https://doi.org/10.33698/NRF0283-Kavita Devi, V. Venkadalakshmi, Avinash Kaur Rana, Vanita Suri
ABSTRACT:
Background: Labour is the most exciting and most painful situation for the women. A woman may feel happy and sad at the same time. Happy feeling are due to the delivery of baby and sadness due to pain and prolong labour process. The purpose of this study was to assess the level of anxiety, intensity of labour pain and duration of rst stage of labour among primigravida mothers. Objective: To assess the level of anxiety, intensity of labour pain and duration of rst stage of labour among primigravida mothers. Methodology: Study was conducted in CLR, Nehru Hospital PGIMER Chandigarh, from 18th July to 8th September. Thirty-nine primigravida mothers were selected by total enumeration sampling technique. Researcher introduced herself to mothers and explained about the research project. The primigravida mothers was assessed for the level of anxiety intensity of labour pain and duration of rst stage of labour by using interview schedule comprised of socio demographic prole, STAI Scale, numeric pain scale and WHO portogram. First assessment of labour pain was done at 3-4 cm. dilatation of cervix, second assessment done after 2 hours of rst observation and third assessment was done after 2 hours of second observation in the subjects. Duration of active phase of rst stage of labour was assessed by partograph from 3- 4 cm. to full dilatation of cervix. Results: Result showed that there was high level of anxiety. Intensity of labour pain in the study subject ranged from moderate (61.5%) to severe (33.3%). Average duration of active phase of rst stage of labour is 6 hours in primigravida mothers, study results showed 51.3% mothers had duration of labour 3-6 hours and 43.6% mothers had > 6 hours of duration of active phase of rst stage of labour. Conclusion: Study concluded that high level of anxiety of primigravida mothers may increase the intensity of pain and also may increased the duration of labour. So nurses and other health personnel should give psychological support and explained the labour process to the primigravida mothers either before onset of labour or during antenatal period.
Keywords: Primigravida mother, Anxiety, Labour pain.
Address for correspondence
Ms Venkadalakshmi Lecturer,
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
Pregnancy and Childbirth is the special events for the mother and the family. Childbirth involves labor process and delivery of the baby. Labor is the series of events that take place in the genital organs in efforts to expel the viable fetus out of the womb through the vagina into external world. 1 Labor pain is unpleasant and distressing situation for the mother during the process of labor. It is a subjective and personal experience. There are many factors inuencing the labor pain such as coping ability, sensitivity, past experience of pain, birth environment, psychological factors, etc. Labor pain is the most severe kind pain woman can experience admitted at CLR, Nehru Hospital, PGIMER, Chandigarh.
Methods and material
This is descriptive study done at Clean Labor Room (CLR), Nehru Hospital, PGIMER, Chandigarh. Accessible population was primigravida mother admitted in CLR, with 37 to 40 weeks of period of gestation. Total enumeration sampling technique was used to draw the sample from primigravida mother admitted throughout her life. Severity and duration of in CLR from 18th July to 8th September labor pain psychologically affect, a mother may lower the condence, self-esteem and increase the level of anxiety.1
Anxiety is one of the factors that come with the labor pain or any other types of pain. It can occur with or without any cause. Mild anxiety is considered as normal but excessive anxiety and fear during labor increases catecholamine secretion, resulting in the mother to feel more pelvic Sample size was 39 primigravida mother. In the Process of data collection, Prior permission was obtained from the Department of Obstetrics and Gynecology, PGIMER and on duty doctors were also informed. Ethical clearance was taken from Institute Ethics Committee of PGIMER, Chandigarh. Investigator introduced herself to the participants and the objectives of the study were explained and written pain.2 A result of a survey of several informed consent was taken from the investigations which included both primiparas and multiparas; shows that the incidence of intolerable pain ranged from35% to 58% during labor. Another result found that 77% of primipara reported severe or intolerable pain during primigravida mothers.
Tool used for study was interview schedule comprised of
a) Identication data
b) Socio demographic prole
c) Clinical prole
d) State and Trait Anxiety Intensity Scale (STAI)
e) Numeric Pain Scale
f) childbirth.3 The need was felt to assess
WHO portogram, Data collection was anxiety, intensity of pain and duration of active phase of labour so that some complementary therapies can be practiced in reducing it.
Objectives:
To assess the level of anxiety, intensity of labor pain, and duration of rst stage of labour among primigravida mothersn divided into two phases i.e. Identication phase and assessment phase. The anxiety was classied on the basis of State and Trait Anxiety Intensity Scale (STAI) as mild (20- 40 score), moderate (41-60 score) and severe (61-80 score). In Numeric Pain Scale the pain the paricipants were asked about pain in the scale of zero to 10 where zero is considered as was no pain and 10 was considered as worst kind of pain. It was classied as no pain (0 score), mild pain (1- 3 score), moderate pain (4-6 score), severe pain (7-10 score). In identication phase identication of the primigravida mothers with gestational age of 37 to 40 weeks were identied during their admission at CLR. They were interviewed and their Sociodemographic and Clinical Prole Performa was lled by the investigator. In years. All the participants were educated, and 43.6% participants were educated up to post graduation level. Most of participants (79%) were housewives and 82.1% were Hindus. Two third of participants (66.7%) were from rural background and 61.5% were from joint families. Per capita income of 41% participant was between Rs. 5,001- 10,000.
Table 1: Socio demographic profile of the
Phase II: Assessment; In this phase, follow up by investigator was done to assess the level of anxiety, intensity of labour pain and duration of active phase of rst stage of labour.
|
The investigator assessed the following parameters: A: Assessment of Anxiety: anxiety was assessed by interviewing them by using STAI. B: Assessment of Pain: It was assessed using the Numeric Pain Scale after every 2 hours during active phase of rst stage of labour three observations were made; 1 s t observation done at 3-4 cm dilatation of cervix, 2nd observation done after 2 hours of
study subjects
| Variables | Subjects (n=39)
n(%) |
|
| Age (in years) ♯
20-25 26-30 >30 |
12 (30.8)
21 (53.8) 06 (15.4) |
|
| Religion
Hindu |
32 (82.1) | |
| Sikh Othersa | 07 (17.9)
– |
|
| Education | 01 (02.6)
09 (23.1) 12 (30.8) 17 (43.6) |
|
| Secondary | ||
| Higher secondary | ||
| Graduate | ||
| Post graduate and above | ||
| Occupation
Housewife |
31 (79.9) | |
| 01 (02.6) | ||
| Government service | ||
| Private service | 07 (17.9) | |
| Percapita income (in Rupees)$ | ||
| <5,000 | 11 (28.2) | |
| 5,001-10,000 | 16 (41.0) | |
| >10,000 | 12 (30.8) | |
| Family type
Nuclear Joint |
15 (38.5)
24 (61.5 ) |
|
| Residence
Rural Urban |
13 (33.3)
26 (66.7) |
aMuslims and Christian, Age in years (Mean ± SD) = 26.51 ±3.3, Range (20-36 )
$Percapita income in rupees (Mean ± SD) = 14857.92 ±25458.9, Range (1,000 –20,0000 )
N=39
1st observation and 3rd after 2 hours of 2nd observation done observation. C:
Assessment of Duration of rst stage of labor: Duration of rst stage of labour was assessed using the WHO partograph in primigravida mothers from 3-4 cm to full dilatation of cervix. Data was entered in SPSS and analyzed by using descriptive and inferential statistics.
Results
Table 1 depicts the Socio demographic prole of the study participants. This table shows that more than half (53.8%) of the women were in the age group of 26-30 a Muslims and Christian, Age in years (Mean ± SD) = 26.51 ±3.3, Range (20-36 ) $Percapita income in rupees (Mean ± SD) = 14857.92 ±25458.9, Range (1,000 –20,0000 )
Table 2 shows the level of anxiety on the basis of State and Trait Anxiety Inventory. Majority of the primi mothers reported moderate anxiety (84.9%) and half of them (51.3%) showed mild trait of anxiety.
Table 2: Anxiety level of the subjects using STAI (State and Trait Anxiety
Inventory)
N=39
|
Figure 1: Intensity of labour pain during 1st observation
Intensity of labour Pain of the subjects using Numeric Pain Rating Scale
Assessment of pain done by rating the *numbers from “0” to “10”. No pain (0 score), mild pain (1-3 score), moderate pain (4-6 score), severe pain (7-10 score). Higher score indicated greater pain intensity. Figure 1 revealed that majority (61.5%) of the mothers felt moderate pain and 33.3% experienced severe pain during rst observation i.e. at 4 cm. of dilatation. Figure 2 shows that 89.7% mothers were felt severe pain during 2nd observation i.e. after 2 hours of rst observation. Figure 3 depicts that all mothers (100%) reported severe type of labour pain i.e. after 2 hours of 3rd observation.
Duration of active phase of rst stage of labour in the primigravida mothers N=39 Figure 4 shows the duration (<3, 3-6 and >6 hours) of active phase of rst stage of labour in the primi mothers. Half of the mothers (51.3%) had duration of active phase of rst stage of labour between 3-6 hours. The of active phase of rst stage of labour ranged from 1-7 hours with mean ± SD duration was 4.36 ± 1.85 hours.
DISCUSSION
Most of the mother feel excitement as incidence of intolerable pain ranged from35% to 58% during labour. Another result found that 77% of primipara reported severe or intolerable pain during childbirth.3 The present study is descriptive type of study done on primigravida mothers with 37 to 40 weeks of gestation. It showed that most (82.1%) of the subjects expressed moderate level of anxiety.
A study was supported by the study of Nisha Walia conducted in 2013 to assess the level of anxiety during labour process in primigravida mothers. Results showed that the the majority of the primigravida (79%) had moderate level of anxiety, 14% of primigravida had mild level of anxiety and 7% of them expressed severe type of anxiety.4 In the present study during rst observation of labour pain more than half of the primi gravida mother expressed moderate pain, during 2nd observation more than 2/3rd mother expressed severe pain and well as fearful feeling during labour. They during 3 r d observation all mothers are having happy and sad feeling at same time, fear and anxiety may have effect on the intensity of labour pain and length of duration of active phase of rst stage of labour. Anxiety is one of the factors that come with the labour pain or any other types of pain. It can occur with or without any cause. Mild anxiety is considered as normal but excessive anxiety and fear during labour increases catecholamine secretion, resulting in the mother to feel more pelvic pain.2
A result of a survey of several investigations which included both primiparas and multiparas; shows that the expressed severe pain. so labour pain is the most severe pain which is experience by women in their life. A qualitative study supported the ndings was done by Nastaran Mohammad Ali Beigi, et al in 2010. This study was done by the interview with 14 help seekers who were hospitalized in the postpartum wards of Isfahan hospitals. Among all of the participants, 9 of them had their rst delivery, 4 and one had their second and fth delivery, respectively and all of them were aged between 18-35 years.5
Nature of labor pain is consisted of two sub-concepts of “severity and type of the pain” and “feelings accompanied with labor pain”. Help seekers’ experience of severity and type of the pain was described as, “delivery pain is really hard to endure, it is not similar to other pains … the most severe pain that I’ve ever tolerated was labor pain”, told by one of the participants.
And also “its pain is unbearable and indescribable” was said by another participant. To describe the type and location of the pain another participant said, “I had pain during my menstruation; its pain was like that but 10 times more.”5
The median duration of active phase of rst stage of labour in present study was 3-6 hours. One of the study supported the present study which was done by Edgardo Abalos et al in 2018. Their study result showed the median duration of active rst stage (when the starting reference point was 4 cm) ranged from 3.7–5.9 hours (95th percentiles: 14.5–16.7 hours). With active phase starting from 5 cm, the median duration was from 3.8–4.3 hours (95th percentiles: 11.3–12.7 hours).6
Conclusion: Labour is very sensitive phase of a women, and fear and anxiety may be high in primi mothers during process of labour, and it affects the duration of labour and intensity of pain perception during labour.
Recommendation: Further research is needed to assess the effectiveness of non- pharmacological intervention on the level of anxiety, intensity of pain and duration of active phase of rst and second stage of labour.
References:
- Dutta DC. Textbook of Obstetrics.7th edition. Delhi: New Central Book Agency (P) ltd; 2008. Pg. 113,117-118.
- Maternal anxiety and obstetrics. Journal of Psychosomatic Research. [online] 1979. [cited 2 February 2018]; 29(23): 109. Available from https://www.ncbi.nlm.nih.gov/pubmed/3 14979
- Laesser JP, Bonika JJ. Bonica management: 3rd Steph [cited 2 February 2018] Available from am- edicine.com/tag/bonicas_management_of _pain_3rd_edition_pdf_free_download
- Walia Ramanadin PV. Kiran. Asian Journal of Nursing Education and Research. To assess the level of anxiety during labour in primigravida mothers. [online] 2013. [cited 18 July 2018]; 4(3): 273-275. Available from https://www.ajner.com.
- Ali Beigi N.M. Broumandfar K. Bahadoran and Ali Abedi H. Women’s experience of pain during childbirth. Iran J Nurs Midwifery Res. [online] 2010. [cited 19 June 2018]; 15(2): 77-82. Available from https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC3093177/.
- Abalos E, Olufemi T, Chamillard OM, Díaz V, Pasquale J, Bonet M, Souza J, et al. Duration of spontaneous labour in ‘low-risk’ women with ‘normal’ perinatal outcomes: A systematic European Journal of Obstetrics and Gynaecology and Reproductive Biology. [online] 2018. [cited 19 June 2018]; volume 223 123-132. Available from https://www.ejog.org/article/S0301- 2115(18)30082-4/fulltext.