RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES ,KARNATAKA,BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.NAME OF THE CANDIDATE AND ADDRESS / MS.RAMALA SHARMA
Ist yr M.Sc (Nursing)
Sarvodaya College Of Nursing,
No.11/2, Magadi Main Road,
Agrahara Dasarahalli, Bangalore-560079.
2. NAME OF THE INSTITUTION / Sarvodaya College of Nursing, Bangalore-560079.
3.COURSE OF STUDY AND SUBJECT / 1st Year M.Sc nursing,
OBSTERTIC AND GYNAECOLOGYCAL NURSING.,
4. DATE OF ADMISSION TO COURSE / 12-6-2009
5.TITLE OF THE TOPIC / ‘‘A STUDY TO ASSESS THE EFFECTIVENESS OF WARM MUSTARD OIL MASSAGE IN THE REDUCTION OF BACK PAIN AMONG POSTNATAL MOTHERS IN SELECTED HOSPITALS OF BANGALORE’’
6. BRIEF RESUME OF THE WORK. 6.0 Introduction. 6.1 Need for the study. 6.1.1 Statement of the problem. 6.2 Review of related literature. 6.3 Objectives of the study. 6.3.1 Operational definitions. 6.3.2 Assumption. 6.3.3 Hypothesis. 6.3.4 Sampling criteria. (i) Inclusion criteria. (ii) Exclusion criteria / Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed
7. MATERIALS AND METHODS:
7.1 Sources of data: Data will be collected from the postnatal mothers in selected maternity units in Bangalore.
7.2 Method of data collection: Interview method.
7.3 Does the study require any investigations of interventions to be conducted on the patients or other human being or animals? Yes.
7.4Has ethical clearance been obtained from your institution?
YES. Ethical committee’s report is here with enclosed.

RAJIVGANDHIUNIVERSITY OF HEALTH AND SCIENCES

BANGALORE, KARNATAKA

1 / NAME OF THE CANDIDATE AND ADDRESS / MS. RAMALA SHARMA
1ST YEAR M.SC NURSING
SARVODAYA COLLEGE OF NURSING
#11/2, MAGADI MAIN RD,
AGRAHARA DASARAHALLI
BENGALURU -560079, KARNATAKA
2 / NAME OF THE INSTITUTE / SARVODAYA COLLEGE OF NURSING
BENGALURU 560079
3 / COURSE OF THE STUDY AND THE SUBJECT / M.SC NURSING
OBSTETRICS AND GYNAECOLOGYCAL
4 / DATE AND ADMISSION OF THE COURSE / 12-06-2009
5 / TITLE OF THE STUDY / “A Study to Assess the Effectiveness of Warm Mustard Oil Massage in the Reduction of Back Pain Among Postnatal Mothers in Selected Hospitals of Bangalore.”

PROFORMA FOR REGISTRATION OF SUBJECT OFDESSERTATION

6.BRIEF RESUME OF INTENDED WORK

6.0 INTRODUCTION

Postnatal is the period beginning immediately after the birth of a child and extending for about six week. Biologically, it is the time after birth, a time in which the mother's body, including hormone levels and uterus size, return to pre-pregnant states. The major focus of postpartum care is ensuring that the mother is healthy and capable of taking care of her new born; equipped with all the information she needs about breast feeding, reproductive health and the immanent life adjustment. In some case this adjustment is not made easily and women may suffer from postpartum depression, post traumatic stress disorder or even puerperal psychosis. So the women need to be taken care properly during postnatal period. Most postpartum women experience relatively little discomfort related to physical changes. The physical care women receive during postnatal period can influence her health for the rest of her life.1

In some East Asian cultures, such as Chinese and Vietnamese, there is a traditional custom of postpartum confinement known in English as “Doing the month” or “Sitting the month”. Confinement traditionally lasts 30 days, although regional variants may last 40, 60 or as many as 100 days. This tradition combines prescribed foods with a number of restrictions on activities considered to be harmful. It is widely believed in many East Asian societies that this custom helps heal injuries to the perineum, promote the contraction of the uterus, and promote lactation.5

In Nepal post natal period is traditionally considered as a period of impurity due to the process of child birth and the period of confinement is12 days recommended to the mother, during this phase all the house hold and religious activities are restricted. Complete rest with oil massage is given for both mother and baby for a month. During this period mothers are encouraged to take high protein diet and complete rest. In India this Period is called as sutakam traditionally considered a period of relative impurity, period of confinement is 10 days; all the religious and house hold activities are restricted for the mother.5

Back pain is very common during pregnancy and postnatally, and is a serious cause of morbidity. Postnatally 68% of women are affected with back pain in 8 weeks and 60% in 8 months. Antenatal and postnatal back pain is common. Neither elective caesarian section nor assisted vaginal delivery increase the risk of postnatal back pain compared with spontaneous delivery. Most of the time analgesic is given to the postnatal mothers in order to reduce the pain.The action of analgesic is temporary which helps to reduce pain for very short period but the massage therapy plays very important role in minimizing pain, disability and speedy recovery to normal condition.

The various forms of therapeutic superficial tissue manipulation have been practiced for thousands of years across culture. Chinese use of massage dates to 1600 B C and Hippocrates made reference to the physician being experienced with “rubbing” as early as 400 B C. There are reference to oil massage in ancient record of Chinese, Japanese, Arabic, Egyptian, Indian, Greek and Roman nation.7

References to oil massage are also found in the Bible and the Veda. Term for massage include the French word “massar” the Greek word “knead” a Hindu word “press” and an Arabic word means “ to press softly”. Many different therapeutic techniques can be classified as massage therapy. Most involve the application of fixed or moving pressure on manipulation of the muscle- connective tissue of the clients. Practitioners may use their hand or other areas such as forearm, elbow and feet. Lubricants may be added to aid the smoothness of massage strokes.A technique called Swedish massage was developed in 19th century by Per Henrik Ling (1776 – 1839) as a combined form of massage. Swedish massage includes; Superficial stroking in direction away from the heart or deep stroking towards the heart, Kneading in a circular pattern using finger and thumb, Deep muscle stimulation, Rhythmic movement such as slapping or tapping.7

In approximately 80% of women who are pregnant, back pain is prevalent. Back pain and the causes in pregnant patients are not entirely understood. Therefore, the treatment recommendations are poor. By educating both the physician and the patient, treatment options can be improved. Pain in the pelvic region, for which a clear-cut diagnosis has not been made, is termed peripartum pelvic pain. This pain may start during pregnancy, or within three weeks of delivery. Anatomically, pain presents itself most commonly in the following areas: sacroiliac joints at the posterior superior iliac spine (42%), the groin areas (53%), coccyx (33%), pubic symphysis anteriorly (77%), and occasionally other areas of the pelvic and upper legs.Rarely does pain occur below the knee. Pain tends to be influenced by posture and is associated with a waddling gait. In approximately 80% of pregnancies, back pain is usually localized, but the site may vary. Although long-term pain is very rare, short-term pain tends to be dominant. Usually during the third trimester, 50% of pregnant patients will experience back pain. The prevalence of postpartum period pain falls to approximately 9% in decreasing order as follows: sacral, lumbosacral, lumbar, cervicothoracic, and remaining areas.The median time for back pain to resolve was within six months. Approximately 35% of patients continued to describe intermittent back pain lasting one to one and half months after partum. At the first postpartum visit, only 15% of patients continued to have low back pain. Therefore, in most cases, pain does improve after the postpartum period.

6.1 Need for Study

The postnatal period or puerperium refers to the 6-weeks period following childbirth. Back pain is one of the major problems among postnatal mother, it disrupt normal breast feeding and makes mother to feel sick during the postnatal period. Warm mustard oil massage is an effective and inexpensive method of relieving back pain. 2

Postnatal massage is a method to care for women and babies after birth. Body goes through significant changes,during the first few weeks postpartum healing has to occur in the site within uterus where the placenta was attached. The intestinal track and urinary bladder has to regain their original positioning, abdominal muscle may be very relaxed and flaccid and mother may feel very weak during this period. Breast feeding may put strain on back and shoulder. Regular massage during postnatal period is very beneficial to all new mothers. Postnatal massage addresses physical discomfort as well as emotional state. Body, mind and soul are nurtured. Postnatal massage therapy is widely practiced and has numerous benefits for the new mother.7

For mothers who deliver naturally without any complication postnatal massagecan be started as soon as they are comfortable and ready. For caesarean, it is best to wait for 2 weeks after giving birth or when the incision is properly healed before starting the postnatal massage. A soothing Swedish massage using firm yet gentle stroke to ease muscle tension, increase circulation and encourage a state of both relaxation. Oil or cream can be chosen based on patient need. Warm oil melts tension and creates a deeper sense of relaxation, increase the blood circulation and reduce the inflammation.7

A study was conducted to assist the effectiveness of a single session of nurses administer massage for short term relief of non-malignant pain. 101 patients were randomized and evaluated, 50 in the massage and 51 in the control group. Patient in the massage but not the control group had significantly less pain compared to baseline immediately after and 1 hr post treatment.

Some pregnant mother experience an easy birth, while others go through a prolonged and difficult process with many hours of labour. One thing is absolutely for certain after the delivery process; new mothers are tired, than having to breast feed and nurse a new born several times per night can add to the exhaustion. New mother’s today do not have much time to relax and rest during her postnatal 'confinement' period at home. Many mothers also need to return to work quickly which for some means facing additional pressure to lose weight in order to fit back into their work attire and feel more comfortable reintegrating into social situations.

Post-natal massage therapy may be an effective solution for at least some of the new mothers needs. The top 6 benefits of postnatal massage therapy for mothers: are Relaxation, Stress Relief, back aches,neck and Shoulders pain, Reduction of fluid retention, help uterus to return to original size, reduction of cellulite and helps to tone up the body.Postnatal massage also provides an important sense of continuing comfort for the new mother. The aim of this massage is to give nurturing and emotional support as well as alleviate the muscle aches from the strain of labour and childbirth. Some post-natal massage therapies may also be done in conjunction with a detoxification program that assists the abdominal area to reduce post birth 'bagginess'.

In many parts of Asia, it is common for women prior to delivery to actually pre-book sessions with a massage therapist for a series of post-natal massages.In Indonesia, postnatal massage is a traditional treatment which has been handed down from generation to generation and is still widely practiced today. This treatmentinvolves the use of massage oil applied to the stomach and a stomach wrap called a 'bengkung' made up of a cotton cloth several meters long. The bengkung is used to wrap the body in order to push up the uterus, clear water retention, relieve wind and spasms, shrink the stomach and help to reduce weight.

Mustardoil is versatileoil that can be used for therapeutic use. As one of the more common types of seed found in the Mediterranean ,Nepal,Bangladesh and North India like Punjab, Haryana and West Bengal, mustard seeds produce an oil that is both aromatic and soothing to the skin. When it comes to the use of oils as a soothing topical agent, mustard oil is considered to be helpful with the pain and associated discomfort. Along with leaving relatively little residue, mustard oil provides a pleasant aroma that may also appeal to the user of the oil. The use of mustard oil as an ointment for stiff joints has a long history, and is still recommended by persons who prefer to use natural agents to treat various health ailments.

Storage of containers of mustard oil is not difficult. As long as the container remains unopened, the mustard oil can be stored in a cabinet at room temperature. It is possible to keep mustard oil fresh and usable for several months.

Mustard oil massages is also very effective in treating pain, incurred during sporting activities. The oil helps in promoting circulation and also helps in the detoxification of toxic wastes from the body.Mustard is a rubefacient which causes reddening and warming of the skin. This volatile oil is a powerful irritant, rubefacient, and vesicant, used for pains and colic. Mustard oil is very effective in treating the muscles cramp,muscle pain and joint pain. Oil has to be heated to Luke warm and applied for better results. Theresearcher’s has observed the benefits of warm mustard oil massage which is routinely practiced for the postnatal mothers in North India, Postnatal mother’s who had regular massage with warm mustard where found to experience fewer discomforts. In comparison to massage oils like gingely oil, olive oil which costs about Rs.160 and Rs.400 respectively,mustard oil cost Rs 60 per liter, making it most affordable and available to all. Mustard oil is considered one of the best oil for massage therapy. It provides heat to the body, reduces pain and inflammation and does not have any side effect. With the above points in mind the researcher thus attempts to measure the effectiveness of warm mustard oil massage in the reduction of back pain among the postnatal mothers which is low cost and having no side effect.

6.1.1 Statement of problem

A Study To Assess The Effectiveness Of Warm Mustard Oil Massage In The Reduction Of Back Pain Among Postnatal Mothers In Selected Hospitals Of Bangalore.

6.2 Review of Literature

The chapter deals with an extensive review of literature to gain deeper insight into the problem as well as to collect maximum relevant information for building up of the study.

The literature directs the researcher in design the study and interpreting the outcomes. The primary purpose is to gain broad background or understanding of the information that is available related to the problem. This helps the investigator to gain in depth knowledge need to make changes in practice and problem. The review helps the investigator in developing a deeper insight into the concept of effectiveness of massage therapy with mustard oil and in gaining information on trends in various related studies in this area. The most common usage of the term review of literature is to refer to that section of research study in which the researcher describe the link between previously existing knowledge in the current study ( Grippa & Lueero in 1994)

Literature related to low back pain after the child birth

A study on Long term back aches after childbirth and prospective search for causative factors was conducted 599 women were recruited, of whom 450 (75%) replied to a follow up questionnaire. 152 women (33.8% of responders) reported backache lasting three months after delivery and, of these, 33 (7.3%) had not previously suffered with backache. There was no significant differences between the treatment groups in the incidence of postnatal backache overall or of new backache or any symptoms after childbirth. Among all demographic, obstetric, and epidural variables examined the only factors significantly associated with backache after childbirth was backache before and during pregnancy.11

Questionnaires were sent to 1615 women who had delivered their first baby in the defined period, to assess longterm backache after child birth1015 either replied by post or were contacted by telephone. 299 women (29.5% of responders) reported backache lasting more than six months and of these 156 (15.4%) said they had had no back problems previously. Those women who had received epidural analgesia in labour were significantly more likely to report new onset backache (17.8%; 95% confidence interval 14.8% to 20.8%) than those who did not (11.7%; 8.6% to 14.8%). Younger women, unmarried women, and those reporting other antenatal symptoms were significantly more likely to report new long term backache. The 156 women Reporting new backaches were asked to attend an outpatient clinic and 36 (23%) did so. The majority had a postural backache which was not severe. Psychological factors were present in 14 women.12