INTRODUCTION:

Labor pain intensity is one of the most severe pains that almost all women experience during labor, which may have some adverse effects for the mothers and fetus.

Therefore, pain relief care for mothers during labor is very important, and both pharmacological and non-pharmacological methods can be used for this purpose. The use of complementary and alternative medicine (CAM) for pain reduction among women during labor has grown in the past decade. In women with respiratory and heart diseases or mothers who have allergy to drugs, use of non-pharmacological methods such as CAM is more necessary as an alternative. Massage, muscle relaxation, breathing techniques, music therapy, mind body techniques, reflexology, herbal medicines, hypnosis, and touch therapy are some types of CAM that use to reduce the pain in the world. Massage therapy for pain relief during labor stage can reduce need for analgesic drug consumption. (Mehdi Ranjbaran, 2017)

SevgulDonmez and OyaKavlak (2015) conducted a study on Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perineum stated that, each year more than approximately 600,000 women die due to complications related to pregnancy and childbirth. Vast majority of them has been determined to occur in undeveloped countries. Antenatal, perinatal and postnatal care is among the fundamental protective services for protection and improvement of the health of both mother and the infant to be delivered. The study was found that perineal massage and Kegel exercises are important in maintaining the integrity of perineal significantly. It is thought that when the perineal massage and Kegel exercise being performed during pregnancy is supported by health professional, it will play a significant role in women’s quality of life.

Jamie Hatcher (2018) stated that, perineal massage is a simple technique that can be done before the birth which may reduce the incidence of perineal trauma or tearing. The technique works by gently stretching the perineal tissues, thus increasing the elasticity of the perineum. Regular practice of perineal massage may also help the woman anticipate and adjust to the sensations associated with crowning and birth.A review of research studies focused on the outcomes of perineal massage found that there are some benefits! Women who performed perineal massage starting between 34-36 weeks of pregnancy experienced a small reduction in the likelihood of perineal trauma and ongoing perineal pain. The most significant benefit noted was a decrease in episiotomy rates among women who did perineal massage. Women who performed perineal massage also reported feeling that the area returned to feeling normal more quickly, and reported less pain 3 months after childbirth. So it looks like perineal massage is a good thing to be doing.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of perineal massage on labour outcome among primi mothers at selected hospital, Erode.

OBJECTIVES:

· To determine the effectiveness of perineal massage on labour outcome among primigravida mothers in both the groups.

· To find out the association between post test scores of labour outcome among control and experimental group of primigravida mothers with their demographic variables.

Hypothesis:

H1: There is a significant difference in the labour outcome among control and experimental group of primi gravid mothers after implementation of perineal massage.

H2: There is a significant effectiveness of perineal massage on labour outcome among primi gravid mothers in both the groups.

H3: There is a significant association between post test scores of labouroutcome among control and experimental group of primi gravid mothers with their demographic variables.

REVIEW OF LITERATURE:

WHO recommendation on techniques for preventing perineal trauma during labour, (2018) stated that, Globally, approximately 140 million births occur every year. The majority of these are vaginal births among pregnant women with no identified risk factors for complications, either for themselves or their babies, at the onset of labour. However, in situations where complications arise during labour, the risk of serious morbidity and death increases for both the woman and baby. Over a third of maternal deaths and a substantial proportion of pregnancy-related life-threatening conditions are attributed to complications that arise during labour, childbirth or the immediate postpartum period, often as result of haemorrhage,

Roonak Shahoei Farzaneh Zaheri, Lila Hashemi Nasab and Fariba Ranaei (2017) conducted a randomized clinical trial on the effect of perineal massage during the second stage of birth on nulliparous women and concluded that childbirth and puerperium are of the most important periods in women’s lives and can affect different aspects of their lives. Although childbirth is a physiological process, there is a risk of perineal trauma when the neonate’s head is exiting, and thus, an episiotomy may be needed. Perineal trauma refers to any damage to the genital tract during childbirth spontaneously or because of episiotomy.

Perineal massage during labor is associated with significant lower risk of severe perineal trauma, such as third- and fourth-degree lacerations. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant. (Carmen Imma Aquino.et.al., 2018)

Amira S. Dieb.et., al, 2020, conducted a study on Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy. Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively).It was concluded that performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

Mehdi Ranjbaran, Maahboobeh Khorsandi, Pegah Matourypour, and Mohsen Shamsi, Effect of Massage Therapy on Labor Pain Reduction in Primiparous Women: A Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials in Iran, stated that Pain is a common experience for women during labor. Therefore, pain relief care for mothers during labor is very important. The results of Chi-square based on Q-test and I2 statistics showed heterogeneity among studies in the latent phase (Q = 63.52, P value < 0.001 and I2 = 87.4%), active phase (Q = 26.42, P value < 0.001, and I2 = 77.3%), and transitional phase (Q = 104.84, P value <0.001, and I2 = 95.2%). Results showed that massage therapy reduces labor pain in the latent phase (SMD = −1.23, 95% CI: −1.73 to −0.74), active phase (SMD = −1.59, 95% CI: −2.06 to −1.12), and transitional phase (SMD = −1.90, 95% CI: −3.09 to −0.71). This study provides valid evidence for the effect of massage therapy in Iran for labor pain relief. Therefore, the use of massage therapy can be recommended in the primiparous women.

Labour pain is considered as one of the most intense forms of pain. Psychological challenge such as anxiety can contribute towards women’s perception of pain and may also affect their labor and birth experience. There are modern many non-invasive methods to relieve pain during childbirth. Among these methods is aromatherapy which is the most popular complementary therapy during child birth. Therefore this study aimed to assess the effect of aromatherapy massage using lavender oil on the level of pain and anxiety during labor among primigravida women. The present study concluded that aromatherapy massage with lavender oil can reduce pain and anxiety during labour. Also, it is an effective way to decrease labor duration. It was recommended that lavender aromatherapy massage can be offered to women in labour for pain relief. (Sahar Mansour Lamadah, Ibtesam Nomani,2016)

MATERIAL AND METHODS:

Research approach:

The research approach used for the present study was a quantitative approach and evaluate in nature.

Research design:

The research design selected for the present study was true experimental design where posttest only with control group design.

Setting:

The study was conducted in private maternity hospital, Erode district.

Population:

The population for the present study was all the mothers attended antenatal OPD at private maternity hospital, Erode district.

Sample:

The sample consisted of 30 (15 control and 15 experimental group) primi mothers attending antenatal OPD in private maternity Hospital, Erode District.

Sampling technique:

Simple random sampling technique was used to select the sample for the study.

Development of tool:

Based on the objectives demographic data and maternal outcomes observational rating scale will be used to assess labour outcome. The tool was formulated based on the review of literature and discussion with the three experts in the field of nursing.

Description of the tool:

Description of the tool refers to the explanation of the content of the tool.. The tool used for this study is divided into two sections.

Section – 1 Demographic variable:

The section deal with the demographic information which included Age, types of family, education, occupation, family income, religion, residential area and previous source of information regarding perineal massage.

Section – 2 –Maternal outcomes observational rating scale:

It consists of ongoing assessment tool to evaluate maternal outcome such as duration of 1^st, 2^nd and 3^rd stage of labour, cervical dilatation in latent,active and transitional phase, amniotic fluid status, episiotomy, perineal tear, maternal fatique, uterine contraction, fetal movement, FHR, blood loss, vitals, mode of delivery, separation of placenta, bladder and bowel pattern and consciousness.

Data collection procedure:

The data on labour outcome were collected from primi mothers in private maternity hospital, Erode. The data were collected for 4 weeks in the month of June 2021. Permission was sought and obtained from administrative officer. The primi mothers were selected by simple random sampling method among those who fulfilled the sampling criteria. Totally 30 mothers were selected and divide them as 15 each in group (control and experimental). From both group the personal data were collected and to the experimental group external perineal massage was taught to the primi mother by demonstration. The mother encouraged to practice ittwice a week for the duration of 20 minutes from 7th months to onset of labour. Post test was conducted for both control and experimental group with Maternal outcomes observational rating scale while mother was admitted in labour ward with pain and assessed labour outcome. Confidentiality of the information shared was assured the mothers were well co-operative.

Plan for data analysis:

· Labour outcome among primi mothers in control group after antenatal exercise was analyzed by using frequency, percentage, mean, standard deviation and mean percentage.

· Labour outcome among primi mothers in experimental group after antenatal exercise was analyzed by using frequency, percentage, mean, standard deviation and mean percentage.

· Determine the effectiveness of perineal massage on labour outcome among primi mothers in both the groups will be analyzed by using paired “t’’ test and unpaired “t” test.

· Association between post test scores of labour outcome among control and experimental group of primigravida mothers with their demographic variables will be analyzed by using chi-square test.

RESULTS:

Section A: Frequency and percentage wise distribution to assess the effectiveness of perineal massage on labour outcome among primi mothers at selected hospitalaccording to their demographic data.

Frequency and percentagewise distribution a study to assess the effectiveness of perineal massage on labour outcome among primi mothers at selected hospital, Erode, according to their demographic data,regarding age of the mother in both control and experimental group similar majority 40% (6) of the mothers were between 24-26 years, according to their education the highest percentage in control group 40% (6) had no formal education and in experimental group 33.3% (5) had high school education, in occupation majority 40% (6) of the mothers were private employee in both control and experimental group, the family monthly income of the mother shows that the majority 46.7% (7) of them earning Rs. 5001-10,000 in control group whereas in experimental group majority 46.7% (7) of them earning below Rs.5000.

According to their type of family in control group the majority 53.3% (8) of them were in joint family and majority of the mothers in experimental group were 60% (9) belongs to nuclear family. In both the groups the highest percentage 53.3% (8) and 40% (6) of the primi mothers were lived in rural areas. Regarding previous source of information the highest percentage in control group 40% (6) of them got from health professional whereas in experimental group the highest percentage 40% (6) of them got the information from mass media.

It infers that the effectiveness of perineal massage on the maternal outcome during labour among primi mothers in experimental group overall posttest mean score was 32.4, SD of 2.99 and the mean percentage was 5.4. The obtained‘t’ value was 4.96 (p<0.001) was highly significant. Hence it was inferred that the perineal massage was more effective andthe maternal outcome was fair during labour among the primi mothers in experimental group.

Section E- Data on Association between the Posttestlevel of maternal outcome and the Selected Demographic Variables among primi mothers in Control and Experimental Group.

Among the control group there was no significant association between maternal outcome and demographic variables such as age (χ2=3.45), education (χ2=0.93), occupation (χ2=0.73), income per month (χ2=0.06), type of family (χ2=0.218), living area (χ2=0.11) and previous source of information (χ2=1.13) at 0.05 level respectively. Whereas in experimental group also there was no association between the maternal outcome and demographic variables such as age (χ2=1.61), education (χ2=1.607), occupation (χ2=6.96), income per month (χ2=2.95), type of family (χ2=1.22), living area (χ2=2.14) and previous source of information (χ2=2.94) at 0.05 level respectively.

CONCLUSION:

The perineal massage was more effective in improving maternal outcome during labour among the primi mothers in experimental group.

There was no significant association between the maternal outcome and demographic variables such as age, education, occupation, income per month, type of family, living area and previous source of information regarding perineal massage in both control and experimental group.

RECOMMENDATIONS:

· Replication of the study could be done with a larger sample to validate and generalize the findings.

· The study can be conducted among different groups in hospital and community settings.

· Comparative study can be done to assess the effectiveness of perineal massage and antenatal exercise among primi gravida mothers.

REFERENCES:

1. Amira Y. Shoab.et.al., Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial, International Urogynecology Journal volume 31, pages613–619(2020)

2. Carmen Imma Aquino.et.al., Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials, J Maternal Fetal Neonatal Med. 2020 Mar;33(6):1051-1063.

3. RoonakShahoei FarzanehZaheri, Lila HashemiNasab,and FaribaRanaei, The effect of perineal massage during the second stage of birth on nulliparous women perineal: A randomization clinical trial, Electron Physician. 2017 Oct; 9(10): 5588–5595.

4. Mehdi Ranjbaran,MaahboobehKhorsandi,PegahMatourypour, and Mohsen Shamsi, Effect of Massage Therapy on Labor Pain Reduction in Primiparous Women: A Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials in Iran, Iran J Nurs Midwifery Res. 2017 Jul-Aug; 22(4): 257–261.

5. Sahar Mansour Lamadah, IbtesamNomani, The Effect of Aromatherapy Massage Using Lavender Oil on the Level of Pain and Anxiety During Labour Among Primigravida Women, American Journal of Nursing Science, 2016; 5(2): 37-44

6. WHO recommendation on techniques for preventing perineal trauma during labour, 17 February 2018.

7. SevgulDonmez and OyaKavlak, Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perineum, Health, 2015, 7, 495-505.

8. Jamie Hatcher, CNM “Protecting Your Perineum”, November 12, 2018.

Received on 14.09.2022 Modified on 12.10.2022

Int. J. of Advances in Nur. Management. 2023; 11(1):61-65.

DOI: 10.52711/2454-2652.2023.00013

Level of maternal outcome	Max score	Control -post test scores			Experimental - post test scores			Difference in Mean%
Level of maternal outcome	Max score	Mean	SD	Mean%	Mean	SD	Mean%	Difference in Mean%
Overall	54	37.8	2.95	70	32.4	2.99	60	10

Level of maternal outcome	Control group		Experimental group
	Post test		Post test
	f	%	f	%
Good	0	0	0	0
Fair	6	42.86	14	93.3
Poor	8	57.14	1	6.7
Total	15	100	15	100

Level of maternal outcome	Control post test		Experimental post test		Mean difference	‘t’-value	P-value
	Mean	SD	Mean	SD
Overall	37.8	2.95	32.4	2.99	5.4	4.96	P<0.001***(HS)