RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters) Mrs. SAVITHA V FIRST !AR M Sc N"RSIN# NITT! "SHA INSTIT"T! $F N"RSIN# S%I!N%!S& 'AN!!R & (!RA)A*ATT!& MAN#A)$R!+ 1. Name of the Instit2tion ,-.1/0& *ARNATA*A& IN(IA NITT! "SHA INSTIT"T! $F N"RSIN# S%I!N%!S& %$))!#! $F N"RSIN# 'AN!!R& (!RA)A*ATT!& MAN#A)$R!+,-.1/0& *ARNATA*A& IN(IA 3. %o2rse of the st2d4 and s2b5ect FIRST !AR M Sc N"RSIN# $6ST!TRI%S AN( # NA!%$)$# N"RSIN# .. (ate of admission 1.th 7"N! 1008

,.

Title of the to i!" !FF!%T $F AM6")ATI$N ("RIN# FIRST STA#! $F )A6$R $N )A6$R 'AIN AN( $"T%$M! $F )A6$R AM$N# TH! 'RIMI#RAVI(A M$TH!RS IN A S!)!%T!( H$S'ITA)& MAN#A)$R!

/. BRIEF RESUME OF THE INTENDED #ORK

$%& Nee' fo( the )t*'+ Amb2lation d2rin9 labor is becomin9 more :o:2lar. ;alkin9 d2rin9 labor red2ces :atients< discomfort and im:ro=e o2tcomes. Altho29h it :ro=ides the birthin9 >oman >ith the freedom to >alk& mo=e abo2t& and ass2me the :ositions of her choice d2rin9 labor and birth (2nless restriction is s:ecificall4 re?2ired to correct a com:lication). Freedom of mo=ement in labor a::ears to facilitate the :ro9ress of labor and enhance childbirth satisfaction thro29h restrictin9 >omen<s mo=ement ma4 ha=e ad=erse effects. No e=idence of harm fo2nd for freedom to amb2late& mo=e abo2t& or chan9e :osition d2rin9 labor and birth >hen restriction is not re?2ired to correct a com:lication. Amb2lation& mo=ement& and chan9es of :osition d2rin9 the first sta9e of labor ma4 shorten labor. ;omen >ho amb2lated d2rin9 the first sta9e of labor >ere less likel4 to ha=e a s2r9ical deli=er4& defined as caesarean section. ;hen allo>ed the freedom to amb2late& mo=e& and chan9e :osition d2rin9 labor& most >omen choose to do so and find this to be an effecti=e form of :ain relief. ;omen >ho choose to amb2late d2rin9 first sta9e of labor had shorter first and second sta9es of labor& re?2ired less :ain relief medication& and had fe>er abnormal fetal heart rate :atterns1. ;omen >ho ass2med to be in a nons2:ine :osition d2rin9 first sta9e of labor had fe>er :erineal in52ries& less =2l=ar edema& and less blood loss. If the membranes are intact& the :atient is allo>ed to >alk abo2t. This attit2de :re=ents =enaca=al com:ression and enco2ra9es descent of the head. Amb2lation can red2ce the d2ration of labor& need for anal9esia and im:ro=es maternal comfort. The in=esti9ator thro29h her clinical e@:erience and obser=ations noted that& in most of the hos:itals >here mothers are admitted for labor the4 2se to be in bed e=en from the time of onset of :ain. And in fe> hos:itals the4 ma4 be :racticin9 this >itho2t kno>in9 its e@act benefit. Thro29h the literat2re re=ie> on freedom of mo=ement in labor a::ears to facilitate the :ro9ress of labor and enhance childbirth satisfaction. This a>areness made the researcher to :ro=ide the method of Amb2lation d2rin9 the first sta9e of labor on the Intensit4 $f )abor 'ain and the $2tcome of )abor amon9 the Intranatal mothers. $%, Re-ie. of lite(/t*(e A faster labor& fe>er instr2mental and o:erati=e deli=eries and better maternal and infant o2tcomes are some of the alla4ed ad=anta9es to ha=in9 :art2rient >alkin9

earl4 and often. Amb2lation d2rin9 first sta9e of labor decreases 1 ho2rs from the total d2ration of labor& decrease re?2ests in anal9esia& lo>er rates for instr2mental deli=eries& increased A:9ar score. 'atients re:orted 9reater satisfaction of entire laborin9 e@:erience >hen bein9 allo>ed to >alk& e=en if that amb2lation is of short d2ration (!@A >alkin9 across room to toilet).1 Freedom to >alk& freedom to mo=ement in labor a::ears to facilitate the :ro9ress of labor and enhance childbirth satisfaction. restrictin9 >omenBs mo=ement ma4 ha=e ad=erse effects. )ithotom4 :osition raises le=els of maternal stress hormones& thereb4 red2ces 2terine contractilit4 and labor :ro9ress. Amb2lation& mo=ement and chan9es of :osition d2rin9 the first sta9e of labor shortens the labor. ;omen >ho are amb2lated d2rin9 the first sta9e of labor >ere less likel4 to ha=e a s2r9ical deli=er4& defined as caesarean section& force:s or =acc2m e@traction. ;omen >ho ass2med a non+s:2:ine :osition for birth had shorter second sta9e of labor& re?2ired less :ain relief medication& had less :erineal in52ries& less =2l=ar edema and less blood loss and fe> abnormal fetal heart rate :atterns.1 Acti=el4 :romotin9 and enco2ra9in9 >omen to mobiliCe d2rin9 childbirth is a safe& effecti=e >a4 of :ro=idin9 o:tim2m care to health4 >omen& it is a cost+ effecti=e >a4 of red2cin9 com:lications. !=idences for mobiliCation im:ro=es fre?2enc4& stren9th and len9th of contractions& a red2ction in the 2se of o@4tocin to a29ment labor >ith an a=era9e& shorter labo2rs& im:ro=es o@49en s2::l4 to the bab4Dfe> abnormal heart :atterns. It im:ro=es ali9nment of :el=ic bones and the sha:e and ca:acit4 of :el=is& and o:timiCes a chance for the 9ood fit bet>een bab4 and :el=is.3 St2dies carried o2t on amb2lation& mobilit4 and :osition d2rin9 labor a9rees that mobilit4 d2rin9 labor im:ro=es both the >omenBs e@:erience and the o2tcome of labor ((eakin 1001& (o>ne et al 1001& Fl4nn et al 1E-8& Read et al 1E81). In their st2dies& Fl4nn et al (1E-8) and Read et al fo2nd the follo>in9 ad=anta9es on amb2lationA+ There is a more effecti=e 2terine action& shorter labor& less o@4tocin a29mentation& red2ced need for :harmacolo9ical anal9esia. It is also doc2mented that rec2mbent :ositions res2lts in s2:ine h4:otension& diminished 2terine acti=it4 and a red2ction in the dimensions of the :el=ic o2tlet (;alsh 1000)F (e 7on9 et al(1EE-) states that >omen >ho take 2: an erect :osition d2rin9 labor e@:erience

less :ain& ha=e si9nificantl4 less :erinial in52ir4 and ha=e fe>er e:isiotomies.. Amb2lation (>alkin9) abo2t d2rin9 labor refle@l4 intensifies the 2terine contractions. It has been sho>n that in amb2lant :atients the d2ration is shorter& the need for anal9esia is less& and the incidence of abnormalities of the fetal heart lo>er than in rec2mbent >omen. The :atient sho2ld be free to >alk abo2t and rest in an4 :osition that is comfortable to her. She is enco2ra9ed not to lie strai9ht on her back as it ma4 ca2se =enaca=al com:ression., If the membranes are intact& the :atient is allo>ed to >alk abo2t. This attit2de :re=ents =enaca=al com:ression and enco2ra9es descent of the head. Amb2lation can red2ce the d2ration of labor& need of anal9esia and im:ro=es maternal comfort. If ho>e=er& labor is monitored electronicall4 or anal9esic dr29 (e:id2ral anal9esia) 9i=en& she sho2ld be in bed. / $%0 PROBLEM STATEMENT !FF!%T $F AM6")ATI$N ("RIN# FIRST STA#! $F )A6$R $N )A6$R 'AIN AN( $"T%$M! $F )A6$R AM$N# TH! 'RIMI#RAVI(A M$TH!RS IN A S!)!%T!( H$S'ITA)& MAN#A)$R! $%1 O23e!ti-e) of the )t*'+ To com:are the effecti=eness of Amb2lation on the Intensit4 $f 'ain amon9 the control and e@:erimental 9ro2: To com:are the effecti=eness of Amb2lation on the $2tcome $f )abor amon9 the control and e@:erimental 9ro2: in terms ofA i. ii. Maternal o2tcome and Neonatal o2tcome

To assess the 2sef2lness of Amb2lation b4 $:inionnaire To find an association on the effecti=eness of Amb2lation on the Intensit4 of 'ain and $2tcome of )abor >ith selected demo9ra:hic =ariables $%4 O e(/tio5/l 'efi5itio5) Effe!t" In this st2d4& the effect refers to the e@tent to >hich the Amb2lation has its im:act on the abilit4 of )abor 'ain tolerance& Shortenin9 the (2ration of )abor and on the $2tcome of labor amon9 the :rimi9ra=ida mothers in first sta9e of labor as meas2red b4 Vis2al analo92e Scale& $:inionnaire and $bser=ational %hecklist.

A62*l/tio5" In this st2d4& Amb2lation refers to >alkin9 abo2t or the act of tra=ellin9 b4 foot. Mother >ill be amb2lated >hen there >ill be no :o>erf2l 2terine contractions d2rin9 the first sta9e of labor and till the r2:t2re of membrane Fi()t )t/7e of l/2o(" First sta9e of labor is considered to last from re92lar 2terine contractions to f2ll dilatation of cer=i@. In this st2d4& First sta9e of labor refers to acti=e :hase >here the cer=i@ is 3cms to -cms dilated or till the r2:t2re of membranes L/2o( /i5" In this st2d4& )abor :ain means a discomfort arisin9 from labor :rocess and >hich is inter:reted as 0+3 mild :ain& .+/ moderate :ain and -+10 se=ere :ain. 'ain intensit4 >ill be meas2red b4 2sin9 Vis2al Analo92e Scale O*t!o6e of l/2o(" In this st2d4& $2tcome of )abor refers to maternal and neonatal o2tcome in terms of (2ration of )abor& Mode of (eli=er4& Neonatal A:9arBs score. P(i6i7(/-i' .o6e5" 'rimi9ra=id >omen refers to >omen >ho are :re9nant for the first time and >ho are in 3/>eeks to .0>eeks of 9estation >ith no com:lications of labor s2ch as hi9h risk :re9nanc4& hi9h risk intranatal mothers& mothers >ith electi=e caesarean section. O i5io55/i(e" In this st2d4& $:inionnaire refers to the o:inions of 'rimi9ra=id >omen re9ardin9 the benefits of Amb2lation on )abor :ain and $2tcome of )abor $%$ A))*6 tio5) This st2d4 ass2mes that& a. The Intensit4 of )abor 'ain& $2tcome of )abor e@:eriences =aries from >omen to >omen b. Amb2lation hel:s the e@:ectant mother to co:e >ith )abor 'ain and Shortenin9 the d2ration of labor c. Mother de=elo:s a :ositi=e attit2de to>ards Amb2lation $%8 Deli6it/tio5 The st2d4 is limited to 'rimi9ra=ida mothers& ;ho are in 3/>eeks to .0>eeks of 9estation in First sta9e of labor ;ho are >illin9 to :artici:ate in Amb2lation 'rimi9ra=ida mothers Mothers >ith o@4tocin inf2sion ;ho are not >ith risk of :re9nanc4

$%9 P(o3e!te' o*t!o6e :H+ othe)i); To achie=e the stated ob5ecti=e follo>in9 h4:othesis has been de=elo:ed >ill be tested at ,G le=el of si9nificance H&" There >ill be a si9nificant difference in the Intensit4 of )abor :ain bet>een the control 9ro2: and e@:erimental 9ro2: H," There >ill be a si9nificant difference in the $2tcome labor bet>een control 9ro2: and e@:erimental 9ro2:

8%

H0" There >ill be a :ositi=e si9nificant association bet>een Amb2lation and $:inionnaire in the e@:erimental 9ro2:

MATERIAL AND METHOD

8%& SOURCE OF DATA 'rimi9ra=ida mothers >ho are in the first sta9e (acti=e :hase ) of labor 8%&%& Re)e/(!h 'e)i75 1 9ro2: e@:erimental desi9n >hich consists of control and e@:erimental 9ro2: 8%&%, Setti57 This st2d4 >ill be cond2cted in a selected hos:ital& Man9alore 8%&%0 Po *l/tio5 The st2d4 :o:2lation consists of 'rimi9ra=ida mothers bet>een 3/+.0>eeks of 9estational a9e in the acti=e First sta9e of labor 8%, METHOD OF DATA COLLECTION 8%,%& S/6 li57 (o!e'*(e For this st2d4 s4stemic randomiCation sam:lin9 is considered as a::ro:riate 8%,%, S/6 li57 )i<e St2d4 sam:le consists of .0 'rimi9ra=ida mothers bet>een 3/+.0>eeks of 9estational a9e in >hich 10 in each control and e@:erimental 9ro2: in the First sta9e (acti=e :hase) of labor 8%,%0 I5!l*)i-e C(ite(i/ The incl2sion criteria for sam:lin9 areA i. ii. iii. Normal 'rimi9ra=ida mothers in the acti=e First sta9e of labor Mothers >ho are >illin9 to :artici:ate and e@:ectin9 normal labor 'rimi mothers admitted in the hos:ital >itho2t r2:t2re of membrane.

i=. =. i. ii. iii. i=. =. i. ii. iii. i=.

'rimi mothers bet>een 3/+.0>eeks of 9estational a9e >ith li=e fet2s Mothers >ith o@4tocin inf2sion Mothers >ho are not >illin9 to :artici:ate Hi9h risk intranatal mothers M2lti9ra=ida mothers Mothers >ith electi=e caesarean section Mothers >ith :remat2re r2:t2re of membrane (emo9ra:hic :roforma Str2ct2red $bser=ational %hecklist for meas2rin9 indi=id2al e@:eriences on the o2tcome of labor Str2ct2red $bser=ational %hecklist for meas2rin9 the intensit4 of labor :ain b4 2sin9 Vis2al Analo92e Scale Str2ct2red $:inionnaire on the 2sef2lness of amb2lation

8%,%4 E=!l*)i-e !(ite(i/

8%,%4 I5)t(*6e5t *)e'

8%,%$ D/t/ !olle!tio5 6etho' To cond2ct the st2d4 a formal >ritten :ermission need to be obtained from the concerned a2thorit4. Indi=id2al informed consent >ill be taken from the s2b5ect after e@:lainin9 ob5ecti=es& :2r:ose and method of data collection :rior to the st2d4. '2r:osi=e sam:lin9 method >ill be 2sed to select .0 'rimi9ra=ida mothers for the st2d4. S4stematic random sam:lin9 >ill be 2sed to select 10 s2b5ects in both e@:erimental and control 9ro2:. The str2ct2red inter=ie> sched2le for demo9ra:hic data& for meas2rin9 the indi=id2al differences is 2sed. The mothers >ill be Amb2lated >hen there >ill be no :o>erf2l 2terine contractions d2rin9 the First sta9e of labor before the r2:t2re of membrane amon9 the e@:erimental 9ro2:. The time and the distance of amb2lation >ill be taken. The str2ct2red Vis2al Analo92e Scale is 2sed to meas2re the Intensit4 of 'ain. The str2ct2red $bser=ational %hecklist is 2sed to meas2re the $2tcome of )abor to com:are bet>een the control and e@:erimental 9ro2:. The str2ct2red $:inionnaire is 2sed to meas2re the 2sef2lness of Amb2lation amon9 the e@:erimental 9ro2:. At the end data collection res:ondent >ill be thanked for co+o:eration.

8%,%8 D/t/ /5/l+)i) l/5

7

The data >ill be anal4sed in terms of ob5ecti=es 2sin9 both descri:ti=e and inferential statistics >hich >ill be as follo>s i. ii. iii. To com:are the effecti=eness of Amb2lation on the Intensit4 of )abor 'ain amon9 e@:erimental and control 9ro2: Inde:endent Sam:le HtI tset is 2sed To com:are the effecti=eness of Amb2lation on the $2tcome of )abor amon9 e@:erimental and control 9ro2: Inde:endent Sam:le HtI test is 2sed The data of $:inionnaire on 2sef2lness of Amb2lation is anal4sed b4 descri:ti=e statistics (fre?2enc4& :ercenta9e dia9rams) 8%0 Doe) the )t*'+ (e>*i(e /5+ i5-e)ti7/tio5 o( i5te(-e5tio5 to 2e !o5'*!te' o5 /tie5t) o( othe( h*6/5) o( /5i6/l)? If )o le/)e 'e)!(i2e 2(iefl+ es& this st2d4 re?2ires the inter=ention of Amb2lation d2rin9 the First sta9e of )abor on the Intensit4 of )abor 'ain& $2tcome of )abor and to assess the 2sef2llness of Amb2lation thro29h $:innionaire to conform >hether it can be ado:ted or not amon9 the 'rimi9ra=ida mothers. 8%1 H/) the ethi!/l !le/(/5!e 2ee5 o2t/i5e' f(o6 +o*( i5)tit*tio5 i5 !/)e of 8%0 es& the ethical clearance has obtained. 8%4 Refe(e5!e) O5li5e )o*(!e) 1. A=oidin9 common Anal9esia errors. A=ailable from A"R) htt:ADDbooks.9oo9le.co.inDbooksJidK!HmlL/ie3M!%N:9K'OlaborNso2rce P 1. 'ro=ides the 6irthin9 ;oman ;ith Freedom of Mo=ement to ;alk& Mo=e& Ass2me 'ositions of Her %hoice A=ailable from A"R) htt:ADD>>>.:2bmedcentral.nih.9o=Darticlerender.fc9iJartidK1.0E11, Te=t 2oo@) 3. %ha:man Vick4& The mid>ifes labor and birth handbook& first :2blished 1003& first Indian re:rint 100.& 6lack>ell :2blisher&:a9e noA 1,&1-&18 .. Fraser.M.(aine& %oo:er.A.Mar9aret& M4les te@tbook of mid=i>es. 1.th edition 1003F %hirchill )i=in9stone :2blisher& :a9e noA.-1 ,. (aftar4 N Shirish& %hakra=arthi s2di:& Man2al of $bstetrics& 1nd editionF !lse=ier :2blisher& :2blished in 1003& :a9e noA 1E0 /. (2tta ( %& Te@t book of $bstetrics& /th editionF %entral :2blisher& :a9e noA13,

Si9nat2re of %andidate 8
8

Remarks of the 92ide E

1 0

Name and (esi9nation of (in block letters) 10.1 #2ide

'R$F. SA6ITHA NA A* H$( $F $6ST!TRI%S AN( # NA!%$)$# N"RSIN# N"INS& 'AN!!R& (!RA)A*ATT!& MAN#A)$R!

10.1 Si9nat2re 10.3 %o+#2ide (if an4) MRS SH N!! 'A") ASS$%IAT! 'R$F!SS$R (!'T $F $6ST!TRI%S AN( # NA!%$)$# N"RSIN# N"INS& 'AN!!R& (!RA)A*ATT!& MAN#A)$R!

10.. Si9nat2re 1 1 11.1 Head of (e:artment 'R$F. SA6ITHA NA A* H$( $F $6ST!TRI%S AN( # NA!%$)$# N"RSIN# N"INS& 'AN!!R& (!RA)A*ATT!& MAN#A)$R!

11.1 Si9nat2re

1 1

11.1 Remarks of the %hairman and 'rinci:al

11.1 Si9nat2re