 minutes after 10 - 12 hours of caesarean section.

· Then sitting beside the bed for 5-10 minutes while her legs were hanging down.

· Standing beside the bed with support 2- 3 minutes.

· Sitting on stool or chair beside the bed.

· Walking inside the ward or hall 50 meters (with the support from researcher or their relatives)

2) Control Group:

The control group followed routine postoperative care as per hospital protocol.

Ethical Considerations:

Ethical approval was obtained from the Institutional Ethical Committee of Dr. Bhimrao Memorial Hospital, Raipur. Informed consent was taken from each participant prior to the study. Confidentiality of the participants were maintained throughout the research process. Participants had the right to withdraw from the study at any time without any prejudice.

Plan for Data Analysis:

The collected data were analyzed using both descriptive and inferential statistical methods:

· Descriptive Statistics: Mean, standard deviation, and percentage were used to describe demographic characteristics and bio physiological parameters.

· Inferential Statistics: Unaired t-tests was used to compare post-test results between the experimental and control groups. A p-value of less than 0.0001 was considered statistically significant.

The findings were presented through tables, graphs, and charts for better understanding and interpretation.

RESULTS:

This study assessed the effectiveness of early ambulation on the biophysiological health parameters of mothers after cesarean section. Descriptive and inferential statistics like frequency, percentage, mean, standard deviation, unpaired t – test and chi – square test were used for the analysis of the findings in order to determine the improvement in biophysiological health parameters of post cesarean mothers.

SECTION – 1 Description of sample characteristics according to socio demographic variables and obstetrical characteristics

Table No. -1 Distribution of sample characteristics according to socio demographic variables and obstetrical characteristics

S. No

Socio demographic characteristics

Category

Experimental group

Control group

Frequency

Age in Year

≤20 Years

21-25 Years

26 – 30 Years

31 – 35 Years

˃35 Years

6.67

66.66

26.67

33.33

6.67

Occupation

Housewife

Labour

Govt. Job

Private Job

93.33

6.67

Residence

Urban Area

Rural Area

Educational Level

Illiterate

Primary

Middle

High – Higher Sec.

Graduate and Above

3.33

6.67

3.33

36.67

3.33

Type of Family

Nuclear

Joint

43.33

56.67

36.67

63.33

Table No. -2 Distribution of sample characteristics according to socio demographic variables and obstetrical characteristics

S. No

Obstetrical character-istics

Category

Experimental group

Control group

Frequency

type of Caesarean Section

Elective/ Planned

Emergency

36.67

63.33

33.33

66.67

Duration of Pregnancy

Full Term

Post Term

100

Primary Indication for Caesarean Section

Maternal

Fetal

Maternal And Fetal Both

33.33

36.67

Gravida

Primi

Multi

76.67

23.33

56.67

43.33

Type of Previous Labour

LSCS

Vaginal Delivery

Primi

23.33

76.67

33.33

56.67

SECTION 2 Findings related to analysis of post test score of experimental and control group of Bio physiological health parameters of post caesarean section mothers.

To assess the biophysiological health parameters of post caesarean section mothers after early ambulation in interventional experimental group.

Table No. 3 Post test scores of postnatal mothers after caesarean in interventional experimental group

Group

Bio physiological health parameters

Poor

(0-9)

Average

(10-18)

Good

(19-27)

Total

Experiment

12(40%)

18(60%)

30(100%)

Table no. 3 depicts that in interventional experimental group out of 30 samples maximum (18)60% have good score and (12)40% have average score.

To assess the biophysiological health parameters of post natal mothers after caesarean section in non- interventional control group.

Table No. 4 Post test scores of postnatal mothers after caesarean in non interventional control group

Group

Bio physiological health parameters

Poor

(0-9)

Average

(10-18)

Good

(19-27)

Total

Control

22(73.33%)

8(26.67%)

30(100%)

Table no. 4 depicts that in non interventional control group out of 30 samples maximum (22) 73.33% have average score and (8)26.67% have good score.

To assess the effectiveness of early ambulation technique on biophysiological health parameters of post caesarean section mothers in interventional experimental group.

TABLE NO. 5.- t – test value of post test biophysiological health parameters in experimental and control group.

Bio physiologi-cal health parameters

Mean

Mean%

Unpaired t value

Df/Significance

Experimental Group

22.13

81.96

3.76

17.02

5.68

58/p<

0.0001 HS

Control Group

18.13

67.15

0.82

4.52

t – test value of post test biophysiological health parameters in experimental and control group depicts that in experimental group mean is 22.13, mean% is 81.96, SD is 3.76 & CV is 17.02 and in control group mean is 18.13, mean% is 67.15, SD is 0.82 & CV is 4.52. At the degree of freedom 58, the calculated unpaired t value is 5.68 which is more than table value at 0.0001 level of significance.

Table no. 6 depicts that out of 30 samples in experimental group maximum (18) 60% have good score, (12) 40% have average score and in control group maximum (22) 73.33% have average score & (8) 60% have good score. At degree of freedom of 2 the calculated chi square value is 6.78 which is more than critical value 5.99 at the 0.05 level of significance. Hence is significant. The findings of this quasi-experimental study clearly demonstrate that the implementation of early ambulation significantly improves the bio physiological health parameters among post-caesarean mothers.

SECTION 4 Findings related to association between selected socio demographic variable and Bio physiological health parameters of post caesarean section mothers in experimental and control group.

Association between selected socio demographic variable and biophysiological health parameters of post caesarean section mothers in experimental group is calculated using chi- square formula, it reveals that in experimental group the association of biophysiological health parameters with socio- demographic variable Age, occupation, educational level, type of family are not significant at 0.05 level of significance and Residence at degree of freedom 1 the calculated chi square is 5.92 is more than the critical value 3.84 at level of 0.05 significance hence is significant.

Association between selected socio demographic variable and biophysiological health parameters of post caesarean section mothers in control group

The data reveals that in control group the association of biophysiological health parameters with socio- demographic variable Age, occupation, residence& educational level at level of 0.05 significance are not significant and type of family at degree of freedom 1 the calculated chi square is 6.31 which is more than the critical value 5.41 at level of 0.02 significance hence found significant.

DISCUSSION:

The results emphasizes the importance of early movement in enhancing postoperative recovery and preventing complications. In the present study, mothers who engaged in early ambulation showed notable improvement in heart rate, blood pressure, bowel movement, wound healing, and overall physical comfort compared to those who remained on prolonged bed rest. This supports the hypothesis that early ambulation promotes circulation, stimulates bowel motility, and reduces the risk of postoperative complications such as thrombophlebitis, infections, pneumonia, increased pain, delayed recovery and digestive problems like gas pain and constipation.

Furthermore, this study underscores the vital role of nursing professionals in postoperative care. Nurses play a critical role in motivating and assisting mothers to ambulate safely, ensuring continuous monitoring of vital signs and comfort levels. The supportive role of the nursing team in providing reassurance and guidance during early ambulation was a key factor in the successful implementation of the intervention.

Additionally, early ambulation contributes to respiratory efficiency. Prolonged bed rest often causes shallow breathing, which can increase the risk of atelectasis and pneumonia. By encouraging early movement, lung expansion is promoted, and oxygen exchange is improved, thus reducing the chances of respiratory complications. Similarly, ambulation enhances gastrointestinal motility, helping mothers overcome postoperative ileus and constipation. The observed early return of bowel movements in the experimental group is a testament to the physiological benefits of movement after surgery. These improvements collectively contribute to a shorter hospital stay and a quicker return to normal routine, which is vital for both the physical and emotional well-being of post-caesarean mothers.¹²

The early ambulation technique also proved beneficial in terms of psychological well-being. Mothers in the experimental group reported reduced feelings of fatigue, pain, and anxiety, and expressed a greater sense of independence in performing routine activities. These findings are consistent with the observations of other studies, which indicate that early mobilization enhances maternal confidence, accelerates wound healing, and shortens hospital stays. It was also observed that mothers who ambulated early resumed breastfeeding sooner, facilitating better maternal-infant bonding and emotional recovery.¹³

Fig no.2 – nurse assisting in ambulation after cesarean section

RECOMMENDATIONS:

· The study can be done on a large sample of post cesarean motherts to generalize the findings.

· The study may be conducted in different settings.

· The study can be done to find the effect of early ambulation on different aspects.

· The study can be done to assess the knowledge and practice and attitude of caesarean section mothers towards early ambulation after LSCS.

· Study could implement protocol in hospital for early ambulation after caesarean section which can help the staff nurses to enhance their competences in managing the post caesarean mothers.

CONCLUSION:

The present quasi-experimental study titled “An Quasi Experimental Study to Assess the Effectiveness of Early Ambulation Technique on Bio physiological Health Parameters among Post-Caesarean Mothers at Selected Dr. Bhimrao Memorial Hospital, Raipur (C.G.)” was conducted to evaluate the impact of early ambulation on postoperative recovery and bio physiological health indicators. Based on the findings, it can be conclusively stated that early ambulation plays a crucial role in reducing the incidence of postoperative complications such as constipation, abdominal distension, pain, and venous thromboembolism.

This result is in accordance with the study done by Dube. V. et al on Effect Of Planned Early Ambulation On Selected Postnatal Activities Of Post Caesarean Patients. The result of the study shows that early ambulation plays a important and beneficial role in improving the postnatal activities of post cesarean section patients in relation to self care and care of newborn. The mothers who practiced early ambulation regained their independence earlier, experienced less discomfort, and indirectly helps in reducing morbidity. These outcomes indicate that early ambulation is not merely a physical activity but a therapeutic nursing intervention that promotes recovery and well being.¹⁴

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Received on 27.10.2025 Revised on 21.11.2025

Accepted on 13.12.2025 Published on 23.02.2026

Available online from February 25, 2026

Int. J. Nursing Education and Research. 2026;14(1):63-70.

DOI: 10.52711/2454-2660.2026.00013

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Group	Bio physiological health parameters				Df/Critical value	Chi sqr/Significance
	Poor (0-9)	Average, (10-18)	Good (19-27)	Total
Experiment		12(40%)	18(60%)	30(100%)	1/5.99	6.78/p<0.02
Control		22(73.33%)	8(26.67%)	30(100%)