A STUDY TO ASSESS THE CHILD BIRTH EXPERIENCES AND THE LEVEL OF SATISFACTION REGARDING NURSING CARE DURING LABOUR AMONG PRIMI PARA MOTHERS IS SELECTED PHC’S AT BANGALORE
M.Sc. Nursing Dissertation Protocol submitted to
RajivGandhiUniversity of Health Sciences, Karnataka, Bangalore.
By
MS.ASHA. N
M.Sc NURSING 1ST YEAR
2012-2014
Under the Guidance of
MS.SATHIABAMA
HOD, Department of OBG Nursing
K.T.G College of Nursing
Gandhadakaval,
Hegganahalli Cross
Vishwaneedam Post
Bangalore-91
REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE / MS.ASHA. N2 / NAME OF THE INSTITUTE / K.T.GCOLLEGE OF NURSING
3 / COURSE OF THE STUDY AND SUBJECT / M.Sc NURSING I YEAR
OBG NURSING
4 / DATE OF ADMISSION
5 / TITLE OF STUDY
“A STUDY TO ASSESS THE CHILD BIRTH EXPERIENCES AND THE LEVEL OF SATISFACTION REGARDING NURSING CARE DURING LABOUR AMONG PRIMI PARA MOTHERS IN SELECTED PHC’S AT BANGALORE”.
6
7.
8. / BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“The moment child is born; the mother is also born,
She never existed before; the woman existed before,
But the other never,
A Mother is someone absolutely new,
Motherhood makes a woman complete.”
-Ranjeev Sharma
The most admired creation of God are women not just the symbol of beauty, they are the mentors of the young ones, helping hands of the needy and pillars of beautiful homes1.
A woman is treated as a whole person when she bears a child and becomes a mother. It is a great achievement in any woman’s life irrespective of her nation. Pregnancy and childbirth are celebrated universally and this promotes women to motherhood2.
Motherhood is a great responsibility and it is woman’s highest crown of honour. Maintaining good health during pregnancy is very important especially in the present stressful life. Pregnancy and childbirth place a woman at a higher risk of morbidity and mortality, through a fair degree of success has been achieved in reducing maternal deaths and improving maternal care 3.
India has the highest number of maternal deaths in the world. The national maternal mortality rate (MMR) is 254 per 100,000 live births, an absolute number of 68,000 per year. The majority of deaths are preventable through safe deliveries and adequate maternal care. However, only 52.7% of women have a safe delivery. Indian Woman suffers more during pregnancy and child birth because of illiteracy, ignorance, poverty, orthodox, cultural behaviour and firm belief in past deeds or karma. Poor health status of women and children in terms of high maternal mortality and morbidity was also another health priority in this country. 4
Care for the patient is the fundamental aim of health services and it is that which motivates many providers. A Maternity Centre may be soundly organized, beautifully situated and well equipped bit if the nursing care such as providing maternal and child health care through antenatal, intranatal and postnatal services like immunization against prenatal diseases, nutrition interventions like iron and folic acid distribution with vital supplementation is not of high quality, the hospital will fail in its responsibility. Nursing care is as integral part, indispensible and important component of the health care delivery system5.
Each pregnancy is unique. Pregnancy and child birth are special events in women’s lives and indeed in the lives of their families. This can be a time of great hope and joyful anticipation. Pregnancy is by no means a disease but a normal physiological process6.
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman’s uterus. It can be an intense event and strong emotions, both positive and negative, can be brought to the surface. Childbirth is described as a multifaceted experience. Sense of security and perceived control, experienced level of labour pain, personal support, midwifery care, experience of earlier deliveries, intrapartum analgesia, information given and involvement in decision-making contribute to the childbirth experience7.
The advancement of education, development of communities, technology, growing health consciousness among the people and increasing maternal mortality rate, there is a demand that consumer protection act being made applicable to nursing. This would help in improving the quality of nursing care, evaluating nursing performances as well as improving nursing practice and education8
NEED FOR THE STUDY
The International Confederation of Midwives celebrates the ‘International Day of the Midwife’ on the 5th of May every year. The aim of the day is to celebrate midwifery and to achieve the following objectives,
- To increase Midwife numbers
- Improve maternal Health
- Reduce Child Mortality
The maternal mortality rate or the rate of deaths among women during or after pregnancy, in India has declined to 212 per 100,000 live births in 2007-09 as against 24 in 2004-06, according to data released by the Registrar General of India. Though there is a decline of 17% during the period, the country needs to achieve a target of 109 deaths by 2015 to achieve the United Nations-mandated Millennium Development Goals10.
Good quality nursing therefore means a good experience for patients and was identified as six core elements:
- A holistic approach to physical. Mental and emotional needs, patient-centered and continuous care
- Efficiency and effectiveness combined with humanity and compassion.
- Professional, high quality evidence-based practice
- Safe, effective and prompt nursing interventions.
- Patient empowerment, support and advocacy
- Seamless care through effective teamwork with other professions.
The International Council of Nurses developed the theme “Quality costs and nursing”, for International Nurses Day. This has provided a focus and direction for quality issues in nursing for the future. Nurses have a long and proud history of involvement with quality. The challenge for the present and the future is to ensure that in order to assess good nursing care, the right questions about quality issues are being addressed12.
During the labour progress, nurse’s play the main role because she is also responsible for both mother and the child. Nurse must maintain proper communication, support the mother and encourage for the positive outcome of labour progress and also she will educate priory during her antenatal check-up.
The principles of delivering and measuring quality in healthcare can be applied to maternity care, and where this is provided primarily by midwives, the principles of measuring quality applied directly to midwifery care. High quality midwifery care can be defined as care delivered by midwives which is safe and effective, and results in a positive experience for women.13
Women’s experiences of care may include their own view of the safety and effectiveness of that care. Midwifery care which is unsafe, or has poor and avoidable outcomes, is therefore not high quality. By the same token, care which women themselves regard as unsafe, ineffective or resulting in anegative experiences, is also poor quality care; regardless of the clinical outcome.14
Due to the lack of proper care during labour there is increase in the maternal mortality rate, neonatal mortality rate, postnatal depressions and Postpartum Hemorrhage. Due to overpopulation, nurses are not able to take full care of mothers who are admitted in labor room. This study helps to understand the ways to first-time mothers to learn about childbirth and also to provide the basis for developing strategies that may enhance the level of mother’s satisfaction and provide nurses with information about needed aspects that enhance or hinder mother’s satisfaction 15.Midwives, both individually and collectively, are responsible for delivering high quality care. This important role of midwives has been recognized in England: “nurses and midwives are fundamental to high quality healthcare” (Department of Health, 2010) and the “the renewed focus on high quality of care and the experiences of service users” (Prime Minister’s Commission on the Future of Nursing and Midwifery in England 2010). As part of the High Impact Actions for Nursing and Midwifery, ‘promoting normal birth’ was identified as the evidence-based, cost-effective action for midwives to drive up quality (NHS III, 2009).
The quality of care during pregnancy, birth and the neonatal period influences the chances of mortality and morbidity in babies, (Euro-Peristat project, 2008) particularly for women with more complex needs who already have increased risk factors. Midwives are often required to act as obstetric nurses and administrators, meeting the needs of the organization rather than meeting the needs of women.16
REVIEW OF LITERATURE
The review of literature in this chapter has been presented under two broad headings.
1. Literature related to child birth experiences
2. Literature related to satisfaction on intranatal nursing care.
LITERATURE RELATED TO CHILD BIRTH EXPERIENCES:
Annika Karistrom et al (2011) conducted a study on “comparison of experiences and feelings during pregnancy and childbirth in women who preferred caesarean section during pregnancy and were delivered by a planned caesarean section and women who preferred to give birth vaginally and actually had a spontaneous vaginal birth”, among 693 mothers in Sweden. The findings of the study showed that women who preferred and actually were delivered by caesarean section experienced a fear of childbirth to a higher degree as compared to women with a vaginal birth.17
Christina Nilsson, et al (2011) conducted a study on “Self-reported fear of childbirth and its association with women’s birth experience and mode of delivery” among 12 mothers in Sweden. The findings of the study showed that mothers had a negative experience of child birth18.
Larrsson BW, et al (2011) conducted a study on women’s perceptions of their intrapartal care during planned vaginal birth among 1173 mothers in Sweden. Findings of the study stated that, 81 percent of mothers agreed fully or mostly that the birth of their child was a positive experience. Midwife explained the procedure of intranatal care and well supported the mother during labour.19
Veena Jirapaet RN (2010) conducted a study on the benefits of social support in childbirth and strategies that a high level of social support is offered during labour and delivery in Thailand. Findings of the study stated that including a close female relative on the labour unit to support a woman during labour and delivery gave emotional support.20
Hala Bawadi (2009) conducted a study on Muslim women’s experiences of Childbirth among 8 others in London. The findings of the study, that 60% of women had positive experiences of child birth.21
Hatsume Taniguchi et al (2007) conducted the study on childbirth experiences of women in Hawaii among 45 mothers and the findings showed that 50% o mothers had emotional dysfunction during child birth. Multi para others experienced positive experiences than primipara mothers because of language barrier, distance from family and friends, different culture and health care attitude.22
Erica Schytt (2007) longitudinal cohort study was conducted, including 1,302 primiparous women recruited at their first booking visit, at 93 antenatal clinics in Sweden. Two questionnaires were posted and completed in the second trimester and 2 months after the birth. Women were divided into 5 age groups. The very young women, aged 15-20 years, had the most negative expectations of the upcoming birth. In contrast, the older women, aged 35-43 years, did not have negative feelings about the upcoming birth during pregnancy, and did not remember being afraid or experiencing more pain than the reference group, but experienced childbirth overall as more difficult.23
Savage JS (2006) conducted a study to understand the ways first-time mothers learn about birth among nine first-time expectant mothers’ experiences of knowing childbirth in New Orleans. These findings contribute to understanding how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict.24
LITERATURE RELATED TO SATISFACTION ON INTRANATAL NURSING CAREChalmers B, et al (2011) conducted a study to compare perceptions of maternity outcomes and experiences of those who received care from midwives with those who received care from other providers among 421 mothers in Canada. Findings of the study showed that the maternity experience was positive when the primary prenatal provider was a midwife.25
Morrison TE, et al (2011) conducted a study on relationship between prenatal control, expectations, experienced control and birth satisfaction among primiparous women among 31 primipara mothers in USA. Findings of the study showed that women who were cared for midwives had significantly higher experienced control and birth satisfaction than women whose care was provided by obstetricians, while incidence of caesarean birth did not affect either measure, high levels of control correlating with high satisfaction levels.26
Shafiei T al (2011) conducted a study on women’s views and experiences of maternity care among 40 women in Australia. Findings of study showed that women were more likely to rate their intrapartum care as very good (70%) compared with antenatal care (49%) and postnatal care (57%). Factors important in women’s satisfaction with maternity care were predominantly related to interactions with caregivers, their attitudes and behavior and receiving adequate information, explanations and support from staff.27
Naughton C, et al (2011) conducted a study on Mother’s level of satisfaction on midwives care during intranatal period among 140 mothers in Ireland. Finding of the study showed that 70% of mothers were highly satisfied with the care they received from midwives during labour progress.28
Goberna-tricas J, et al (2010) conducted a study on Satisfaction with pregnancy and birth services the quality of maternity care services as experienced by women among 250 mothers in Spain. Findings of study showed that majority of mothers 73.3% were satisfied with the nursing care received during intranatal period.29
Stahl K (2009) conducted a study on how women are satisfied with maternity care in German hospital among 373 mothers. Fifteen percent were satisfies with midwife/midwives caring for them during labour 25% of them are satisfied with welcoming the mothers for labour.30
Andy Dahl (2009) in the study explored the satisfaction of mothers in a major hospital to determine the extent to which mother satisfaction relates to the quality of intranatal nursing care among 300 mothers. The results showed that a direct and positive relationship exists between the satisfaction of mothers and the quality of intranatal nursing care in a major urban hospital.31
Allhusban MA et al (2009) conducted a study to assess the level of patients’ experiences of nursing care and identify important aspects that enhance such experiences and to assess the level of patients’ satisfaction with nursing care and identify important aspects that enhance satisfaction among 200 patients in Jordan. The findings of the study indicated that the level of satisfaction of Jordanian patients with nursing care was moderate and their experiences of nursing care were positive. Gynecological patients were ore satisfied than medical/surgical patients and patients in the semi-private hospitals were more satisfied than those in public hospitals.32
Susan J Harris (2008) conducted a study on single room maternity care and client satisfaction among 205 patients in the postpartum ward who either had a normal delivery or an emergency caesarian section in Jordan. The finding of the study showed that the nursing care offered during intrapartum was average but was poor during postpartum. Majority of the ratings for patients’ satisfaction during intrapartum (42.3%) were good implying that the patients were fairly satisfied; while a majority of the ratings during postpartum (37.6%) were poor implying that they were unsatisfied with the care.33
Hodnett ED et al (2005) conducted study on “Caregiver support for women during childbirth” among 5000 women in Canada. The continuous presence of a support person reduced the likelihood of medication for pain relief, operative vaginal delivery, caesarean delivery and a 5 minute Apgar scoreless than7. Continuous support was also associated with a slight reduction in the length of labour. Six trials evaluated the effects of support on mothers’ views of their childbirth experiences; while the trials used different measures (overall satisfaction, failure to cope well during labour, finding labour to be worse than expected and level of personal control during childbirth) in each trial the results favoured the group who had received continuous support.34
Madeleing T king et al (2004) study was conducted on client satisfaction with intranatal midwifery care among 250 mothers in Sweden. Women assessed the midwives’ interest and caring, education and information provided their own progress with delivery and baby care and their own physical and emotional health. They were also asked about their expectations of and gains from intranatal care. The findings indicated that women choosing domiciliary care and women choosing hospital care had different expectations of their intrapartum care, but were largely satisfied with the quality of the care they chose.35
STATEMENT OF THE PROBLEM“A STUDY TO ASSESSS THE CHILD BIRTH EXPERIENCES AND THE LEVEL OF SATISFACTION REGARDING NURSING CARE DURING LABOUR AMONG PRIMI PARA MOTHERS IN SELECTED PHC’S AT BANGALORE”
6.3 OBJECTIVES OF THE STUDY
6.3.1 To assess the child birth experiences among primi para mothers.
6.3.2 To assess the level of satisfaction on nursing care received among primi para mothers.
6.3.3 To find the relationship between child birth experiences and level of satisfaction on nursing care received among primi para mothers