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KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
NURSING
INTRODUCTION
Childbirth is more admirable than conquest, more amazing and courageous, with lots of
excitement, relief, anticipation, uncertainty, anxiety or even fear. It might be relaxed and
Pregnancy is a beautiful and natural phenomenon, nine metamorphic months with lots of
excitement, planning and nervousness at the awesome unravelling of life, With a ravishing
experience. Every woman owns the unique experience. It has tremendously powerful stages
of development that bring a woman to motherhood, a couple, to family and a beautiful child
into the world. Labour process may be viewed as a test of womanhood, a test of personal
competence, a peak of experience, and the first act of motherhood. It starts with the onset of
regular uterine activity associated with effacement and dilatation of the cervix and descent
Labor is defined as rhythmic contraction and relaxation of the uterine muscles with the
progressive effacement and dilation of the cervix, leading to expulsion of the products of
conception. Each experience is unique and calls for a celebration. The fear and anxiety
about childbirth often prevents most women from enjoying this experience an adequate
knowledge about signs of labor and labor and delivery in general can impart a feeling of
labor.1
During Labor, the woman experiences some degree of stress and discomfort , as the
system responds to the physical changes that prepare to give birth. The Perception of pain is
the onset of regular uterine contractions to full dilatation of cervix. The second stage of
labor last from full dilatation of cervix to birth of fetus. The third stage of labor lasts from
birth of fetus, until the placenta is delivered. The fourth stage starts from expulsion of
placenta to six weeks of post – natal period. On average, labor starts 12-18 hours in a
woman's first pregnancy and tends to be shorter, averaging 6-8 hours in subsequent
pregnancies.2
First stage of labor has been divided in to three phases a latent phase, active phase and
transitional phase. were latent phase being prior to the active first stage and cervix dilates 0-
3/4 cm, Active Phase undergoes more rapid dilatation from 4cm dilated with rhythmic
contractions and complete cervical dilatation. As contractions get stronger, body releases
endorphins—nature's narcotic—to ease labor pain. Transition phase is where cervix dilates
century. Natural child birth was pioneered by Grantly Dick Read in 1932. He suggested
that pain of child birth is brought about by fear and tension and recommended passive
therapy, music, guided imagery, acupressure, and aromatherapy are some self comfort
measures women may initiate during labor to procure an effective coping level for their
pharmacologic techniques to reduce or vary labor pain without any possible harmful
respond more effectively to the pain onset, as contraction increases and make it more
productive and promotes oxygen and strengthen both mother and baby.6
Lamaze breathing is a technique used to help and relax during labor. Dr Ferdinand Lamaze,
a French obstetrician, pioneered the Lamaze breathing technique in the late 1950s,
Although the method was initially pioneered in breathing techniques to reduce labor
pains and the techniques utilize several breathing patterns in order to encourage relaxation.
The breathing patterns include inhaling for five seconds, then breathing out for five
seconds. Another option is the two short breaths, then one deep breath exercise that sounds
like “hee hee hooooo.” The last breath should be released through the mouth. Lamaze
during childbirth, according to Modern Stork. Lamaze is also designed to help to conserve
energy while giving birth—this helps to reduce the level of exhaustion following birth. 6
The Lamaze method of prepared childbirth involves class sessions for the mother and
her partner in which they learn about the birth process and the mechanisms of labor,
are taught what to expect and what is expected of them during the birth of their child
and are trained in special exercises that develop neuromuscular control, promote
physical conditioning, and eliminate or reduce the need for drugs and instruments
during delivery. Advocates of the Lamaze method do not claim complete absence of
pain during labor and delivery in every case, but they do feel that the method enriches
the lives of the parents in many ways and provides for them a means of sharing the
birth experience that is denied to them in the other methods of hospital deliveries.
6.1 NEED FOR THE STUDY
According to the latest data from 150 countries, currently 18.6% of all births occur by CS,
ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin
America and the Caribbean region has the highest CS rates (40.5%), followed by Northern
America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based
on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the
global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate
of increase of 4.4%. The largest absolute increases occurred in Latin America and the
Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%),
Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern
America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and
Northern America were the regions with the highest and lowest average annual rate of
In the last decade or so, the numbers have escalated in many parts of the country reaching
as high as 41% of deliveries in Kerala, and 58% in Tamilnadu says a reports(pdf) by the
ICMR school of public health. And it’s happening across both urban and rural areas.
Mumbai saw an exponential growth in c sections in both private and public hospitals,
while one study (Jan 2007 to Dc 2012) demonstrated a spike from 31% to 51% over just
In India, C-section deliveries sky-rocketed since and the NFHS report states that 23.6% of
all babies in Karnataka are delivered under the knife. In Bengaluru, out of 3,683 deliveries
in 2016, around 2,264 were Caesarean births; that is 61.60 per cent at private hospitals
empanelled under the Central Government Health Scheme (CGHS) as against the national
average of 17.2%, according to the fourth National Family Health Survey (NFHS) report.
The highest is in Chandigarh that records 98.35% C-section deliveries. Till 2010, C-section
deliveries in India was around 8.5%, was well below the 10-15% recommendation of
About a million women give birth using the Lamaze method, according to Lamaze
International, the nonprofit organization that teaches people its Lamaze birthing
philosophy. After the rising popularity of the epidural in the 1980s and the common place
theory that a hospital was the only safe place to give birth, the Lamaze method encouraged
expectant mothers to use the breathing training to learn how to cope with the labor pains
without drugs and to give birth at home or in birthing centers with a birthing partner and/or
midwife. This idea challenged the conventional wisdom of using any medical intervention
necessary to deliver the baby so that the mother experienced as little physical pain as
possible.10
Conscious breathing works best in combination with many other comfort strategies. In
Lamaze classes, women no longer spend large amounts of time practicing breathing.
Women move, change position, slow dance, sway on birth balls, learn massage, and
identify the countless other ways they normally relax and find comfort. Each of these
breathing may be one of very few comfort strategies available for women in labor. It is one
Lamaze breathing technique refers to the act of breathing at any number of possible rates
and depths. Some women prefer breathing deeply, using their diaphragm to fill their
abdomen with air. Other women prefer light breathing, inhaling just enough to fill their chest.
The goal is to find breathing patterns that have a calming and relaxing effect,breathing
should be at a comfortable rate and should not lead to short of breath or light-headed.
b. The mother remains in a more relaxed state and will respond more positively to the onset
of pain,
e. Increased oxygen provides more strength and energy for both the mother and baby,
g. Patterned breathing and relaxation can become techniques for dealing with life’s every
day stressors.11
A study conducted on Lamaze practices reveals that the study group was more satisfied with
vaginal birth, where the mother pushes and births her own baby with minimal medical
interference. Lamaze breathing today, unlike 50 years ago, is one of many ways that
women now have to manage contractions, to facilitate the physiologic process of labor, and
to give birth with confidence. Hence the investigator felt the need for Lamaze breathing
work, which acquaints the investigator with fact finding work after scrutinization.13
Review of literature for the present study has been divided into the following headings:
(Lamaze preparation) on labor and delivery among 129 primiparas who had completed
ante-partum Lamaze-training with an equal number of matched controls who had not. The
former was given narcotics less frequently during labor (P 0.001), received conduction
anesthesia less often (P less than 0.001), and had a higher frequency of spontaneous
vaginal deliveries (P less than 0.001) than the control patients which suggest that Lamaze
breathing exercise on labor pain among primi gravida mothers. The study was conducted at
labour ward, Mahatma Gandhi Medical college and hospital, Puducherry. Simple random
sampling technique (Lottery method) was used to select the samples. Sixty samples were
selected for the study (30 samples each in Experimental and Control group). A Pre-test was
carried out to assess the level of pain during labour using Visual Analogue Scale in both
the groups. In Experimental group Lamaze breathing exercise was administered and
Control group there was no intervention. The study result shows that in experimental group
Pre-test 1 mean value 4.67 , Post-test 1 mean value 4.07 and control group Pre-test 1 mean
value 5.10, Post-test 1 mean value 7.23.In comparing Pre-test 2 and post-test 2 in both
groups. In Pre-test2 mean value 5.90, Post-test2 mean value 4.47 and Control group Pre-
test 2 mean value 8.87 and post-test 2 mean value 9.33. In experimental group at ‘P’ value
0.9341 and control group at ‘P’ value 0.0000. Comparison between Pre-test2 and Post-test
2 of both groups. In experimental group at ‘P’ value 0.0000 and control group at ‘P’ value
0.0015 and the study reveals that there was a significant reduction in level of pain during
The study was aimed to determine the effectiveness of Lamaze method on mode of labour
between experimental &control group mothers. A research design adopted for this study
was True experimental design 67% experimental group mothers had normal delivery &
Mothers those who are in control group (25 %)were delivered normally, The total
Proportion (%) of normal delivery in the Control group=3/12=25% & the Proportion (%)
P<0.05) and hence it is concluded that there was a strong evidence of a difference in the
mode of delivery.16
on labor pain and anxiety towards labor outcome among primigravida mothers during first
stage of labor. 20 women were selected in control group and 20 were in experimental
group selected by purposive sampling technique, & data were collected. Pain perception in
women of control group was assessed by visual analogue pain perception scale, and in
experimental group, the women were instructed to perform Lamaze breathing technique by
using observational rating scale and after that their pain perception were assessed by the
same visual analogue pain perception scale., and Evaluation of data related to effectiveness
of breathing exercises on labor outcome during labor was done by paired ‘t’-test. The mean
in experimental group was 4.55 and in control group was 7.55 with a standard deviation of
1.234 and 0.944 respectively. The mean % of experimental group is 45.5 and in control
group it is 75.5. The paired t test – value was 3.96 which are highly significant at P< 0.001.
As the result shows, that after receiving the Lamaze breathing exercises, the labor outcome
techniques on labor pain and anxiety. Women taken in control group were assessed for
their labor pain, and women in experimental group were instructed to perform Lamaze
breathing exercises during pains and their level of pain & anxiety were assessed and then
compared with women of control group. Methods and Material: The tools used were-
Demographic variables, clinical variables, a visual analogue pain perception scale, and an
observational rating scale for performing Lamaze breathing. Statistical Analysis Used: The
findings were analyzed using ‘t’ test, chi square test, and Karl Pearson formula.
Comparison of level of pain perception between control and experimental group on the
basis of paired ‘t’ test shows that the level of pain perception in control group is higher
than the experimental group. The mean of control group is 7.55 and of experimental group
are 4.55. Mean percent is 75.5% and 45.5% of control and experimental group
respectively. And, SD of control group is 0.945 and of experimental group, it is 1.234. The
‘t’ value is 3.96 and P value is P<0.001 which is highly significant. Result shows, that after
receiving the Lamaze breathing exercises, the labor outcome during first stage of labor was
good and Practice of breathing exercises shortens the duration of labor, and prevents the
hand-picked controls, matched for age, race, parity, and educational level. Lamaze
preparation was found to have a significant beneficial effect in almost every obstetric
cesarean sections and one-fifth the amount of fetal distress (P less than .005). Postpartum
infection, measured both by maternal febrile morbidity and by the incidence of antibiotic
use, was one-third that of the controls (P less than .005). Similarly, the "prepared" patients
had fewer perineal lacerations and those that occurred were not as serious as those in the
control patients (P less than .005). The control patients had three times as many cases of
toxemia of pregnancy (P less than .005) and twice as many of prematurity (P<0.05).19
A retrospective observational study was carried out on pain intensity and need for
analgesics with water births and land births with an 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
massage on first stage of labor pain among primi gravida mothers at chrompet govrnment
general hospital. A sample of 60 primigravida mothers with labour pain was selected by
using Non- probability purposive sampling technique. The findings showed that regarding
experimental group 22 (73.3%) are annoying pain and 8 (26.7%) are uncomfortable pain.
None of the mothers are dreadful pain, horrible pain and agonizing pain. Considering the
control group 7 (23.3%) are dreadful pain and 23 (76.7%) are horrible pain. None of the
mothers are agonizing pain. It was concluded that Circular Hip Massage to the
A randomized and quasi-randomized trial review was conducted to determine the effect of
standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) in
the first stage of labor on 3706 women. Result of this review revealed that the first stage of
labour was approximately one hour shorter for women randomized to upright as opposed
to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomized to upright
positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).
Walking and upright positions in the first stage of labor reduce the length of labour and do
1. To assess the labor outcome among parturient mothers in group A (Lamaze breathing
parturient mothers
3.To determine association between the selected demographic variables with labor,
routine measures versus hospital routine measures during first stage of labor, by
NICU.
short breaths, then one deep breath exercise that sounds like “hee hee hooooo.” The
last breath should be released through the mouth, which will be practiced for 20
minutes with the period of 10 minutes rest in left lateral position and the same will
be practiced till full cervical dilatation which will be assessed using Lamaze
3. Parturient mothers: it refers to the primi gravida women, who are in first stage of
labor, admitted in the selected hospitals and undergoing labor process after
2. Neonatal outcome- APGAR score (at 1 minute and 5 minutes) and admission to
6.6 ASSUMPTIONS
neonatal outcome.
6.7 HYPOTHESIS
NH1: There will be no significant difference in labor, neonatal outcome among group
6.8 DELIMITATIONS
6.9 VARIABLES
Attribute variable
Socio demographic data includes age, education status, work pattern, religion,
residential area, type of family, food pattern, habit of doing regular exercise,
medical induction of labor, BMI of the mother, gestational age of the mother,
The Data will be collected from mothers who are in first stage of labor with the
7.1.2 Setting
This study will be conducted in the labor room of selected hospitals, Kolar.
7.1.3 Population
The population will be primigravida mothers in first stage of labor with 38 weeks
Simple random sampling technique- Lottery method 2-4 parturient mothers per day
routine measures)
1.Parturient (primi gravida) mothers in first stage of labor (3-4 cm dilatation) who
2. Parturient (primi gravida) mothers in first stage of labor (3-4 cm dilatation) who
have completed 38 weeks of gestation available on the time of data collection.
3.Mother who is willing to sign the written informed consent and participate in the
study.
Part I: Socio demographic data includes age, education status, work pattern,
religion, residential area, type of family, food pattern, habit of doing regular
exercise, medical induction of labor, BMI of the mother, gestational age of the
Part II: Modified WHO partograph (Maternal outcome) to assess the cervical
labor.
Part IV: APGAR score of 1 minute and 5 minutes (neonatal outcome) and
inclusion criteria
mothers.
breathing for 20 minutes with the period of 10 minutes rest in left lateral
position and continue this till full cervical dilatation along with the other
application, massage).
mothers.
mentioned instruments.
Descriptive statistics
Inferential statistics
1. Independent ‘t’ test will be used to assess the effectiveness of group A versus group
B on duration of labor, intensity of uterine contraction.
2. chi square test/ fishers exact score test will be used to assess the effectiveness of
3. one-way ANOVA and chi-square/fishers exact test will be used to associate the
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
LIST OF REFERENCES
www.medindia.net.
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5. Simkins, Penny, P.T., et al, The Birth Partner Second Ed Pregnancy, Child birth and
the Newborn.http://americanpregnancy.org/labor-and-birth/patterned-breathing.
6. Rachel nall. Lamaze Breathing Techniques to Use During Labor:
7. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR (2016) .The
https://doi.org/10.1371/journal.pone.0148343.
india-are-skyrocketing-and-there-is-reason-to-be-very-worried.
10. Patel Bansariben bharat Kumar. A Study was conducted to investigate the Lamaze
method: www.rguhs.ac.in/cdc/onlinecdc/uploads.
11. Simkin, Penny, P.T., et al, The Birth Partner Second Ed Pregnancy, Child birth and
12. F Fahima the Effect of Lamaze method Practices on the outcome of pregnancy and
Labor in Primi Para Women. Iranian Journal of Nursing and Midwifery Research.
2007;12(3):111.
13. Polit and Hungler. Nursing Research Principles and Methods. 5th ed.
14. Scott JR, Rose NB. Effect of psycho prophylaxis on labour and delivery in
mode of labor among primigravid women Int J Pharma Bio Sci 2017 July;
17. F Fahami The Effect of Lamaze method Practices on the outcome of pregnancy
and Labour in Primi Para Women. Iranian Journal of Nursing and Midwifery
Research. 2007;12(3):11119.
19. Hughey MJ, McElin TW, Young. Maternal and fetal outcome of Lamaze
20. Geissbuehler V, Stein S, Eberhard J. Water births compared with land births: an
Issue 2. Jun.2016.
22. L ben Regaya, R Fantnassi, A Khlifi, M Fekih, S Kebaili etl. Role of deambulation during labour.
GUIDE
11.3 CO-GUIDE
CO-GUIDE
Mrs. T. BEAULAH MERCY MARY
11.5 HEAD OF THE E.T.C.M College of Nursing
KOLAR-563 101
DEPARTMENT
HOD
12. 12.1 REMARKS OF THE The topic was discussed with the member of
PRINCIPAL research committee and was finalized. She is
permitted to conduct the study
12.2 SIGNATURE