CHAPTER 1  

INTRODUCTION

“Pregnancy is like the beginning of all things: Wonder, hope and a dream of possibilities…..”

A mother’s joy begins when new life is stirring inside; when a tiny heart beat is heard

for the first time, and a playful kick remains her that she is never alone. The delivery of a

child is often associated with excitement and joy, and the new mother is expected to happily

welcome her new responsibility. For some mothers, however, this new responsibility not be

an enjoyable experience because of ignorance or mishandling of postpartum psychological

health. Postnatal mothers may struggle with their mental health as they transit in to

motherhood.

The puerperium is a stage that produces change and adaptations in women, couple and

family. Effective coping during this stage depends on the relationship between the demands

of stressful or difficult situations and the resources that the puerperal individual has. Roy

(2004), in her Middle Range Theory about the Coping and Adaptation Processing, defines

Coping as the ''behavioral and cognitive efforts that a person makes to meet the environment

demands''. For the puerperal individual, the correct coping is necessary to maintain her

physical and mental well being, especially against situations that can be stressful like

breastfeeding and return to work.

Mental health disorders such as depression, anxiety or obsessive - compulsive

disorders may surface during or after pregnancy. Additionally, birth-related post-traumatic

stress disorder or a severe but rare condition called postpartum psychosis can happen

following childbirth.

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1.1 BACKGROUND OF THE STUDY

Physiologically, the puerperium is considered the period of time transpired from the

expulsion of placenta until the return of woman's reproductive organ to it’s state prior to

gestation. From the psychological and social point of view, it is a period of re-adaptation and

adjustment for the whole family; the woman may end up feeling relegated, given that the

attention is centered on the newborn and she may even have to modify her role to dedicate

herself to care the newborn, in spite of the physical discomfort caused by giving birth.

Mothers commonly experience what is called the “baby blues,” mood swings that are

the result of high hormonal fluctuations occur during and immediately after childbirth.

Postpartum blues are very common, occurring in up to 80 percent of new mothers. The onset

of postpartum blue usually occur three to five days after delivery, and should subside as the

hormone levels begin to stabilize. Symptoms generally do not last for more than few weeks,

and this condition is not considered as mental health disorder, however if a person continues

to experience mood swings or feelings of depression for more than two weeks after

childbirth, the problem may be more serious.

Many mothers who suffer postpartum blue may lead to its severity in terms of

postpartum depression or psychosis, and have thoughts of harming themselves or their

infants. The risk of suicide and or infanticide is high among these women. Consequently,

early screening, identification, and intervention are essential to the wellbeing of the mother,

infant and family. There are many literatures that prove the incidence, prevalence and

significance of the psychological health of women during and after pregnancy as mentioned

below.

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Bener. A (2012) states, that the prevalence of postpartum depression in women living

in Qatar was comparable to previous epidemiology research done in developing countries.

Giriyappa Venkatesh (2010) states that postpartum disturbances are the outcome of several

socio cultural pressures faced by the women. Suri.R said that sertoline was found to be

effective for the treatment of major depression occurring within 6months of delivery.

Dietz et al. (2007) assessed the incidence of postpartum depression before pregnancy,

prenatal, and postnatal amongst 4,398 women and found that 678 were depressed at some

point before, during or after pregnancy.

Mental health disorders specific to pregnancies were identified in 11.8 % of the

women (Dietz et al., 2007). Of those who were identified as depressed before pregnancy,

54.2 % also experienced depression during or after pregnancy. Postpartum depression affects

many postpartum mothers. When postpartum depression is not timely assessed, identified,

and treated, it can lead to problems with mother child bonding and cause family problems,

negligence, and infant death. The purpose of this phenomenological study was to understand

Imo State women’s lived experiences and perception on sufficiency of the assessment and

treatment received for their postpartum depression. The participants stated that feelings of

unhappiness and sadness increased after delivery of their babies, which were misinterpreted

by family and friends. Participants stated that they sought recovery through prayers and

herbs. The findings from this study can be used to promote positive social change by

enhancing Imo State women’s awareness on postpartum depression and also to support health

care providers in designing relevant assessments in providing care for women with

postpartum depression.

The treatment of postpartum psychological disorders is generally holistic and includes

reassurance, familial and social support, psycho-education, and in some cases, psychotherapy

and/or pharmacologic treatment. In moderate to severe depression and Post partum psychosis,

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medication becomes necessary. But most of the pharmacological agents produce hazards to

the newborn babies hence it has to be chosen very carefully.

However, some kind of interventions are available without medications such as non

pharmacological interventions including acupressure, psychotherapy, family counseling,

group counseling, guided imaginary techniques, yoga, exercises and emotional freedom

technique etc.

By looking into the literatures, it is evident that the psychological health of the

postnatal mother is essential for the health of mother and the newborn baby.

The present study is aimed to determine the effect of one of the non pharmacological

intervention, The Emotional Freedom Technique on the level of postpartum blue among the

postnatal mothers in selected maternity hospitals at Chennai. This will also help the

researchers to know the prevalence and identify the risk factors of postpartum blues among

the postnatal mothers using Edinburgh postnatal depression scale score (EPDS). Such kind of

studies will help in reducing the incidence of postpartum psychological disorders and will

help the postnatal mothers to cope with the changes of puerperium that in turn help them in

maintaining the normal mental health during puerperium.

1.2 STATEMENT OF THE PROBLEM

A Quasi Experimental Study to Appraise the Perceived Competency and Effect of Emotional

Freedom Technique on Postpartum Blue among Postnatal Mothers in Selected Maternity

Centers, Chennai.

1.3 OBJECTIVES

1.3.1 To assess the Demographic Variables of the Postnatal Mothers.

1.3.2 To assess the knowledge regarding postpartum blue among the postnatal mothers

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1.3.3 To assess the Level of Postpartum Blue among the Postnatal Mothers.

1.3.4 To determine the effect of Emotional Freedom Technique on the Level of Postpartum

Blue among the Postnatal Mothers.

1.3.5 To find out the association between selected Demographic Variables and the Pretest

Level of Postpartum Blue among the Postnatal Mothers.

1.4 OPERATIONAL DEFINITION

1.4.1 Appraisal - It is an act of assessing the level of knowledge regarding postpartum blue

and the level of postpartum blue using a researcher made and standardized questionnaire

among the postnatal mothers.

1.4.2 Perceived competency - It is the competency or the level of knowledge regarding

postpartum blue identified among the postnatal mothers using a semi structured

questionnaire.

1.4.3 Effect – In this present study, effect means the influence of Emotional Freedom

Technique on the score obtained by the mothers in Edin Burgh Postnatal Depression Scale.

1.4.4 Emotional freedom technique – It is a self-help technique that involves tapping near

nine end points of “energy meridians” located around the body in order to reduce tension and

relieve from stress performed twice daily for 3 days by the postnatal mothers.

1.4.5 Postpartum blue – In this present study, postpartum blue is a subjective feeling

perceived and the score marked in the Edin Burgh Postnatal Depression Scale by the

postnatal mothers.

1.4.6 Postnatal mother – Mothers who have given birth to a living newborn irrespective of

the mode and type of delivery in the selected maternity centers of Chennai.

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1.5 HYPOTHESIS

1.5.1 H0: There is no significant homogeneity between the experimental and control group

postnatal mothers.

1.5.2 H0: There is no significant difference in the pretest and posttest level of post partum

blue among the postnatal mothers from control group.

1.5.3 H0: There is no significant difference in pretest and posttest level of post partum blue

among the postnatal mothers from experimental group.

1.5.4 H0: There is no significant difference in the posttest level of post partum blue between

the experimental and control group postnatal mothers.

1.5.5 H0: There is no significant association between the pretest level of post partum blue and

the selected demographic variables among the postnatal mothers.

1.6 CONCEPTUAL FRAMEWORK

Conceptual framework helps to express the abstract ideas in more readily

understandable and precise form from the original conceptualization. It presents, logically

constructed concepts to provide general explanation of the relationship between the concepts

of research study, without using an existing theory. Conceptual frame work is usually

constructed using researcher’s own experience or from previous research in finding on

concepts of several theories and models.

Conceptual framework of the present study was based on the general systems theory

[2003]. The main concepts of general system theory are input, throughput and output. In this

theory, input refers to any form of information, energy or material, which enters into the

system. Throughput refers to the process whereby the system transforms, creates and

organizes input. Output refers to energy, information and matter, which are transferred in to

the environment. In this study input, throughput and output refers to,

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1.6.1 Input

Through the process of selection, the system regulates the type and amount of input

received. The energy and raw material transformed by the system is the input. In this study,

the input refers to the postnatal mother’s demographic variables, postpartum blue score

measured in Edinburgh Postnatal Depression scale and pain score measured among the

postnatal mothers.

1.6.2 Through Put

The process deals with the interventions carried out in between input and output. It

enables the input to be transformed into output in such a way that it can be readily used by

the system. In this study, the Emotional Freedom Technique intervention brings about change

in the level of postnatal blue among postnatal mothers in experimental group.

1.6.3 Output

It is the product or service which results from the system’s throughput or processing

of technical, social, financial and human input. Here output refers to the change in

postpartum blue score assessed using Edinburgh Postnatal Depression Scale among the

postnatal mothers. It is expected to show decrease in the level of postpartum blue level

among the postnatal mothers.

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