INTRODUCTION:

Labor is a serious of continuous and progressive contractions of the uterus that will help the cervix to dilate and efface. This is the way only the fetus move through the birth canal¹. It is a normal birth as spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and their delivery. The infant is born by spontaneously in the vertex position and its normal position between 37 to 40 completed weeks of pregnancy². Labour pain is caused by the contractions of muscles on the uterus and by pressure over the cervix. The pain can be felt as strong cramping in the groin, abdomen, and back, as well an achy feeling also having. Some women experience pain in their sides or thighs also³.

“Sacral massage” stimulates to release endorphin, which are natural pain killing substances and stimulates for the production of oxytocin, decreases stress hormones and neurological excitability. Individual cells of body with abundant supply of blood and lymph. This supply nutrition and oxygen and it are achieved by sacral massage⁴. “Music therapy” treats acute and chronic pain, stress and anxiety. It diverts the person’s attention away from the pain and creates a relaxation response⁵.

Globally 80% of births in 2021 were the vaginal delivery, with the rates of varying from 95% in sub- Saharan Africa to Caribbean the percentage is 45%⁶.

The current India normal vaginal delivery rate in 2022 is 17.163 births per 1000 mother’s, 2021 was 17.377 births per 1000 people, 2020 was 17.592 births per 1000 live normal vaginal delivery rates, and 2019 was 17.806 births per 1000 mothers in this world⁷.

MATERIAL AND METHODS:

Research Approach: An Evaluative Approach was adopted for this study.

Research Design: The research design selected for the study was Quasi experimental Non equivalent control group post test only design.

Setting of the Study: The study was conducted in selected hospital at Dindigul.

Population: The target population selected for this study was Women in labor.

Sample: The sample consists of women in first stage of labor with 4cm dilatation.

Sample Size: Sample sizes consist of 60, 30 were in experimental group and 30 were in control group.

Sampling Technique: The samples were selected by non-probability purposive sampling technique was used to select the sample for experimental and control group.

Instrument and Scoring Procedure: The tool consists of 3 parts.

Part -I: Demographic variables consist of age in year, religion, education status, occupation, income, area of residence, type of family, type of marriage, age at marriage, number of antenatal visit, and gestational week of the mother at the time of labor.

Part –II

Numerical pain scale consists of level of pain like no pain, mild pain, moderate pain, severe pain. The scoring procedure as follows,

Part -III

Birth satisfaction scale consists of 30 item self report scale was developed for the purpose of gaining new insights into childbearing women’s level of birth satisfaction. The research-based expressions of perceived birth satisfaction/dissatisfactions were transcribed into statements. Birth satisfaction score consist of score very poor, poor, fair, good, and very good. A report from a superimposed scale of women‘s views about their birth experience, with scores out of 150.Birth satisfaction scale was 5-point Likerts Scale. Half of the items are reversing scored a possible range of scores is 30-150, where a score of 30 represents least satisfied and 150 most.

Validity: The content validity of the tool was validated consultation with 1 obstetrician and 3 nursing experts in the field of obstetric and gynaecological nursing. The recommendations and suggestions given by the experts, it was duly considered and corrections were made.

Reliability: Reliability of numerical pain rating scale assessment was established by testing the internal consistency by using Cronbach’s alpha formula and to be reliable (r=0.91)

Reliability of birth satisfaction scale tool were assessed by the internal consistency by using Cronbach’s alpha formula and to be reliable (r=0.99)

Protecting the Human Rights:

Selected sacral massage with petroleum jelly and music therapy will help to reduce the pain perception and improve the birth satisfaction among women in labor. Which will enable the women in labor to cope up with the pain and promote comfort and satisfaction during first stage of labor and thereby enhancing the safe confinement.

Data Collection Procedure:

The main study was conducted in Kasturba hospital at Dindigul. The data collection done for a period of 6 weeks. The investigator obtained written permission from the medical director in Kasturba hospital. The written consent was obtained from each participant prior to the study. The purpose of the study was explained to the subject were selected by using purposive sampling techniques in both groups. 30 samples were selected for control group and 30 samples were selected for experimental group respectively. The researcher plan to select subject who fulfilling the inclusion criteria for control group and the researcher completed the control group first. Post test was done for the control group to assess the level of pain perception by using numerical pain rating scale and birth satisfaction by using birth satisfaction scale. Researcher gave routine hospital care for the laboring mother.

After completion of control group the samples were selected in experimental group, subjects who had fulfilled the inclusion criteria. During the contraction the mother were taught to do the sacral massage for 10 minutes it includes, to preventing friction, drop of petroleum jelly was used for all the steps. Apply pressure over the sacrum with the index finger of the right-hand f or 2 minutes. Apply pressure with the use of thump finger of both hands and either side of the sacrum to lumbar vertebrae for 5 minutes. Massage lateral parts of the lumbar vertebrae on both sides, with the pad of fingers in circular motion for 3 minutes.

Immediately will start with music therapy for 20 minutes it includes Instruct the mother to relax the whole body by following body relaxation method for 5 minutes (Legs, Knees, Thighs, Hip, Shoulders, Hands) Start the hypnobirthing music with mother using the ear phone for 15 minutes. After completing intervention post test was conducted to assess the level of Pain perception by using numerical pain rating scale and to assess the birth satisfaction by using birth satisfaction scale. Repeat for the procedure for after the next contraction start.

Table 1: Frequency and percentage distribution of post-test level of pain perception among women in labor in experimental group and control group. n₁₌30, n₂₌30

S. No.	Level of Pain Perception	Experimental Group		Control Group
		Post test		Post test
		F	%	F	%
1.	moderate pain	24	80	2	7
2.	severe pain	6	20	28	93

Table 1 depicts that in experimental group post test majority 24(80%) was had moderate pain, 6(20%) was severe pain. In control group the post test 28(93%) severe pain perception 2(7%) severe pain perception. No one falls in the category of no pain and mild pain.

Table 2: Frequency and percentage of post test level of birth satisfaction among women in labor in experimental group and control group. n₁₌30, n₂₌30

S. No.	Level of birth satisfaction	Experimental group		Control group
		Post test		Post test
		F	%	F	%
1.	Fair	1	3	27	90
2.	Good	1	3	3	10
3.	Very good	28	94	0	0

Table 2 depicts that in experimental group post test majority 28(93%) had fair, 1(3%) had good birth satisfaction, 1(3%) had very good birth satisfaction. Whereas In control group the post test majority of the mother 27(90%) had fair birth satisfaction,3 (10%) has good birth satisfaction. No one fall in the category of very poor birth satisfaction and poor birth satisfaction.

Table 3 showed that the mean post test score of pain perception in experimental group and control group was 6(SD±0.66) AND 8.13(SD±0.66). The mean difference was 2.13. The calculated independent “t” value was 50.45 was significant at p< 0.05, level, which showed that sacral massage, and music therapy was effective in reducing pain perception among women in labor. Hence H₁ the mean post test level of pain perception in experimental group is significantly lower than the mean post test level of pain perception in control group was accepted.

Table 3: Comparison of mean, standard deviation, mean difference and independent “t” test value of post test level pain perception among women in labor in experimental and control group. n₁₌30, n₂=30

S.No	Variable	Mean	Standard deviation	Mean difference	Independent “t” value	Table value	Inference
1	Experimental group	6	±0.66	2.13	50.45	2.00	Significant
2	Control group	8.13	±1.56

df= 58 P<0.05

Table 4: comparison of mean, standard deviation, mean difference and independent “t” test value of birth satisfaction among women in labor between experimental and control group. n₁₌30, n₂=30

S. No	Variable	Mean	Standard deviation	Mean difference	Independent “t” value	Table value	Inference
1	Experimental group	107.4	±6.36	23.8	16.08	2.00	Significant
2	Control group	83.6	±6.12	23.8	16.08	2.00	Significant

df= 58 P<0.05

Table 4 showed that the mean post test score of birth satisfaction in experimental group and control group was 107.4(SD±6.36) AND 83.6(SD±6.12). The mean difference was 23.8 the calculated independent “t” value was 16.08 was significant at p< 0.05, level, which showed that sacral massage and music therapy were effective in improving birth perception among women in labor. Hence H₂the mean post test level of birth satisfaction in experimental group is significantly higher than the mean post test level of birth satisfaction in control group was accepted.

Chi square values were calculated to find out the association between post test level of pain perception among women in labor and their demographic variables. The findings revealed that there is no significant association between post test level of pain perception and demographic variables. Except religion (χ²= 119.9), educational status (χ² = 13.2), occupation (χ² = 16.25) at P < 0.05 level of significance in experimental group. Hence H₃there is a significant association between post test level of pain perception among women in labor and their selected demographic variables in experimental group.

Chi square values were calculated to find out the association between post test level of birth satisfaction among women in labor and their demographic variables. The findings revealed that there is no significant association between post test level of pain perception and demographic variables. Except age in year (χ² = 8.1), educational status (χ² = 313.4), occupation (χ²= 31.7), and age at marriage (χ² = 189.6) at P < 0.05 level of significance in experimental group. Hence H₄there is a significant association between post test level of birth satisfaction among women in labor and their selected demographic variables in experimental group.

RESULTS AND DISCUSSION:

Regarding age in experimental groups, a majority of mothers 2(73%) belongs to the age group of 21-25 years, 8(27%) belonged to the age group of 26-30 years. in control groups, a majority of mothers 17(57%) belongs to the age group of 21-25 years, 13(43%) belonged to the age group of 26-30 years. Regarding religion in experimental groups, a majority of mothers 21(70%) was Hindu, 7(23%) was Christian, 2(7%) was Muslim, in control groups, a majority of mothers 15(50%) was Christian, 14(47%) was Hindu, 1(3%) was Muslim. Regarding educational status in experimental group, majority of mothers 15(50%) was graduate, 12(40%) was high school, 3(10%) was primary school. In control group mothers13 (43%) was graduate, 12(40%) was high school, 5(17%) was primary school. Regarding occupation in experimental group, majority of the mothers 20(67%) was house wife, 9(30%) was private job, 1(3%) was government job. in control group, majority of the mothers 20(67%) was house wife, 8(26%) was private job, 2(7%) was government job. Regarding type of family in experimental group, majority of the mothers 18(60%) was joint family, 12(40%) was nuclear family. in control group, majority of the mothers 20(67%) was joint family, 10(33%) was nuclear family. Regarding monthly income in experimental group, majority of the mothers 20(67%) was above Rs.12.001, 9(30%) were in between Rs. 8001- Rs 12.000, 1(3%) were in between Rs.4001- Rs 8000. in control group, majority of the mothers 21(70%) was above Rs.12.001, 9(30%) were in between Rs. 8001- Rs 12.000. Regarding area of residence in experimental group, majority of the mothers 20(67%) was rural, 10(33%) was urban. in control group, majority of the mothers 20(67%) was rural, 10(33%) was urban. Regarding type of marriage in experimental group, majority of the mothers 27(90%) was non- consanguineous, 3(10%) was consanguineous. in control group, majority of the mothers 21(70%) was non- consanguineous, 9(30%) was consanguineous. Regarding age at marriage in experimental group, majority of the mothers 22(73%) were in between 21- 25 years, 6(20%) were in between 26- 30 years, 2(7%) was in between 18- 20 years. in control group, majority of the mothers 23(77%) were in between 21- 25 years, 5(16%) were in between 18-20 years, 2(7%) was in between 26- 30 years. Regarding number of antenatal visit in experimental group, majority of the mothers 28(93%) was in above 6 visit, 1(3%) were in between 4-6 visit, 1(3%) were in between 1- 4 visit. in control group, majority of the mothers 20(67%) was in above visit, 10(33%) were in between 4-6 visit. Regarding gestational week of the mother at the time of labor in experimental group, majority of the mothers 20(67%) were in between 39-40 weeks, 10(33%) were in between 37- 38 weeks. in control group, majority of the mothers 26(87%) were in between 39-40 weeks, 4(13%) were in between 37- 38 weeks. In experimental group post test majority 24(80%) was had moderate pain, 6(20%) was severe pain. In control group the post test 28(93%) severe pain perception 2(7%) severe pain perception. No one falls in the category of no pain and mild pain. In experimental group post test majority 28(93%) had fair, 1(3%) had good birth satisfaction, 1(3%) had very good birth satisfaction. Whereas In control group the post test majority of the mother 27(90%) had fair birth satisfaction, 3(10%) has good birth satisfaction. No one fall in the category of very poor birth satisfaction and poor birth satisfaction.

CONCLUSION:

The present study was conducted to evaluate the effectiveness of sacral massage and music therapy on pain perception and birth satisfaction in selected hospital. The calculated independent ‘t’ value for level of pain perception was 50.45 which was significant at p<0.05 level of significance. The calculated independent ’t’ value for the birth satisfaction was 16.8 which was significant at p<0.05 level of significance. The result of the study showed that sacral massage and music therapy effective in reducing the level of pain perception and improving birth satisfaction among women in labor.

NURSING IMPLICATIONS:

The findings of the study have certain improvement implication for

· Nursing service

· Nursing education

· Nursing administration

· Nursing research

NURSING SERVICE:

· The nurse must conduct in service education about non- pharmacological measures used in treating women under labor pain.

· Nurse as the change agent, can introduce the various measures for reduction of level of pain perception and improving birth satisfaction among women in labor got admitted in the labor ward.

NURSING EDUCATION:

· The nurse educator can orient the student with alternative therapies in reducing level of pain perception and improving birth satisfaction among women in labor.

· Nurse educator should motivate the student to do mini project on techniques to promote sacral massage and music therapy among women in labor.

· Nurse educator should conduct workshop and seminars to update the knowledge of the students to promote practicing alternative therapies among women in labor.

· Encourage the students for effective utilization of evidence based practice.

NURSING ADMINISTRATION:

· Nursing administration should take on initiative in creating policies and plan to providing education to who are in pregnancy state and help them in safe delivery.

· Nurse administrator needs to facilitate the utilization of evidence based nursing care aspects in day to day practice to formulate policies and make necessary changes in health care delivery therapy system in hospital.

· Nurse Manager can plan for antenatal classes for sacral massage and music therapy as well as video assisted programme on OPD basis in order to prepare the mother to perform during intrapartum period.

· Provide opportunities for the nurse midwife to attend training program on complimentary therapies for labor pain management.

NURSE RESEARCH:

· Nurse could conduct research on other non – pharmacological measures to assess the effectiveness of sacral massage and music therapy on pain perception and birth satisfaction among women in labor.

· The study findings can be effectively utilized by the emerging researchers to conduct further studies.

· The latest journal and current research findings can be updated to the nursing staff through provision of web services.

RECOMMENDATION:

Based on the findings the following recommendations are started

· Similar study can be replicated in large samples thereby findings can be generalized to a large population

· Comparative study can be done between the effectiveness of various non pharmacological measures on reducing pain perception and improving birth satisfaction among women in labor.

LIMITATION:

· The study was limited to only women in labor.

· It was time consuming to explain the mothers undergone women in labor of difference in their level of understanding.

· The mother can’t able to hear the hypnobirthing music during the contraction time. So that the researcher will suffer to give music therapy.

REFERENCES:

1. Lowder Milk Perry Bobak. Maternity and women’s health car., (6^thedition). Mosby Company. 210 – 225

2. D.C. Dutta. Text Book of Obstetrics. (5^th edition), Calcutta: New Central Book Agency . 2022; 114-130.

3. 1-lansee S.B., and O’Connel. The effects of music on relaxation of expectant women during labor. Journal of Music Therapy. 1983; 20(2): 50-58.

4. Hesman.L.Fonteins P. The nature and Management of labor pain. American Journal of Nursing. 2001; 63

5. http:// www. Pain Management Nursing. Orgut

6. http://www.statista.com

7. https:// American pregnancy .org/ labor and birth / birthing.com

Received on 28.02.2024 Modified on 25.05.2024

Int. J. of Advances in Nur. Management. 2024; 12(3):115-119.

DOI: 10.52711/2454-2652.2024.00026