RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MISS. MINERVA DEVI MAIBAM

FIRST YEAR M. SC NURSING

OBG NURSING

YEAR 2010-2012

EAST WEST COLLEGE OF NURSING

BANGALORE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the Candidate and address: / Minerva Devi Maibam
1st Year M.Sc (Nursing)
East West College of Nursing #63,Magadi Road, BEL Layout, Bangalore -91, Karnataka.
2. / Name of the Institution : / East West College of Nursing
#63, Magadi Road, BEL Layout, Bangalore -91, Karnataka.
3. / Course of study and subject: / 1st Year M.Sc (Nursing)
Obstetrical and Gynaecological Specialty.
4. / Date of admission to the course: / 15/05/2010
5. / Title of the study: / “Slide Show on knowledge regarding Water birth among staff nurses in Maternity ward”

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6. Brief resume of the intended work:

6.1 Introduction.

“There is no other door to knowledge than the door Nature opens; and there is no truth except the truth we discover in nature.”-Luther Burbank.

People learn how to be mother or father from their own parents. Memories of their parents’ behavior and attitude lead them to develop ideas about what a parent is or should be. When a woman gets pregnant for the first time, she may desire to gain experience and closeness of the mother child relationship or to strengthen ties with her partner. In other words it can said having a child may be viewed as a new beginning, an enriching life experience leading to a feeling of creativity and competence.1

The term pregnancy is state as gravid, and a pregnant female is referred to as a gravid a. And embryo is the term used to describe the developing offspring during the first 8 weeks following conception and the term fetus is used from about 2 month of development until birth. Pregnancy is the period of reproduction during which a female caries one or more live offspring from implantation in the uterus through gestation. It begins when a fertilized zygote implant in the female uterus and ends once it leaves the uterus. To simplify reference to the different stage of prenatal development, the human pregnancy is somewhat arbitrarily divided into three trimester periods i.e. 1st trimester- 1to 12 weeks, 2nd trimester-13 to 28 weeks, 3rd trimester-29 to 40 weeks.2

During pregnancy there is progressive anatomical and physiological changes not only confined to the genital organ but also all the system of the body which are with and caused by the effects of specific hormone. This is principally a phenomenon of maternal temporary adaptation to the increasing demand of growing fetus.3

To ensure delivery of a mature live and healthy infant’s birth under the best circumstances possible and to avoids any medical and obstrical condition that would endanger the life or impair the health of pregnant women/baby. Few methods/types of childbirth are used eg. Vaginal delivery, Caesarean, Medicated Birth (epidural anesthesia) Lamaze Method and Bradley Method etc.2

Water birth is a method where the lower portion of the laboring women is immersed in bathtub or basin full of warm water while giving birth to the baby. The first recorded account of an underwater birth in Europe was in 1803 in France. The efficacy of water birthing was studied during the 1960s by several researchers of obstetrics. During the1980s and 1990s, interest in water birth grew in the UK, Europe and Canada. By 2005, more than 300 US hospitals had adopted Monadnock’s protocol or developed their own protocols.4

The water birth has finally made its foray into India. Violet, a baby girl born to a Britist couple in Delhi April 28, 2007 is the first baby to be born in India through this method. As to mention further, in Bangalore some hospital like Columbia Asia, Manipal Hospital and Sagar Apollo etc are practicing this method of childbirth.5

Water birth should always occur under the supervision of a health care provider as it has many potential benefits to both mother and baby like. Water is soothing, contorting, relaxing in the later stages of labor, the water seem to increase the woman’s energy and lower high blood pressure and provides a sense of privacy which release inhibitions, anxiety and fear. And besides water birth, eases the stress of the birth providing reassured and security to the baby by creating a similar environment as the amniotic sac. The theory behind water birth is that the baby has been in the amniotic sac for 3 months and birthing into a similar environment is gentler for the baby and less stressful for the mother.6

Water birth still remains a controversial birthing method due to large part to the lack of studies performed .Critics argue that because water aspiration is always a possibility that can lead to many serious complication some potential difficulties which underwater birth are, contamination of the bath water with feces expelled with pushing effort during the 2nd stage of labor, aspiration of bath water by a fetus which could lead to pneumonia and maternal chilling when she leaves the water. Advise women choosing this method that research on the safety and wisdom of the method is ongoing.7

Recent surveys shows that, of 290 UK maternity units for which data on birthing pools were available,64% had at least one birthing pool, with 20 units having two or more. There are no current data on the number of women who actually use these facilities during labor of for water birth, apart from a postal survey carried out between April 1994 and March 1996, which reported that at that time, fewer than1% of birth in England and Wales occurred in water.8

Midwives should discuss antenatal the use of immersion in water in labor with all women in a low risk category as part of their overall discussion regarding options for pain relief, and information leaflets should be available. It is important that information on water birth is conveyed to all women in a form they can understand and in a culturally sensitive fashion, to quality services. Midwives, manager and supervisors of midwives should ensure that training in caring for a women who wishes to have a water birth in undertaken by midwives who undertake intrapartum care, in order to increase choice for quality care.8

6.2 Need for the study

In today’s competitive world, lots of competition is going on, in every corner of the country. So to mention about “water birth” is the latest procedure for delivery which is practicing in western countries now- a -days. Even today continuous researches are going on this case by known practitioner in country like USA, France etc. So it is much for Indian midwives to have the knowledge regarding water birth to become a participant in today’s competitive world.

Water birth is the process of giving birth in a tub of warm water. In water labor the women stays in the water during labor and leaves before the delivery. Both methods are advantageous for the mother; the water birth offer advantage for gentle entrance in this world for the baby.8

According to Harpes reports, water birth is a form of hydrotherapy which in studies, has been shown to be an effective form of pain management for a variety of condition especially lower back pain .Benefit from hydrotherapy in pain functions self-efficacy and affect, joint mobility. Full immersion in water promotes physiological response in the mother that reduces pain including a redistribution of blood volume which stimulates the release of oxytocin and vasopressin (Katz 1990) the latter which also increase oxytocin blood levels. Water birth the buoyancy of the mother and the baby allow for a gravitational pull. This pull not only opens up the mother’s pelvis but also allows the baby to descend more easily. Water birth is believed to aid stretching of the perineum and decrease the risk of skin tears. Support from the water slows crowning of the infants head and offers perineal support, which decrease the risk of tearing and reduces the use of episiotomy a surgical procedure which can cause a no. of complication. Indeed there is a zero episiotomy rate in the water birth.9

Water births are helpful in specific conditions like:- High Body Mass Index, for a woman with a raised Body Mass Index, immersion in water for labor and birth enables her to more and change position easier and quicker than if she was in a semi-reclining position on a bed. The mobility can utilize the advantage of gravity, enlarge the outlet and enhance fetal descend urging a better pushing technique in the second stage.(Sinkin and Ancheta,2005).In water there is no weigh or compression on the mother’s lower back make it easier for the baby to negotiate the pelvis and more comfortable for the mother. There is no compression of the internal blood vessels from the weight of the heavy uterus and abdomen this helps to ensure that the baby has enough Oxygen throughout labor and reduce the risk of fetal distress (Balaska 2004).10

In Hypertensive condition, with careful and regular monitoring women with high Blood pressure, mild pre– eclampsia or pregnancy induced hypertension could benefit from using a birth pool as an alternative to drug therapy. The Blood pressure is reduced due to a part of dilatation of the peripheral blood vessel in response to immersion in warm water and also Blood pressure reduced because warm water inhibits the release of a pituitary hormone vasopressin. Previous caesarean section: - Attitudes about the use of a birth pool by mother who had a previous caesarean section can vary greatly. Although there is some increase in risk of scar rupture. However, provide the labor progress well and is properly monitoring the chances of a problem occurring are very slim (Balaskas 2004).10

Birth generally occurs when the baby’s head is just able to fit through pelvis, Human babies have a large brain and a small body with its largest brain / body weight ratio at birth. Therefore the chance of damaging acceleration is greatest at birth especially with the skull plates soft and moveable. The best way to minimize acceleration is to birth the baby into water, which damps acceleration and increase neutrally buoyant support as the baby is delivered from amniotic fluid directly to water. Hence the better outcomes seen in underwater birth. Since the water babies develops 6 months faster is their first 2 year, and are ambidextrous, we feel that this slows the degree of damage caused by ordinary birthing and demonstrates the well-being of our babies, according to John C ,Lilly ,M.D.11

All midwives should ensure that they are competent to care for a woman who wishes to have a water birth and have a good understanding of the basic principles of caring for a woman in labor, and should make themselves aware of local policies and guidelines.8

The very first birth witness as a researcher, is a video clip in a workshop, was a women having a physiological water birth, the experience amazing and deeply moving. It convinced that immersion in water works wonder. It pleased to see promoting the benefits of water birth and giving women the choice. Water birth seemed a natural topic for the dissertation when looking at the wider picture. Evidence was found that water birth could be offered as a possible option in some “at risk” pregnancies.

Childbirth is always challenging. Natural birth has always allowed for a woman to keep their power and their strength for the birth. Water birth allows much more. It allows less pain and less suffering.12

6.3 Conceptual Framework:

To describe the relationship of concepts in the study, General System theory by Ludwig von Bertalanffy is used. This theory was introduced in 1930. Theoretical framework provides a certain frame work of reference for clinical practice, research and education. This theory is most suitable because it has components like input, throughput, output, feedback.

The following are the major concepts of the theory:

Input: Input is the matter, energy and transformation that enter the system. In the present study, the input is the characteristics of the staff nurses like, Age, education, income, religion and experience.

Objectives: This contributes directly to the knowledge they possess. The knowledge was assessed and measured using questionnaire. The questionnaire was constructed based on knowledge regarding water birth.

Throughput: Throughput is the use of biologic, psycho logic and socio-cultural sub systems to transform the inputs. Throughput was the processing of information of water birth through slide show.

Output: Output is the return of matter, energy and information to the environment in the form of both physical and psychosocial behavior. The expected outcome was obtained by assessing the knowledge and skills through close-ended questionnaire. The output was considered in times of change in post test knowledge scores obtained through close-ended questionnaire

Feedback: Differences in pre and post test scores were observed from the knowledge and practice scores of the samples. In the present study, the feedback was considered as a process of maintaining the effectiveness of slideshow assisted teaching. It was assessed by comparing the pre and post test scores, through “t” test. The effectiveness of the slideshow assisted teaching was also tested between the obtained scores of the samples with their demographic variables through chi-square and the effectiveness of slideshow assisted teaching related to the association of knowledge on practice was tested through the “r” value.