Chapter I

THE PROBLEM AND ITS BACKGROUND

Introduction

Childbirth is a significant event in a woman’s life, but the pain of childbirth

is undoubtedly the most excruciating one to bear. Even though it can be anticipated

during the labor process, if it exceeds the pain threshold of the woman, it can have

adverse psychological and physiological effects on the mother and the fetus

(Simavli, Kaygusuz, Gumus, Usluogullari, Yildirim & Kafali, 2013).

For a mother, severe labor pain elevates the metabolic rate and the demand

for oxygen. It also heightens the production of catecholamines, cortisol and

glucagon. It also has an effect on the respiratory process of the mother and can

inhibit or slow down the progression of labor. A mother’s long-term emotional

stress can also be traced down to the severity of the pain she experienced during

the labor process and that can have adverse implications on the mother’s mental

health. It may also manifest in family relationship, especially the mother-child

relationship. Furthermore, unrelieved pain can ruin the experience of a lifetime for

both partners (Labrague, Rosales, Rosales and Fiel, 2013).

The International Association for the Study of Pain defined pain as “a

displeasing event (sensory or emotional) coupled with actual or potential tissue

damage” (IASP, 2013).

According to the study on the experience of pain among women of Ali-Beigi,

Broumandfar, Bahadoran and Ali-Abedi (2010), labor pain is a result of

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physiological-psychological causes. If a woman attacks her perception of pain with

a psychological point-of-view, her feelings toward it would change. Lack of

knowledge, previous abnormal deliveries, and bitter experiences associated with

childbirth can greatly increase feelings of pain. On the other hand, a normal

pregnancy, a high self-esteem along with constant relaxation and pleasure can

decrease the pain and, henceforth, make the delivery pain-free and tolerable.

Pain tolerance is the individual’s capacity to endure and accept pain in a

specified range. It differs among individuals and could be influenced by a lot of

factors like a person’s physical, psychological and cultural background. (Du Gas

BW, 2003)

Although pharmacologic methods for pain and anxiety management have

been proven effective through scientific experiments, non-pharmacologic methods

proved to be as beneficial and as useful as pharmacologic treatments as well.

Rhythmic respiration, meditation, progressive relaxation, dreaming, biofeedback,

massage therapy, hypnosis, distraction, music therapy, hot-cold treatments and

acupressure are some on the non-invasive methods.

Non-pharmacologic treatment strategies maintain freedom of movement,

decreases the adverse effects of pain medications, increase women’s satisfaction

with pain relief, and help patients feel more in control throughout the whole birthing

process (Jones, 2012)

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Background of the Study

The researchers chose to conduct this study because two of them has had

first-hand experience in labor and delivery. They knew the pain and severe anxiety

associated with it and the risks that came along with it. Hence, the objective of this

study was to assess the effects of a certain non-pharmacological method not

known to many: Binaural Beats. Furthermore, the researchers chose the active

stage of labor because this is where labor pain and contractions are more intense

and where patient anxiety is more evident.

The researchers also aimed to bring awareness and hopefully be able to

incorporate the said intervention, initially in a lying-in clinic, then ultimately, the

hospital setting. The researchers wanted to show the efficacy of binaural auditory

beats as a non-pharmacological method in managing pain and anxiety of women

in labor.

The third-year nursing students of Arellano University Pasig Campus

conducted this study among twenty (20) years old to forty (40) year old mothers at

a private lying-in clinic in Marikina City. A total of six (6) mothers were chosen to

participate in this study.

Theoretical Framework

This study was supported by Betty Neuman’s Systems Model (McEwen and

Willis, 2011). It is a practical guideline used by caregiving and administrative staff

members to produce positive client outcomes. The model outlines a dynamic script
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deployed by practitioners around the world, and the framework emphasizes client

individuality by considering the clients’ unique circumstances and background. The

Neuman’s Systems Model shows a comprehensive conceptual structure related to

stressors, reactions given against stressors and protective interventions. In the

healthcare setting, Neuman’s Systems Model seeks to help patients heal

physically, mentally and spiritually. labor at times can be overwhelming and can

cause some women to feel like they are losing control which leads to panic. In

relation, laboring women are highly agitated during these times making stress

highly evident. labor is an overwhelming feeling and can highly aggravate as

stressors. Following the Neuman Systems Model, an individual is said to have a

central "core" of basic survival mechanisms, such as temperature control, heart

rate control, ego and organ function. By conducting the experiment using this

nursing theory, the researchers will be able to see how labor greatly impacts the

central core of the patients and through listening to binaural auditory beats, the

researchers will be also able to prove how that central core alters, stabilizes and

regulates by documenting the client’s pain levels through their vital signs.

Florence Nightingale’s Environmental Theory will also be an anchor for this

study (McEwen and Willis, 2014). In the model, a patient’s environment has a

strong influence on the outcome of care. The goal of nursing in this model is to

alter the patient’s environment in order to affect change in his or her health. Thus,

environmental factors play a great role in a patient’s health. This theory proves that

binaural beat therapy is more than just a pleasant background noise. It may

actually make one healthier and be able to better regulate bodily functions during
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labor and delivery. The researchers can incorporate these beats as an

environmental factor that can alter and change a person’s health status,

specifically, the woman’s perception and feelings of pain. According to Nightingale,

nursing is different from medicine. The goal of nursing is to put the patient in the

best possible condition in order for nature to act. Health is “not only to be well, but

to be able to use well every power we have.” Hence binaural beats, as a byproduct

of environment, may give out extraordinary sense of comfort and relief.

Research Paradigm

Reduced labor pain

Binaural Auditory and anxiety on active
Beats phase of labor

Figure 1. The Effects of Binaural Auditory Beats in Reducing labor Pain on

the Active Phase of Labor

The paradigm entails the independent variables together with the

dependent and intervening variables of the problem in the study. The independent

variable is Binaural Auditory Beats. This variable is what triggered the curiosity of

the researcher. The dependent variable is reducing the labor pain and anxiety of

women on the active phase of labor. This serves as the inference or the result of

the independent variable being mentioned above that is being evaluated. The
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intervening variable connects both the independent and dependent variable and

those are the demographic profiles of the respondents such as age, civil status,

educational background, and medical illnesses.

Statement of the Problem

This study determined the effects of binaural beats in reducing labor pain

and anxiety being experienced by women during the active phase of labor in a

private lying-in clinic in Marikina City.

Specifically, it sought to answer the following sub-problems:

1. What is the profile of respondents in terms of?

1.1 age;

1.2 civil status;

1.3 educational background;

1.4 medical illnesses?

2. What is the level of pain of the respondents before listening to Binaural

Auditory Beats?

3. What is the level of pain of the respondents after listening to Binaural

Auditory Beats?

4. Is there a significant difference between the level of pain of the

respondents before and after listening to Binaural Auditory Beats?

5. What is the level of anxiety of the respondents before listening to

Binaural Auditory Beats?

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6. What is the level of anxiety of the respondents after listening to Binaural

Auditory Beats?

7. Is there a significant difference between the level of anxiety of the

respondents before and after listening to Binaural Auditory Beats?

Research Hypotheses

To assess the relationship between the independent and the dependent

variables of this study, the researcher tested the following null hypotheses that will

be tested on a 0.5 level of significance:

Ho1: There is no significant relationship between binaural auditory beats

and level of pain of the respondents in the active phase of labor.

Ho2: There is no significant relationship between binaural auditory beats

and level of anxiety of the respondents in the active phase of labor.

Significance of the Study

The outcome of this study will be significantly important to the following:

Patients. This study would contribute in helping women in labor in reducing

pain and alleviating any discomforts brought about by labor by using non-

pharmacological interventions. Additionally, by using this method, women can

avoid any adverse reactions associated with pain medications.

Nurses. This study would give them more knowledge about non-

pharmacological approaches made during induction of care to women in labor.

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Moreover, these interventions can help the nurse reduce the patient’s cost of

medication and prevent complications brought about by adverse reactions due to

medication.

Nursing students. This study would help the student nurses enhance their

knowledge in the use of non-pharmacological therapeutic tools in managing pain

and providing relief and comfort. It is one of the vital of skills to learn during the

course of nursing education.

Future Researchers. This study can be used as a reference data in

developing more significant studies in the future. It can provide necessary data

and information regarding non-pharmacological approaches to reducing labor pain

in women.

Scope and Limitation of the Study

This study wants to explore the effects of binaural auditory beats on the pain

and anxiety levels of six (6) women who were in the active phase of labor. It was

conducted in private lying-in clinics in Metro Manila within the months of December

and January.

Definition of Terms

Relevant terms used in the study are as a result of this defined

operationally.
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Active Phase of labor. This is the second phase of labor where the cervix

dilatation is at 3cm up to 7cm. Contractions are more concentrated, more intense

and more painful. Contractions will also become longer, typically lasting 40 to 60

seconds, and more frequent. The researchers utilized the intervention during this

phase.

Anxiety. This is a feeling of worry, nervousness and unease. The

researchers utilized the Hospital Anxiety and Depression Scale to measure the

anxiety level of the respondents during the active phase of labor.

Binaural Auditory Beats. This is a non-pharmacological intervention that

the researchers used in managing pain related to childbirth. The presented audio

utilized rhythmic, pure-toned binaural beats in multiple frequencies ranging from

1.5 hertz to 10 hertz. The beats will be embedded in nature sounds, specifically, a

natural and continuous flow of water. These frequencies are associated with

relaxation, headache relief and lower back pain relief. The respondents can expect

a slight tingling sensation inside their head while they listen to the sound and it will

leave the respondents in an entrained state and, eventually, reduce their labor pain

and/or anxiety levels.

Labor Pain. This is a recurring and intense physical discomfort being

experienced by women in labor. The researchers used the numeric pain scale to

determine the intensity of pain being felt by the chosen respondents during

contractions.