A STUDY TO ASSESS KNOWLEDGE AND

ATTITUDE OF STAFF NURSES REGARDING

WATER BIRTH WITH AN VIEW TO DEVELOP
INFORMATION BOOKLET AT SELECTED
HOSPITALS AT BIDAR

PROFORMA FOR REGISTRATION OF STUDENTS FOR

DISSERTATION

SHOBA RANI S. CHINCHOLI

M.Sc. Nursing First Year
Obstetrics And Gynaecological Nursing
Year 2010-11 (MID-STREAM)

VASANATHA COLLEGE OF NURSING

Naubad, BIDAR

RAJIV GANDI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF STUDENTS FOR

DISSERTATION

1.

Name of the Candidate & Address

SHOBA RANI S.
1st Year M.Sc.
Vasantha College of nursing,
Naubad Bidar.

2.

Name of the institution

Vasantha College of nursing,

Naubad Bidar.

3.

Course of study

M.Sc. in Nursing ( 1St Year)

Obstetrics And Gynaecological
Nursing

4.

Date of admission to the course

batch 2010-2011.

15.10.2010
2010-11 (MID STREAM)

5.
TITLE OF THE TOPIC
A STUDY TO ASSESS KNOWLEDGE AND ATTITUDE OF STAFF
NURSES REGARDING WATER BIRTH WITH AN VIEW TO
DEVELOP INFORMATION BOOKLET AT SELECTED HOSPITALS
AT BIDAR

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION
Child birth is always challenging. It is not a small thing to bring a new soul into the
world and not a small thing to suffer so that another may have life. But birth is not meant to
be unbearable. We are not meant to suffer so completely that the experience leaves us felling
less of a woman. Instead of more. Natural birth has always allowed for a woman to keep her
power and her strength for the birth. Water birth allows much more. It allows less pain and
less suffering and nurtures ones belief in oneself. Child birth is believed to be a strenuous
experience for the baby. Properly heated water is claimed by proponents to help ease the
transition from the birth canal to the outside world because the warm liquid is thought to
resemble the intrauterine environment. Water birth in India is emerging as a promising
alternative to painful traditional delivery methods. Its relatively painless, needs minimal
intervention and is an ideal medium to bring a child into the world.
Water is soothing and relaxing.

When the waters rose

In the darkness
In the wake of the endless flood
It flowed into our memory
It flowed into our blood.
When something broke the surface
Just to see the starry dome

We still feel that relation, when the water takes us home.

Water birth is a method of giving birth which involves immersion in warm water,
proponents believe that this method is safe and provides many benefits for both mother and
infant, including pain relief and a less traumatic birth experience for the baby. However,
critics argue that the procedure introduces unnecessary risks to the infant such as infection
and water inhalation.
Water birth is a leading alternative to the conventional bed delivery practiced by most
US hospitals. There are many reasons why the women choose home birth by water. Many
women consider conception, pregnancy and labor to be very personal and natural processes
that do not need intervention from medical monitoring or analgesics, women can feel

alienated at a hospital by the lack of personal attention or by other birthing mothers in their
ward. Many women find it distracting to be in a new place, with bright florescent lights and a
stream of unfamiliar faces. Any of these anxieties could raise the stress level in mother and in
turn greatly increase the perception of pain. Birthing pools can be rented or bought for your
home or used in hospitals for assisted care. They are usually heated. It is the heat of the pool
that contains most of the claimed effects of relaxation and calming. These pools can either be
still or jet powered like a spa.
Water birth first came to the united states through couples giving birth at home but
soon was introduced into the medical environment of hospitals and free standing birth centers
by midwives and obstetricians.
It is the safety of this procedure that is under speculation. Personal testimonials
supporting this method are most often found on website trying to sell birthing pools and
therefore should be validated. Whatever style you choose to deliver your baby, just remember
the choice is yours dont be bullied by well meaning friends and distant family. Research the
situation and come to a decision that suits you and your immediate family.
Learn all about this wonderful new innovation that enables gentle, joyous,
empowering. Child birth the pioneering study is dedicated to the belief that every mother has
the right to have the birth experience she wants & to educate expectant parents & birth care
professional about the extra ordinary value of water labour & water birth to everyone
concerned read on & learn how you can give yourself your mate & your baby the wonderful
gift of gentle, joyous water birth your worth it.

NEED FOR STUDY

How beautiful everyone interested in supporting the optimal health of mothers &
babies needs to see this uplifting & transformational method of delivery
The birth of your baby is one of the most important events of your entire life. It will
have for reaching consequences that effects your most intimate family relationships for many
years to come .water birth is a gift that lasts a life time it can optimize your birth & create
your own personal miracle of love and empowerment safe,gentle,joyous water birth is
available to you now what could be more important.

Water birth is not a new concept; women throughout history have given birth in water,
with the advent of modern medicine the practice become less common.
In recent years, water birth is experiencing a revival as more women choose this
method for giving birth. There are many benefits to giving birth in the water.
THE BENEFINTS OF WATER FOR LABOUR AND OR BIRTH
Greater comfort and mobility. The mother has much greater ease and freedom to more
spontaneously and to change position to assist the descent of the baby.
Reduction of pressure on the abdomen. Buoyancy promotes more efficient uterine
contractions and better blood circulation, resulting in better oxygenation of the uterine
muscles, less pain for the mother, and more oxygen for the baby.
Helps mother to conserve her energy. Immersion reduces opposition to gravity;
supports the mothers weight so that her energy can be used to cope with the contractions.
Promotes deeper relaxation. As a woman relaxes deeply in water, her hormones kick
in and she starts progressing faster and with more rhythm; labor becomes more efficient.
Water relaxes the pelvic floor muscles.
Water minimizes pain so effectively that for most women other pain control methods
are no longer needed.
Water stimulates the touch and temperature nerve fibers in the skin. It blocks impulses
from the pain fibers, known as the Gate Theory of Pain.
Immersion is often more effective and safer than an epidural. Some people call water
birth an aquadural.
Facilitates a dysfunctional labor. Water can be an effective way to stimulate dilation of
the cervix when the mother has difficulty progressing into the active stage of labor.
Water can reduce the need for drugs to artificially stimulate labor. Often, simply
getting into the tub will result in dramatic and rapid progress to full dilation within an hour or
two.

Lowering of blood pressure. When anxiety is causing high blood pressure, immersion
in water often helps lower it.
Change of consciousness. Immersion helps relieve anxiety and promotes relaxation.
Water helps a woman to let go and focus inward as labor strengthens.
Easier breathing. Moisture in the air makes it easier to breathe and can be helpful to
women with asthma.
Facilitates the second stage of labor. Many mothers are less inhibited in the water. The
warm water softens the vagina, vulva, and perineum, leading a fewer injuries to these tissues.
Many women experience rapid second stages, with the baby emerging minutes after
the body starts pushing, also known as the fetus ejection reflex.
Empowerment of the mother. When a woman delivers her baby while remaining
awake, aware and in control, it greatly enhances the birth experience for her and becomes a
source of great personal strength and power that enriches her life forever.
Greater involvement of the father. Because the mothers pain and stress is so greatly
reduced, it is much easier for fathers to participate and take a more active role in the birthing
process. Many men are reluctant to become involved in the birth experience when they know
that the mother is likely to endure intense pain, trauma and suffering during labor and
delivery.
Enhanced family relationships. When the mothers pain is dramatically reduced, many
fathers eagerly take a more active role in the delivery, resulting in a greater family bond.
When fathers are more involved it increases the possibility of a joyous birth. Both parents and
child get to share a wonderous experience that can enhance their relationships with each other
for the rest of their lives.

Better parent-child interactions. A mother who has had a beautiful and empowering
birth experience will have an especially positive association in her mind and emotions to that
child; and a baby who has had an easy, non-traumatic, not painful, gentle birth will have an
especially positive association to the parent. This exceptionally positive start to their
relationship will likely enhance the parent-child interactions forever.

Water birthing is without a doubt rising in popularity to one of the most popular world
wide alternatives to traditional practices. Although there are records of water births dating
back to the early 19th century, there is still a surprising lack of conclusive data on the safety of
the procedure. One of the main reasons for this lack of information is the inherent danger of
childbirth scientists have to ask themselves, is it truly ethical to perform controlled trials of
water birthing versus bed births? Nevertheless there is still informative scientific information
available that supports water birthing ability to release the nerves, clam and sooth the mother,
possibly shorten labor time and reduces episitomies. For many women especially first time
mothers who may be a little anxious about the birth experience a hospital water birth could be
the perfect solution. There are now a number of Australian hospitals that support water births.
This is great news for all those mums to be who would love a natural birth, have heard
about the pain relief of water births, want to be guided by an expert midlife , but need the
assurance of medical assistance incase there is a birth emergency. Keep in mind that hospital
water birth is becoming more commonplace, so even if your local hospital, does not appear in
the list below give them a call to see if they have recently added water birth to their services
or are planning to do as in time for your babys birth. Water birth is a subject that can polarize
opinions around many mothers in Australia; it has its heroes and critics. But having the right
information will help you to make an informed decision.
The number of people inquiring about water birth has steadily grown. The only
facility in the capital to undertake such births the phoenix hospital has reported nearly 45
women opting for water birth ever since it was introduced about two years ago of these 30
women have delivered babies by this method on an average, we handle two water births
every month since the last two years we are the only centre in Delhi doing this procedures.
The water birth thus finally made its foray into India. This form of delivering a baby
is very safe and results in less labor pain. During a water birth, a mother gives birth to her
child in a pool or tub full of water, parents who are considering this option need not worry
there is no chance of the babys death due to asphyxiation or drowning.

Violet, a baby born to a British couple in Delhi on Saturday April 28, at 6:45 am, is
the first baby to be born in india through this method. Dr. Urvashi Sehgal, who facilitated the
delivery, said a water birth improves the chances of a normal delivery without the use of any
painkillers or drugs, which may be required in the conventional method. According to her

Water helps or provide relief from pain, and offers great benefits to the women in labor.
Take this opportunity to make the very best of yours delivery. The information available here,
along with the materials. The Single best source of information on water birth that
experienced both inspirational and educational done with objectivity and sensitivity. It held
my attention like a magnet. A must for all parents and health professional interested in
explaining optional methods of birthing.
A descriptive study was conducted on comparison of water birth & traditional
delivery methods be reviewing 1,825 water birth at a single institution over a period of 9
years by compare 830 primipara deliveries in water with 424 primipara deliveries in
traditional bed and 136 on the delivery stool and also evaluated the duration of labour, arterial
cord blood PH and base excess in the primipara and perineal trauma, shoulder dystocia and
deliveries after preceding caesarean section as well as rates of neonatal infection in all the
1,825 water birth results revealed that the duration of the first stage of labour was
significantly shorter with water birth than with the other delivery positions and concluded
that water births appears to be associated with a significantly shorter first stage of labour, a
lower episiotomy when compared with other delivery positions. if women are selected
appropriately, water birth appears to be safe for both the mother and neonate.
A study was conducted on alternative delivery methods and changes in obstetric
practice among selected hospitals with an objective to integrate water birth, alternative
delivery positions and less invasive conduct of labour into practice according to the wishes of
the mother. By comparing recent data 12,041 deliveries between 1991 and 1999. The results
revealed that after 1991 the proportions of women delivered in bed declined episiotomy rate
decreased from over 80% to 10% cesarean section rate remained lower than that in national
data base and concluded that alternative delivery methods, particularly water birth have
become popular. This shift has helped keep the cesarean delivery rate and has prompted more
careful use of other obstetric interventions.
A randomized clinical trait study was conducted experience of water birth delivery
among 106 pregnant women with an objective to evaluate the controversies surrounding
water birth and to find out the interest of women in this delivery method clinical trial, 106
pregnant women were assigned to control and experimental groups. The experimental group
underwent the labour and delivery in standardized warm water pools and the control group
gave birth by conventional delivery method at the hospital.

A questionnaire was completed during the labour for women in the both control and
experimental group including the method of delivery; labour length; use of different drugs
such as analgesics, antispasmatic and oxytocin; use of episiotomy, and newborns apgar score
and weight. The results revealed that 53 cases and 53 controls with the mean age of 26.4 + / 5.9 and 27.1 + / - 5.9 who completed the study, the women in control group required. All the
participants in the only 79.2 < of the controls had normal vaginal delivery and concluded that
those who gave water birth experienced less pain and completed the delivery was
accomplished more frequently with this group. These all lead to a decreased necessity for
medical interventions as well as an increased socioeconomic advantage for the society.
A comparative study was conducted by review of 969 deliveries with other delivery
positions with an objective to analyze 969 consecutive water births and compare them with
other delivery positions, by compared 969 water births, 515 deliveries in the traditional in the
traditional bed, and 172 deliveries on the delivery stool. Duration of labour, rates of
episiotomics and lacerations, arterial cold blood PH, analgesic requirements and postpartum
maternal hemoglobin levels were analyzed. The results revealed that first stage of labor was
significantly shorter in primiparas with water birth compared with the other delivery positions
(381 VS 473 min). There were no differences in the duration of second stage. The low
episiotomy rate with the water births (0.52% compared with 17.2% and 7.6% for the other
two positions) was not associated with an increased rate of primeval lacerations (23% in all
three groups) of the priniparas , 58% has no lacerations with water birth compared with 36%
and 48% for other positions, respectively, no women with water birth required analgesics and
concluded that water birth appears to be safe for the mother and the fetus neonate if
candidates are selected appropriately.
A Study was conducted to analyze the experience of under water birth among 26
pregnant women the results revealed that 23 of women who delivers in the pool had excellent
results and came to an conclusion the short term indicators of neonatal outcome were good,
which explained 5 different physiological factors which inhibit initiation of fetal breathing
under warm water. Which showed no increases in risk of infection of either mother or baby
birth under water is safe and beneficial if done properly for low risk patients.
A study was conducted to assess the attitude of pregnant women towards labor and
forms of preparation and preferences among 275 women hospitalization in obstetric wards
with an objective to assess knowledge and attitude of alternative delivery technique among

pregnant women. The mean age of women was 26+/-4.9. 55.7% of them were nulliparous,
44.3% multiparous. The results showed that majority of questionnaire women knew
alternative positions during delivery and possible analgetic techniques. 25.1% of women
attend labour school 81.2% wanted to give birth in the hospital, 10% at home and 88% in the
delivery room. 51.1% preferred water birth, and the study concluded that influence on
womens knowledge and their preferences. Water birth and other modern delivery techniques
are very popular among better educated women from big cities, while those with lower
education from small cities and villages prefer classic labour and recommended promotion
of modern delivery methods and active participation in labour should be concentrated on
these groups of women.
A experimental study was conducted on the influence of water immersion on the
course of labour among 109 women immersion on the course of labour among 109 women
who have delivered in water in obstrical ward. 110 Women composed control group mean
patients age in study and control group was respectively 26.4 + / - 4.33 and 26.72 + / - 5.82
years(ns) gestational age was 40.69 + / - 5.91 and 39.71 + /-2.03 weeks(ns). The duration of
labour stages, time from membranes rupture to delivery, birth weight and newborns
condition, frequency of episiotomy and perineum injuries as well as necessity of labour
stimulants use were analyzed by using T-test. Results showed that mean duration of 1 st labour
stage was 319 min in study group and 375 min in control group (9<0.02). The 2nd and 3rd
labour stage did not differ significantly .The episiotomy was less frequent in study group
(p<0.01), where as perineum injuries in control one (p<0.05). Use of oxytocin was
comparable between both groups, which concluded the profitable influence of water
immersion and it is safe method of labour in patients with physiological pregnancy.
A prospective study was conducted on the influence of warm tub bath during delivery
among 135 women to analyze first and second stage ob labour after a strictly normal
pregnancy. A control group consisted of 135 women fulfilling the same criteria, but who did
not take the both during labour. The newborns weight, their condition, perineum injury, time
of first and second stage of delivery and number of periteotomies was analyzed and
concluded that the observed features were undistinguishing.
A prospective observational study was conducted on maternal and neonatal infections
and obstetrical outcome in water birth with an objective to assess the effect of water birth on
objective to assess the effect of water birth on obstetrical outcome, the maternal and neonatal

infection rate in a selected low risk collective among 513 women who wished to have a water
birth comparing three groups; women who had a water birth, a normal vaginal delivery after
immersion and a normal vaginal delivery without immersion outcome measurements were
maternal and fetal infection rate, obstetrical outcome parameters and relevant laboratory
parameters. Results showed there was no maternal infection related to water birth, significant
differences were observed in obstetrical outcome parameters, concluded that water birth is a
valuable alternative to traditional delivery. The maternal and fetal infection rate was
comparable to traditional deliveries and recommend that a careful selection of low risk
collective is essential to minimize potential risks.
A prospective observational study was conducted on water birth more than a trendy
alternative method among 513 patients of low risk collective who requested a water birth.
Primary outcome measurements included the maternal and fetal parameters. Secondary
outcome measurements comprised data on the incidence of water births in an interested, low
risk population in an academic hospital, results revealed that significant differences were
observed in maternal outcome parameters, which included the use of analgesia/ anesthesia
during labour, the duration of first and second stage of labour, perineal tears and episiotomy
rate, and concluded water birth is a valuable and promising alternative to traditional delivery
methods.
A retrospective observational study was carried out on pain intensity and need for
analgesics with water births and land births with a objective to investigate the intensity of
labour pain experienced and the need for analgesics differs between water and bed births
among 12103 spontaneous singleton births in cephalic presentation of these, 4768 were water
births, 5141 bed births, 1429 Maya stool births and 765 used other birthing methods. Results
revealed that during the different birthing stages, all birthing methods showed an almost
identical intensity of pain, as measured with the visual analogue scale (VAS 0-100) : early
dilation phase (VAS 38-54), late dilation and expulsion phase (VAS 70-77) when looking
back during the puerperal period, first time mothers who chose a water birth remembered the
birthing experience as being significantly less painful, than did their bed birthing sisters
(water birth VAS 68.98, bed birth VAS 72.43 and the need for analgesics was significantly
lower among water births and concluded water births remembered the birthing experience as
being less painful than bed birthers

A 8 years prospective clinical study was conducted to examine whether guidelines for
water temperature and bathing are actually among 10,775 births in a regional womens
hospital. Neonatal and maternal body temperature and morbidity parameters were compared
between land and water births. Results revealed that neonatal and maternal birth and perinatal
parameters, and body temperature do not differ between water and land births, except at birth,
when water bearing temperature were 36.9 degrees CVS 36.3 degrees C on land. Neonatal
rectal temperatures did not differ significantly between the two groups, water temperature
increased from beginning of the bath (35.2 degrees c) to 35.7 degrees C, and fell at the end of
the bath to 32.9 degrees C, water temperature range: 23 degrees C to 38.9 degrees C. Bathing
duration: 28 min to 364 min, and concluded water births pose no thermal risk. The parturient,
with her inborn code of body temperature regulation, regulates water temperature of mother
and child remain within the physiological range.
An exploratory study was conducted on womens experiences of labour in water to
examine womens attempts. The data were collected in the maternity unit of local general
hospital set in a semi-rural location, results revealed labour in water was seen by all but one
of the participants as beneficial, particularly as they felt that this gave them more control over
the process. They valued their own involvement in determining the outcome of their care.
The support of the midwife in making decisions was seen as necessary to remain in control
and concluded labour in water was a positive experience for this group of healthy women.
The feeling of freedom to make decisions, however, was balanced with a wish for the support
of the midwife.

6.3 REVIEW OF LITERATURE:

Review of literature is the key step in research process. The review of literature is
defined as a broad, comprehensive in depth, systematic and critical review of scholary
publications, unpublished scholary printmaterials, audio visual materials and personal
communication.

Emphasis has been placed on pharmacologic procedural sedation and analgesics, but
environmental and non pharmacologic therapis contribute greatly to distress reduction.

6.4 STATEMENT OF PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF STAFF
NURSES REGARDING WATER BIRTH WITH AN VIEW TO DEVELOP
INFORMATIONAL BOOKLET IN SELECTED HOSPITALS AT GULBARGA.

6.5 OBJECTIVES OF THE STUDY:

1. The asses the knowledge of staff nurses regarding water birth
2. To asses the attitude of staff nurses regarding water birth.
3. To associate the knowledge and attitude of staff nurses with selected socio demographic
variables.
4. To develop informational book let regarding water birth and its benefits.

6.6 OPERATIOAL DEFINITION:

1. Knowledge: - It refers to the understanding or awareness of mother regarding water
birth & its benefits among staff nurses.
2. Attitude: - It refers to view and ideas or opinion expressed by the mother regarding
water birth and its practices.
3. Staff Nurse: - In this study staff nurses refers to health care professions who are
working in obstetric & gynic wards in selected hospitals.
4. Water Birth: - Water birth means where the motherspends the final stage of labour to
deliver her baby by fully submerging into water. The babys head must remain
submerged under water until after the body is born, then the body is brought to the
surface immediately. The babys head must not be submerged again.
5. Informational Book let: - It refers to self learning information prepared in
Kannada & English on the aspects of water birth & its benefits.

6.7 ASSUMPTIONS:
1. Staff nurses may have knowledge regarding water birth
2. Staff nurses may have favorable attitude regarding water birth and its benefits.
3. Informational book let may improve the knowledge of mothers in providing
knowledge regarding water birth and its benefits.

6.8 Hypothesis:
H1: There will be a significant association between knowledge and selected socio
demographic variables of staff nurses.
H2: There will be a significant association between attitude and selected socio
demographic variables of mothers.

6.9 Variables:
Study Variable: Knowledge of staff nurses regarding water birth and its benefits.
Socio-demographic variables: It consists base line characteristics such as age religion,
education source of knowledge.

6.10 Delimitations :
The study is limited too
1. Staff nurses who are working in labour post natal, Antenatal, septic wards, O.T. and
Gynic OPDs.
2. Who are available at the time of study.

7.0 Material and Methods :

7.1 Source of data:
Staff nurses working in selected hospitals at Gulbarga .

7.2 Methods of data collection:

7.2.1 Research Design:
Non Experimental Descriptive research design

7.2.2 Setting of the study:

A study will be conducted in the selected hospitals at Gulbarga.

7.2.3 Population:
Staff nurses working in selected hospitals at Gulbarga.

7.2.4 Sample :
Staff nurses working in selected hospitals and who fulfill the inclusion criteria

7.2.5 Sample Size:

60 staff nurses.

7.2.6 Sample technique:

Purposive sampling technique.

7.2.7 Sampling Criteria:Inclusion Criteria :

1. Staff nurses who are available during study.
2. Staff nurses working in labor ANC, PNC, OT, Septic and Gynic OPD
3. Staff nurses working in selected hospitals.
Exclusion Criteria: 1. Staff nurses working in other sectors/wards.
2. Student nurses who are posted to the respective wards.

7.2.8 Tools
The tools for data collection consist of the following section.
1. Section :- Socio demographic
2. Section: - Structured questionnaires.

7.3 DATA ANALYSIS AND INTERPRETION:

1. Data collected on knowledge regarding water birth and its benefits through
following techniques.
2. Descriptive statistics and inferential statistics mean standard deviation frequency
will be used to asses the knowledge regarding water birth and its benefits chi-square test will

be used to bring association between the knowledge with selected socio demographic,
variables of staff nurses. The analysed data will be presented in the form of tablets and
graphs.

PROJECTED OUTCOME:
After the study. The investigator will know the level of knowledge of staff
nurses regarding water birth and its benefits and their attitudes regarding water birth and then
based on the outcome the investigator will develop on formational booklet and distribute to
all participate.

7.4 DOES THE STUDY REQURIE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMALS?
YES.

7.5 HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes, ethical clearance has been obtained from:
1. The institutional ethical committee Vasantha College of Nursing.
2. Head of the institution from selected high school Bidar.
3. Consent will be obtained from all subjects and their parents or guardians.

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3. Burns E. Waterbirth. MIDIRS 2001; 11:510-3.
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pregnancy, Labour and birth. In: The Cochrane Database of Systematic Reviews
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Guide To Effective Care in Pregnancy and Childbirth. Oxford: Oxford University
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second stage of labour? Acta Obster Gynecol Scand 1939;68:713-8.
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11
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