Effectiveness of  Paced Breathing Exercise on Labor Pain Perception among Primi mothers during First Stage of Labor

 

Mrs. S. Leethial¹, Prof. Mrs. Reeta Jebakumari Solomon²

¹Student, OBG Department, Thasiah College of Nursing, Vellivilagam, Marthandam

²Principal of Thasiah College of Nursing, Vellivillagam, Marthandam

 

ABSTRACT:

Background of the study: Child birth includes both labor and delivery. Pain during labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. As pain and discomfort increase, women may be tempted to request pain medications. They will not act to slow down or stop the labor. The aim of this study was to evaluate the effectiveness of Paced breathing exercise on labor pain perception among primi mothers during first stage of labor in selected hospitals at Kanyakumari district. Materials and methods: The design adopted was quasi experimental, non- equivalent control group pre-test post-test design. The sample consisted of 60 mothers, 30 in experimental group and 30 in control group. The purposive sampling technique was used to select the samples. The tools used for data collection procedure was demographic data and Wong-Baker facial grimace scale. Paced breathing exercise was administered to those in the experimental group and post-test was done in both experimental and control group. Result: The mean post-test level of  labor pain perception among primi mothers during first stage of labor in experimental group at observation I, II, III are 4.93, 6.13, 7.96  respectively were lesser than the mean pre-test score at observation I, II, III are 7.06, 7.86, 9.6 respectively (MD of 3 observations=2.13, 1.73, 1.64., t=5.18, 4.06, 4.22., P<0.05). Whereas the mean post-test level of  labor pain perception among primi mothers during first stage of labor in control group at observation I, II, III are 7.33, 8.93, 10  respectively were greater than the mean pre-test score at observation I, II, III are 7.0, 7.6,  9.46 respectively (MD of 3 observations=-0.33, -1.33, -0.54., t=-1.33, -3.2, -3.81., P<0.05). This proves that due to the effect of paced breathing exercise the mean post-test level of labor pain perception among primi mothers in experimental group had marked reduction. Conclusion: The study concluded that paced breathing exercise is an effective non pharmacological intervention for reducing labor pain perception.

 

 

 

INTRODUCTION:

Child birth is the ending of a pregnancy by one or more babies leaving a woman’s uterus. The women in labor has a series of events that bring about the opening up of the cervix, descent of the fetus and finally the delivery of the baby and the after births.  During the period of labor primi mothers experience more intense pain than multigravida as there is increased intensity and duration of labor¹.

 

During the period of labor, primi mothers experience more intense pain than multigravida as there is increased intensity and duration of labor. First-time mothers are more likely to give their pain a higher rating than women who have had babies before³.

 

Pain management during labor is a challenging event in intra-partum nursing care. Non-pharmacological and pharmacological pain management strategies are used to cope with the discomfort of labor⁴.

 

Paced breathing is the most associated with prepared childbirth and includes various breathing methods used to control pain during labor. They are: slow-paced, modified paced and patterned-paced breathing techniques. All patterns of paced breathing begins with a deep, relaxing, cleansing breath to “greet the contraction” and end with another deep breath exhaled to “gently blow the contraction away”. These deep breath ensure adequate oxygen for the mother and fetus².

 

NEED FOR THE STUDY:

A survey conducted with 100 parturient in Chennai India, found that only half of the participants were in favor of labor pain being relieved, but even fewer (18/51, 35.29%) could state the benefits of relieving pain and stress. Hence only (23/100, 23%) women reported any plans to use analgesia during labor. (Joyce Nilima James., 2012)

 

Ravindra., et al (2017) conducted a quasi-experimental study at Vadodara. Non-probability convenient sampling technique was used and selected 60 samples i.e. 30 in experimental group and 30 in control group. The subjective pain was measured by VAS. The mean and SD in experimental group is 15±7.26 and mean percentage of 71.7% was obtained in control group with mean and SD of 21.5±5.12. The ‘t’test value was 4.14* at 5% level. The study concluded that paced breathing is an effective non pharmacological method to bring comfort to the women in times of labor agony.

 

The investigator found that all the women in labor, particularly primi mothers have suffered from severe labor pain. The investigator had empathy upon the sufferers and considering the complications of pharmacological methods. The investigator planned to do research on non-pharmacological methods to alleviate labor pain. Since some studies have proved the effectiveness of paced breathing exercise reduces the labor pain perception. This motivates the researcher to conduct the study on this topic.

 

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of paced breathing exercise on labor pain perception among primi mothers during first stage of labor in selected hospitals at Kanyakumari district.

OBJECTIVES:

1.    To determine the levels of labor pain perception among primi mothers during first stage of labor in experimental and control group.

2.    To assess the effectiveness of paced breathing exercise on labor pain perception among primi mothers during first stage of labor in experimental group.

3.    To find out the association between the pretest level of labor pain perception among primi mothers during first stage of labor and their selected demographic variables such as age, education, occupation, income, body mass index, duration of first stage of labor etc.,

 

HYPOTHESIS:

H₁-There will be a significant difference between pretest and posttest score of labor pain perception among primi mothers during first stage of labor in experimental group.

H₂-There will be a significant difference between mean post-test score of labor pain perception among primi mothers during first stage of labor between experimental group and control group.

H₃ -There will be a significant association between the scores of labor pain perception among primi mothers during first stage of labor with selected demographic variables such as age, education, occupation, income, body mass index, duration of first stage of labor etc.

 

Conceptual framework:

Conceptual Framework based on modified Roy’s Adaptation Model was used.

 

METHODS AND MATERIALS:

The study was conducted at selected hospitals, in Kanyakumari district. The population of this study were primi mothers who were in first stage of labor and who met the inclusive criteria. Purposive sampling technique was used to select the samples for the study. The total number of samples were 60 (i.e.) 30 in each group. The data collection tool used in this study consisted of two sections. Section one was demographic and clinical variables, section two was Wong-Baker facial grimace pain scale to assess the labor pain among primi mothers. Validity of the tool was obtained from 5 experts. Reliability was tested using test re-test method.

 

Pilot study was conducted on 6 samples to find out the feasibility of conducting the study. The main study was conducted in PPK hospital Marthandam. The level of pain was assessed by Wong-Baker facial grimacing scale for both groups. After the pretest, paced breathing exercise taught and practiced in experimental group. Post-test assessment of labor pain perception for both groups.

 

As the variations in the level of labor pain perception could not be completely assessed by a single observation because as the time passes the intensity of pain increases. Therefore 3 observations were recorded. The data were analyzed by using descriptive and inferential statistics and tested the hypothesis at p<0.05 level of significant.

 

RESULTS AND DISCUSSION:

The data was analyzed and presented under the following sections,

Section- I: Frequency and percentage distribution of primi mothers according to the selected demographic variables.

Section- II: Frequency and percentage distribution of the pretest and post-test level of labor pain perception among primi mothers during first stage of labor in experimental group.

Section- III: Comparison of pretest and post-test level of labor pain perception among primi mothers during first stage of labor in experimental group.

Section- IV: Comparison of pretest and post-test level of labor pain perception among primi mothers during first stage of labor in control group.

Section-V: Association between the pre-test scores level of pain perception among primi mothers during first stage of labor in the control group with their selected demographic variables.

 

Section I:

Frequency and percentage distribution of primi mothers during first stage of labor with regards to demographic variables:

Distribution of primi mothers according to age in experimental group majority of them 60% belonged to age between 19 to 25 years, 40% of them belongs to age 26 – 35 years. While in control group majority of primi mothers 56.67% belonged to 19 to 25years, 43.33% of them belonged to age 26-35. Educational level of primi mothers depicted that nearly 3/4^th of them were graduates, whereas more than 1/3^rd of them were secondary.

 

With regards to occupation the dispersion of primi mothers in experimental group more than half of them 53.33% were homemakers, 33.3% of them were private employees. While in control group majority of them 56.67% were homemakers, 30% of them were private employees and 13.33% of them were government employees in both groups.

 

Considering the monthly family income of primi mothers nearly half 14 in experimental group and 13 in control group belonged to income above 10001. While 12 in experimental group and 13 in control group belonged to 5001-10000 and 4 of them belonged to below 5000 in both groups.

 

Dispersion of primi mothers according to type of family in experimental group more than half 16 (53.33%) of the primi mothers were from joint family, nearly half of the primi mothers 14 (46.67%) were from nuclear family. While in control group half of them from nuclear family and other half of them from joint family. According to locality of primi mothers all 60 (100%) resided in village, both in experimental and control groups.

 

Distribution of primi mothers during first stage of labor with regards to clinical variables

With regards to body mass index majority of primi mothers (60%) in experimental group and (56.67%) in control group belonged to above 29.9. In experimental group (40%) of them and in control group (43.33%) of them belonged to 18.5-29.9. On the other hand none of them were below 18.5 in both groups. Dispersion of primi mothers according to the type of conception all of them were conceived naturally.

 

According to the weeks of gestation73.33% in experimental group and 70% in control group were 38-39 weeks of gestation, 26.67% in experimental group and 30% of them in control group were 39⁺¹-40 weeks of gestation.

 

More than 3/4^th of primi mothers 24 in experimental group and 23 in control group had 4-6 hours of duration in first stage of labor. 6 in experimental group and 7 in control group of them had <4 hours and none of them were above 6 hours in both groups.

 

Section II:

Table 1: Frequency And Percentage Distribution Of Pretest And Posttest Level Of Labor Pain Perception Among Primi Mothers During First Stage Of Labor In The Experimental Group At Various Observation                                               (n=30)

Level of labor pain perception	Observation I				Observation II					Observation III
	Pretest		Posttest		Pretest			Posttest		Pretest		Posttest
	F	%	F	%	F	%	F	%	F	%	F	%
No pain	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
Mild pain	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
Moderate pain	0	0.00	16	53.33	0	0.00	4	13.33	0	0.00	0	0.00
Severe pain	14	46.67	14	46.67	4	13.33	14	46.67	0	0.00	2	6.67
Very severe pain	16	53.33	0	0.00	24	80.00	12	40.00	6	20.00	22	73.33
Worse pain	0	0.00	0	0.00	2	6.67	0	0.00	24	80.00	6	20.00

 

 

 

 

Table 2: Distribution Of Pretest And Post-Test Level Of Labor Pain Perception Pain Among Primi Mothers During First Stage Of Labor In The Control Group At Various Observation                                                                                                    (n=30)

Level of labor pain perception	Observation I				Observation II				Observation III
	Pretest		Posttest		Pretest		Posttest		Pretest		Posttest
	F	%	F	%	F	%	F	%	F	%	F	%
No pain	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
Mild pain	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
Moderate pain	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
Severe pain	15	50.00	10	33.33	6	20.00	0	0.00	0	0.00	0	0.00
Very severe pain	15	50.00	20	66.67	24	80.00	16	46.67	8	26.67	0	0.00
Worse pain	0	0.00	0	0.00	0	0.00	14	46.67	22	73.33	30	100.00

 

According to type of labor, majority of primi mothers 80% in experimental group and 76.67% in control group had induced onset of labor. Whereas 20% in

experimental group and 23.33% in control group had spontaneous onset of labor.

 

Figure 1: Comparison of mean pretest and post-test level of labor pain perception among primi mothers during first stage of labor in experimental group

 

Figure 2: Comparison of mean pretest and post-test level of labor pain perception among primi mothers during first stage of labor in control group

 

Section IV:

Table 3: Comparison of The Post-test Level Of Labor Pain Perception Among Primi Mothers During First Stage Of Labor In Experimental Group And Control Group                       N=60

Group	Obser-vation	Mean	SD	MD	Paired ‘t’ Test	‘P’ value
Experimental group	I	4.93	2.31	­2.4	4.76*	<0.05
Control group	I	7.33	1.6
Experimental group	II	6.13	2.81	2.8	4.11*	<0.05
Control group	II	8.93	2.16
Experimental group	III	7.96	2.88	2.04	3.82*	<0.05
Control group	III	10	0

*significant at 0.05 leve

l

Figure 3: Comparison of the post-test level of labor pain perception among primi mothers during first stage of labor in experimental group and control group

Section V Association between the pre-test level of pain perception among primi mothers during first stage of labor and their selected demographic variables in the experimental and control group

There is no association between pre-test level of labor pain perception among primi mothers during first stage of labor and their selected demographic variables like education, occupation, income per month, type of family, locality expect age.

 

There is an association between pre-test level of labor pain perception among primi mothers during first stage of labor and their selected clinical variables body mass index, duration of labor pain and type of labor expect weeks of gestation.

 

These findings proves that due to the effect of paced breathing exercise the level of labor pain perception among primi mothers in experimental group had marked reduction. Paced breathing exercise is an effective non pharmacological intervention for reducing labor pain perception. Nurse should have knowledge regarding the benefits of paced breathing exercise as a nursing intervention in reducing labor pain perception.

 

LIMITATIONS:

·      Sample size was 60 primi mothers

·      The data collection period was only one month.

·      The study was limited to primi mothers who were admitted in PPK hospital

 

RECOMMENDATION:

·      A study can be conducted with large sample size to generalize the result.

·      A study can be carried out for a longer period of time.

·      A study can be conducted in different setting such as rural and urban area.

·      A comparative study can be carried out among primigravida mothers and multi gravida mothers

·      A comparative study on paced breathing exercise can be carried out with different AV aids.

 

REFERENCE:

1.     Dr. s. Vijayalakshmi., (2014).A text book of midwifery and obstetrical nursing,(1^st edition). Vitmed publishers.

2.     Lowdermilk, Perry,Bobak. (1997). Maternity and Women’s Health Care. (8^thedition.). Philadephia:  Mosby.

3.     Kirandeep.,Avinash., Shalini. (2013). Nursing and midwifery research Journal, Vol-9, No-1, January 2013

4.     Annamma Jacob., (2011). A comprehensive text book of midwifery and gynecological nursing, (3^rdedition). New Delhi: Jaypee Brothers

5.     Ravindra.,Poonam., vrutti., et al (2017). International Journal for innovative Research in multidisciplinary field ISSN: 2455-0620 Volume-3, issue -6 June 2017

 

 

 

 

 

Received on 03.03.2018           Modified on 05.06.2018

Accepted on 25.06.2018     © A&V Publications all right reserved