SUBMITTED BY:
Mrs. ANGELA MARIA ROZARIO,
1st year M.Sc. (Nursing)
Obstetrics and GynecologicalNursing,
2011-2013 batch.
Oriental Colleage Of Nurisng,
Bengalure – 560 044.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs. Angela Maria Rozario 1st year M.Sc. Nursing, 2011-2013 batch.
Oriental College of Nursing, #43/52, 2nd Main Industrial Town, West of Chord Road, Bengalure – 560010.
2. / NAME OF THE INSTITUTION / Oriental College Of Nursing,
Bengalure- 560010.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc. Nursing,
Obstetrics and Gynecological Nursing.
4. / DATE OF ADMISSION OF THE COURSE / 10-06-2011
5. / TITLE OF THE TOPIC / “A study to evaluate the effectiveness of ‘Video Assisted Teaching Programme on knowledge regarding Hypnobirthing among mothers attending selected antenatal clinics Bengalure”.
6. / Brief resume of the work
6.1. Introduction
6.2. Need for the study
6.3. Review of literature
6.4. Statement of the study
6.4.1. Objectives of the study
6.4.2. Operational definitions
6.4.3. Assumptions
6.4.4. Hypothesis
6.4.5. Sampling criteria / Enclosed
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7. / MATERIALS AND METHODS
7.1 Sources of data: Data will be collected from Antenatal mothers in selected antenatal clinics, Bangalore.
7.2 Method of data collection: Self administered questionnaire.
7.3 Does the study require any investigations or interventions to be conducted on the patients or other human being or animals? yes
7.4 Has ethical clearance been obtained from your institution? Yes
8 / REFERENCE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs. ANGELA MARIA ROZARIO 1st year M.Sc. Nursing,
Oriental College of Nursing, #43/52, 2nd Main Industrial Town,
West of Chord Road, Bengalure – 560010.
2. / NAME OF THE INSTITUTION / Oriental College of Nursing,
Bengalure-560010.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc Nursing,
Obstetrics and Gynecological Nursing.
4. / DATE OF ADMISSION OF THE COURSE / 10-06-2011
5. / TITLE OF THE STUDY / “A study to evaluate the effectiveness of ‘Video Assisted Teaching Programme on knowledge regarding Hypnobirthing among mothers attending selected antenatal clinics, Bengalure”.
6. BRIEF RESUME OF THE INTENDED WORK:
6.1 INTRODUCTION
“My dream is that every woman, everywhere, will know the joy of a truly safe, comfortable and satisfying birthing for herself and her baby”.
-Marie F. Mongan
Pregnancy is an exciting and often joyous time in women’s life preparing for child birth is one of the most exciting time for the women , however it may also be the time of fear and anxiety for a mother to be. Fear, anxiety and pain are three factors that play an important role during delivery process and if fear and anxiety is removed mental and physical calmness will substitute them. 1
Child birth is a pleasant memory that the mother should always cherish. Labor is an experience of delivering baby and placenta from the uterus through the vagina to the outside world. 2
The child bearing women experience many demanding sensation and discomfort during labor and birth. Labor the culmination of a human pregnancy is an event with great psychological , social and emotional meaning for the mother and her family. Pregnant women commonly worry about the pain during labor. Hence preparation for childbirth should be given more importance during antenatal period in order to accept the labor pain and deliver a healthy offspring.2
For centuries, among western civilization, offering pain relief in labor was thought to be a moral , because according to the biblical account, God commanded Eve, “ I will greatly multiply the sorrow and the conception , in sorrow though shall bring forth children” The prevailing concept was that the childbirth should be painful. ( Genesis 3.16)
The survive conducted in India reported that around 78,000 women die each year in New Delhi due to the complication during the childbirth. This means that on an average every seven minutes one woman dies during or giving birth to a child. There are many ways to handle pain during labor, it includes Hypnosis, breathing technique, relaxation, yoga, meditation walking massage, medication such as analgesics, tranquilizer, regional anesthesia3
Medications have been used for labor and delivery pain relief since the 19th century. Today there are several drugs available to help mothers endure the pain of child birth. Most can be classified as analgesics or anesthetic. Analgesics relieve but do not completely stop pain. Any medication a woman takes can affect her baby. In most of the cases, women report the sensation of breathing difficulties, and some of the medication’s effect on the chest muscles, although it produces no real danger, it can provoke anxiety4
Hypnobirthing allows experiencing birth in an atmosphere of calm, relaxation, free of the fear and tension that prevents the birthing muscles of your body from functioning as nature intended them to it was introduced by Marie.F.Mongan in the year 1990.Hypnobirthing is a complete birth education program, which helps the mother to be in control and to have a better birth experience. It involves teaching simple, but specific self-hypnosis, relaxation and breathing techniques. Hypnobirthing is not tied to any particular belief system5
According to Andrew MI Medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth. This may increase the risk of associated complications and a less satisfactory birth experience. Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth. Hypnosis would be a simple, inexpensive way to improve the childbirth experience, reduce complications associated with pharmacological interventions, yield cost savings in maternity care, and this trial will provide evidence to guide clinical practice.6
In US during the period of October 2005 and January 2008, the Hypnobirthing Institute received 1227 Parents’ Birth Reports. Hypnobirth Labor interventions used fewer interventions during their labors than other mothers. 72% used no pain medication. While Hypnobirthing mothers chose obstetricians and certified nurse midwives equally, 79% of the respondents were attended by obstetricians. Hypnobirthing mothers reported a lower incidence of preterm births and low birth weight infants U.S. Division of Vital Statistics. All Hypnobirthing mothers were satisfied or highly satisfied with Hypnobirthing7
Hypnosis during labor is not meant to be a distractive technique instead it will help to have a control over the body. Hypnosis can benefit during different phase of uterine contraction.8
Hypnobirthing classes teach relaxation skills that will be useful to both mother and baby, regardless of her birth experience. In the event that medical intervention of any sort is needed, she will find herself better able to remain calm and in control. Mothers who have needed scheduled caesareans for medical reasons report that they were totally relaxed before, during and after the procedure. Many report that they needed little or no medication following the birth, and they were able to return to normal functioning in a very short period of time.9
6.2 NEED FOR THE STUDY
Hypnobirthing is as much a philosophy of birth as it is a technique for achieving a satisfying, relaxing and stress free birthing. Hypnobirthing teaches women and birthing companions the art and joy of experiencing birth in a safe, more comfortable manner for themselves and their babies. Through guided imagery and self-hypnosis women learn how to call upon their bodies’ own natural endorphins and thus eliminate or greatly reduce the need for medication. When a woman is properly prepared for childbirth and when the mind and body are in harmony, nature is free to function in the same well-designed manner that it does with women in other cultures and with all other creatures. 9
In 2003 reviews found that women using hypnosis were more satisfied with the management of their labor pain when compared with women using other forms of alternative and complementary methods of pain management (Smith, Collins, et al, 2003). More recently, authors of a 2004 review reported that women using hypnosis did not need analgesia and rated their pain as less severe than those in the non-hypnosis groups10
A comparative study was conducted in Australia, to examine the evidence regarding the effects of hypnosis for pain relief during childbirth. In this study hypnosis during pregnancy and childbirth was compared with a non-hypnosis intervention, no treatment or placebo. 5 randomized control trials and 14 non-randomized comparisons studying 8395 women were identified where hypnosis was used for labor analgesia. 4 randomized control trials including 224 patients examined the primary outcomes of interest. One randomized control trials rated poor on quality assessment. The remaining 3 randomized control trials showed that, compared with controls, fewer parturient having hypnosis required analgesia, relative risk=0.51 (95% confidence interval 0.28, 0.95). Of the two included non randomized controls, one showed that women using hypnosis rated their labor pain less severe than controls. The study concludes that hypnosis reduced opioid (meperidine) requirements, and increased the incidence of not requiring pharmacological analgesia in labor.11
A longitudinal prospective study was conducted in Gujarat, India on Hypnosis in pregnancy with Intrauterine growth restriction and oligohydrmnios. clinical hypnosis was used in addition to the conventional medical management in such pregnancies. The prenatal outcome was compared with the control group wherein hypnosis was not used. The hypnosis group had a significantly shorter preterm delivery rate (p = .004) and fewer incidence of low birth weight babies (p = .009). Significantly reduced operative intervention in terms of lower rate of cesarean section (p = .008) was also observed in the experimental group. Hence, the use of clinical hypnosis as a viable adjunct to medical management is suggested to help to prevent neonatal morbidity and fetal loss. 12
The 2004 national cesarean section rate climbed another 6% to an all-time high of 29.1% (Martin, Hamilton et al. 2005), with individual hospital's rates approaching a staggering 57% (Goldstein, 2005). These numbers far exceed The World Health Organization's call for a rate no higher than 15% (WHO, 1985). Clearly there is a need for greater education of the benefits to both mother and baby of natural childbirth and the potential complications of medically unnecessary interventions of "managed" birth.13
In the year 2001 a journal of family practice published a report about the Effects of Hypnosis on the Labor Processes and Birth Outcomes of pregnant adolescents . The study results shows that hypnotic preparations for labor and delivery can be effective intervention in reducing the number of complications, reducing surgical interventions, reducing length of postpartum hospital stay.14
A study was conducted in 60 nulliparous women to assess the benefits of hypnotic analgesia as an adjunct to childbirth education. Subject were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill terry using an ischemic pain task. Hypnotically prepared births had shorter stage 1 labors, less medications, higher Apgar scores, and more frequent spontaneous deliveries than control briths. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other 3 groups. Author propose that repeated skill mastery facilitated the effectiveness of hypnosis in their study. 15
A descriptive survey approach was used to assess the knowledge and attitude of health professionals regarding hypnobirthing. Non-probability convenient sampling technique was used, to select 100 health professionals working in OBG and Pediatric Departments at M.S. Ramaiah Hospitals, Bangalore. Data was collected using structured knowledge questionnaire to assess knowledge and structured opinionnaire to assess attitude. Over all knowledge scores of health professionals revealed that, 82% had inadequate knowledge, 18% had moderately adequate knowledge, where as none of them exhibited adequate knowledge. The mean percentage score obtained for overall knowledge was 40.40% with standard deviation of 4.47, which showed that the subjects had inadequate knowledge regarding Hypnobirthing. Study concludes that the knowledge about Hypnobirthing is inadequate among Health Professionals.16
Hypnobirthing helps women rediscover their natural birthing instinct. Mothers are awake, and fully in control, but profoundly relaxed as they bring their babies into the world. Mothers will be fascinated as they view Hypnobirthing videos showing laboring mothers, awake, alert and in good humor, as they experience safe, gentle birth free of the Fear-Tension-Pain Syndrome. Hypnobirthing teaches a woman how to release all prior programming about birth, how to trust her body and work with it, as well as how to free herself of limiting thoughts and emotions that lead to pain-causing fear and resistant muscles.17
6.4 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of video assisted teaching programme on knowledge regarding Hypnobirthing among mothers attending selected antenatal clinics, Bengalore”..”
6.3 REVIEW OF LITERATURE
1) Reviews related to effectiveness of hypnosis on complicated deliveries:
A study was conducted to determine the effectiveness of prenatal hypnosis in facilitating uncomplicated birth. A randomized group of 520 pregnant women in their first or second trimester of pregnancy were selected to receiving prenatal hypnosis. The goal was to reduce fear of birth and parenthood; to reduce anxiety; to reduce stress; to identify specific fears that might complicate the labor process and to prepare women for the experience of labor. Women receiving prenatal hypnosis had significantly better outcomes than women who did not. Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to an complicated birth outcome. The routine prenatal use of hypnosis could improve obstetric outcome.18
A study to evaluate the effectiveness of hypnosis to convert a breech presentation to a vertex presentation by One hundred pregnant women whose fetuses were in breech position at 37 to 40 weeks' gestation and a matched comparison group of women with similar obstetrical and socio demographic parameters. The intervention group received hypnosis with suggestions for general relaxation with release of fear and anxiety. As much hypnosis was provided as was convenient and possible for the women until they were delivered of the baby or the baby converted to the vertex position. Eighty-one percent of the fetuses in the intervention group converted to vertex presentation compared with 48% of those in the comparison group. This difference was statistically significant. Motivated subjects can be influenced by a skilled hypnotherapist in such a manner that their fetuses have a higher incidence of conversion from breech to vertex presentation.19