INTRODUCTION:

The pregnancy is the vital event in the life of women. It needs special attention and care from the time of conception to the post natal stage. As labour is a new experience in pregnant women hence anxiety is inevitable. It includes fear of injury to the self and new born, fear of effects in labour and their trauma’s and symptoms, fear of complications during delivery. Pregnancy is at best surprising and at worst chaotic with hormonal changes, pain, stresses, and more it’s nearly impossible to fully prepare yourself for the road ahead to ensure that you are ready to face what’s in front of you. Hormonal changes during pregnancy appear to make one more prone to anxiety and panic attacks simply because they allow certain parts of the brain to become activated during periods of intense stress.²

At this time mother too needs a lot of help for the realization and acceptance of childbirth as a normal physiological phenomenon. The women experience of childbirth is influenced by the knowledge and expectations she has of childbirth. Her expectations from childbirth are based on the information she got from the antenatal clinic, the nursing staff, her mother, friends and family. The purpose of this research was to determine the level of anxiety in women going through labour. Mental preparation is as important as physical and maternal preparation to decrease the anxiety during labour. Sufficient opportunity and time must be given to the expectant mothers to have a free and frank talk on aspects of pregnancy and delivery. It ensures good health throughout purperium, and that every pregnancy may culminate in healthy mother and healthy baby.²

OBJECTIVES:

1. To assess the level of anxiety related to labour among women admitted in labour room.

2. To determine the association between anxiety score with selected socio-demographic variables.

OPERATIONAL DEFINITIONS:

ANXIETY- It refers to the feeling of uneasiness and nervousness regarding the process of labour in women admitted in labour room¹.

WOMEN- It refers to the females of reproductive age 20-45 undergoing labour process admitted in labour room.¹

ASSUMPTIONS:

Women’s level of anxiety will increase during labour.¹

DELIMITATIONS:

The study was limited to women:

· Who were admitted at military hospital Jalandhar Cantt?

· Who were in their reproductive age?

· Who were willing to participate in the study?

RESEARCH METHODOLOGY:

The methodology indicates the general pattern of organizational procedure for gathering valid and reliable data of research purpose. This deals with the methodology undertaken to assess the level of anxiety related to labour among women admitted in labour room, Military Hospital, Jalandhar Cantt, Punjab 2019.

RESEARCH APPROACH:

A quantitative non experimental research approach was used for the concerned study.

RESEARCH DESIGN:

Descriptive research design was used to conduct this study.

RESEARCH SETTING:

The present study was conducted at labour room of Military Hospital, Jalandhar Cantt, and Punjab. The reason for selecting this hospital was investigator’s convenience and expected co-operation from the authorities in getting permission for conducting the study.

VARIABLES:

Research variables: Mother’s age 20-45 years, education, occupation, religion, type of family, source of information on labour.

TARGET POPULATION:

The target population of the study was women undergoing labour admitted in labour room of Military hospital, Jalandhar Cantt.

SAMPLE AND SAMPLINGTECHNIQUE:

Sample for study were the women undergoing labour in labour room. Sample size was 60. Non probability convenience sampling technique was used to select the sample.

INCLUSION CRITERIA:

· Women who are undergoing labour.

· Women who are available for data collection (women who are kept on induction)

EXCLUSION CRITERIA:

· Women who are not willing to participate.

· Women who are not present during the time of data collection.

· Women with other gynaecological disorder.

· Women who are not undergoing labour.

DEVELOPMENT AND DESCRIPTION OF TOOL:

The tool was developed after discussion with the expert to understand the underlying statement and objectives of the study. The extensive literature review was done on anxiety related to labour process to select and develop a tool. Modified Beck’s anxiety inventory was used to assess the level of anxiety regarding labour process.

IT CONSISTS OF TWO SECTIONS:

Section–A: Includes variables such as age, educational status, family income, type of family and source of information.

Section–B:

Consists of modified beck’s anxiety inventory which includes 21 items to assess the anxiety in mothers related to labour process.

RELIABILITY OF RESEARCH TOOL:

The reliability of the research tool was established with the help of Karl Pearson correlation coefficient method before. The reliability was found to be 0.6 highly reliable. Hence tool was found to be reliable.

ETHICAL CONSIDERATION:

· After explain the type and purpose of the study written permission was taken from Principal Madam, Commandant of Military hospital, Jalandhar Cantt.

· Verbal consent was taken from subjects after explanation of purpose of study.

· The responses of subject were kept confidential.

PILOT STUDY:

The pilot study is the sample test of actual study. To ensure the reliability and feasibility, the pilot study was conducted in labour room military hospital, Jalandhar Cantt.

DATA COLLECTION PROCEDURE:

A formal written permission was obtained from Commandant military hospital, Jalandhar Cantt. Data was collected in military hospital. 60 subjects were selected by convenient sampling technique. The purpose of study was explained to subjects and verbal consent was obtained after this data was collected through prepared.

ORGANISATION OF DATA FOR ANALYSIS:

The analysis of the data is done in accordance with the study.

Demographic characteristics:

Table 1: Percentage distribution of demographic characteristic shows that maximum 68.33% of women were in age group of 26-30 years followed by 23.33% in <25 years and minimum i.e. 8.33% were in the age group 31-35 years. Maximum 41.66% were graduate followed by 30% have intermediate education, 25% have post graduation degree and minimum I.e. 3.33% have matriculation as education background. Maximum 75% have 25,001-40,000 family income followed by 23.33% have >40,000 and minimum i.e. 1.66% have 10,001-25,000. Maximum 76.66% belongs to joint family followed by 15% from nuclear family and minimum i.e. 8.33% from extended family. Maximum 36.66% have less knowledge followed by 35% have good knowledge, 15% have appropriate knowledge and minimum i.e. 13.33% have no knowledge. Maximum 60% had previous experience as source of knowledge followed by 11.66% from neighbours as well as internet and minimum 3.33% from others. Maximum 63.33% are multigravida followed by 31.66% as primigravida, 3.33% had abortion and minimum i.e. 1.66% had stillbirth.

Fig 1 (A): Percentage distribution according to Age

Fig 1(B): Percentage distribution according to Education

Fig 1(C): Percentage distribution according to Family Income

Fig 1(D): Percentage distribution according to Type of Family

Fig 1(E): Percentage distribution according to knowledge regarding labour

Fig 1(F): Percentage distribution according to source of knowledge

Fig 1(G): Percentage distribution according to Gravida

Objective 1: To assess the level of anxiety regarding labour among primigravida and multigravida women admitted in labour room. Distribution of mean anxiety score regarding the anxiety of labour among primigravida and multigravida women:

It depicts the level of anxiety among primigravida and multigravida mothers. Here, maximum i.e. 45% women had moderate to severe anxiety with mean score 23.74 and given as rank I, followed by 38.333% had mild to moderate anxiety with mean score 15.39 and given as rank II, ~10% had severe anxiety with mean score 73.80 and given as rank III, 6.666% had minimal to mild anxiety with mean score 6.50 and given as rank IV.Hence, it can be concluded that maximum number of women had moderate to severe anxiety regarding labour process.

Objective II: To determine association of level of anxiety with socio-demographical variables Mean knowledge score regarding the knowledge of level of anxiety in primigravida and multigravida women according to age:

It depicts that maximum number of women belongs to the age group <25-30 years with the mean score 0.062, followed by age group 31-45 years with the mean score 0.Hence , it concluded that maximum number of women belongs to age group 31-45 and had good knowledge regarding the level of anxiety.

Mean knowledge score of knowledge of level of anxiety in primigravida and multigravida women according to Education:

It depicts that mean knowledge score of knowledge level of anxiety in primigravida and multigravida women according to education.

Mean knowledge score on knowledge of level of anxiety among primigravida and multi gravida according to Income:

It depicts that mean knowledge score on level of anxiety among primi and multigravida women according to IncomeIt is found that maximum of women having income between 25001->40000 with mean score 0.019 followed by women having income between <10,000-25000 with mean score 0.

Mean knowledge score on knowledge of level on anxiety among primigravida and multi gravida according to Type of family:

It depicts that mean knowledge score on level of anxiety among primi and multigravida women according to Type of family It is found that maximum of women from nuclear and joint family with mean score 0.215 followed by women from extended and others family with mean score 0.

Mean knowledge score on knowledge of level on anxiety among primigravida and multi gravida according to Knowledge regarding labour:

It depicts that mean knowledge score of knowledge level of anxiety in primigravida and multigravida women according to Knowledge regarding labour It has found that maximum number of women having less and no knowledge with mean score 3.571 followed by good and approximate knowledge with mean score 1.004.

Mean knowledge score on knowledge of level on anxiety among primigravida and multi gravida according to Source of knowledge:

It depicts that mean knowledge score of knowledge level of anxiety in primigravida and multigravida women according to source of Knowledge. It has found that maximum number of women having knowledge from internet or other sources with mean score 125 followed by knowledge from neighbours and previous experience with mean score 0.333

Mean knowledge score on knowledge of level on anxiety among primigravida and multigravida according to Gravida:

It depicts that mean knowledge score of knowledge level of anxiety in primigravida and multigravida women according to Gravida. It has found that maximum number of women in abortion and stillbirth gravida with mean score 15 followed by primi and multigrvidawith mean score 0.0681.

MAJOR FINDINGS:

OBJECTIVE 1: TO ASSESS THE LEVEL OF ANXIETY REGARDING LABOUR AMONG PRIMIGRAVIDA AND MULTIGRAVIDA WOMEN ADMITTED IN LABOUR ROOM:

The analysis of data revealed the followingmaximum i.e. 45% women had moderate to severe anxiety with mean score 23.74 and given as rank I, followed by 38.333% had mild to moderate anxiety with mean score 15.39 and given as rank II, ~10% had severe anxiety with mean score 73.80 and given as rank III, 6.666% had minimal to mild anxiety with mean score 6.50 and given as rank IV. Maximum number of women belongs to the age group <25-30 years with the mean score 0.062, followed by age group 31-45 years with the mean score 0 Maximum number of women belong to matriculation and intermediate with mean score 0.2153 followed by graduate and postgraduate with mean score 0.0267 Maximum of women having income between 25001->40000 with mean score 0.019 followed by women having income between <10,000 - 25000 with mean score 0Maximum of women from nuclear and joint family with mean score 0.215 followed by women from extended and others family with mean score 0.

Maximum number of women having less and no knowledge with mean score 3.571 followed by good and approximate knowledge with mean score 1.00Maximum number of women having knowledge from internet or other sources with mean score 125 followed by knowledge from neighbours and previous experience with mean score 0.333 Maximum number of women in abortion and stillbirth gravid with mean score 15 followed by primi and multigravida with mean score 0.

OBJECTIVE 2: TO DETERMINE ASSOCIATION OF LEVEL OF ANXIETY WITHSOCIO-DEMOGRAPHIC VARIABLES:

The finding of the study had shown there is impact of Age, Education, Income, Type of family, Knowledge regarding labour, Source of knowledge and Gravidaon knowledge score regarding level of anxiety.

CONCLUSION:

A descriptive study was done to assess the level of anxiety regarding labour among primigravida and multigravida women admitted in labour room, military hospital, Jalandhar Cantt, 2019. It was concluded that 6.666% women had minimal to mild anxiety, 38.333% had mild to moderate anxiety, 45% women had moderate to severe anxiety, and 10% had severe anxiety regarding labour process. It was also concluded that there was significant association between the level of anxiety regarding labour among primigravida and multigravida women and their sociodemographic variables (age of the women, education, and family income, type of family, gravida, and previous knowledge regarding labour).

IMPLICATIONS:

Findings of the study provide several implications in nursing practices, nursing administration, nursing education and nursing research.

NURSING PRACTICE:

· The study can guide the nurses for active involvement through health education and teaching programme in clinical as well as in community setting regarding labour process.

· The present study can encourage nurses to explore more on the same topic.

NURSING ADMINISTRATION:

· Nurse administrators may organize the programs for nurses to update their knowledge regarding labour process.

· Nurse administrator should plan and provide in- service education to staff nurses on various aspects of labour process and conduct counselling programme for the nurses and parents in meeting their needs.

NURSING EDUCATION:

· It will help to prepare dedicated nurses to impart their education in both community and clinical areas by using various methods of educational technology to educate the women regarding labour process.

· These findings can be used in seminars, workshops and conferences etc.

· Hence, nursing curriculum for all level of nursing courses should provide in depth knowledge regarding labour process.

NURSING RESEARCH:

· The present study can be valuable source of data for the future researches.

· The study can be replicated and the data can be used to disseminate knowledge regarding labour process among pregnant women to a large population.

· The research methodology, tools and findings of the study and instructional module can be added to utilize in various Indian population for the purpose of standardization.

LIMITATIONS:

· The size of sample was 60 in which only those women were included who were in their reproductive age hence it was difficult to make a broad generalization.

· Purposive sampling was done from Military Hospital, Jalandhar Cantt, Punjab, which restricted the generalization of study findings.

· The study was limited to primigravida and multigravida women admitted in labour room and were willing to participate in the study.

RECOMMENDATIONS:

· The study can be repeated by taking a larger sample so as to validate and generalize the findings.

· A comparative study can be done among primigravida and multigravida women.

· A true experimental study can be conducted to evaluate the effectiveness of information booklet.

· A follow up study can be done to analyse women attitude towards labour process.

· An experimental study can be done to evaluate the effectiveness of planned teaching programme.

· A similar study can be done to assess the attitude of women towards learning about labour and its process.

REFERENCES:

1. Ningthoujam Sujita Devi, Priyanka Sindhe, Gulista Shaikh, Shital Khole. Level of anxiety towards childbirth among primigravida and multigravida mothers: International Journal of Applied Research: 2018;4(5):10-13.

2. Raksha G, Anjali T, Kirna T. Anxiety among the primigravida planned for normal vaiginal delivery and caesarean section: Matern Pediater Nutr, An Open Access Journal:2017; 3(1)

3. Ms Nisha Walia, Mrs Vadivukkarasi Ramanadin.Level of anxiety related to labour process among the primigravida: International Journal of Nursing Education and Research :2013;1(1)

Received on 27.02.2020 Modified on 30.03.2020

Int. J. of Advances in Nur. Management. 2020; 8(3):181-186.

DOI: 10.5958/2454-2652.2020.00043.8