A Study to Assess the Effectiveness of Lamaze Method in terms of Labour Pain Perception, Anxiety and Progress of Labour among Primi Mothers in active first stage of Labour

Kiruba Gnana Chitra. J

Department of Midwifery and Obsterical Nursing, Bishop’s College of Nursing, Dharapuram, Tamilnadu, India.

*Corresponding Author E-mail: kirubapaul056@gmail.com

ABSTRACT:

Background: Natural childbirth is a beautiful experience. Women dream of the perfect birth with less pain. But severe pain is a phenomenon embedded in the very nature of human existence. Though experiencing pain during labour is a universal feature of childbirth, the degree of pain perception can be reduced using many simple, effective, low cost non-pharmacological methods which also helps in improving labour progress and patient satisfaction. The concept of painless child birth gave rise to many scientific discoveries and research findings. Among that Lamaze method is one, which prepares mother for child birth and to tackle Labour pain. Objective: The objective of this study are to evaluate the effectiveness of Lamaze method in terms of pain perception, anxiety and progress of labour among primi mothers in first stage of labour admitted at Christian fellowship Hospital, Oddanchatram. Method: The research design used for the study was quasi experimental nonequivalent control group posttest only design. The sample size was 60 samples. Out of which 30 were in experimental group and 30 were in control group. The Samples were selected by using Non probability purposive sampling technique. Primi mothers at their term was selected and was given antenatal teaching on “Normal labor process and non-pharmacological labour pain management” in antenatal OPD for about 30 minutes. The same primi mothers who attended teaching were selected for experimental group during their labour period. During the first hour of active first stage of labour Lamaze intervention of visual stimuli was provided by showing natural sceneries during each contraction for the second hour auditory stimuli was provided by making the mother to listen to light music by using ear phone. During the 3^rd hour of active first stage of labour abdominal effleurage stroke was done during each painful contractions. Followed by that hot water bag application on the sacral region was provided and was continued till delivery. Primi gravid mothers who did not undergo Lamaze teaching and interventions were selected for control group. Posttest was done on both experimental and control group after four hours of active stage of labor to assess the level of labor pain perception, the level of anxiety and progress of labor by using Universal pain assessment scale, modified Max Hamilton anxiety rating scale and Labor progress assessment scale. The level of satisfaction on Lamaze method among experimental group was assessed by using Likert scale on satisfaction of Lamaze method. Total time taken to perform posttest in both groups was 30 minutes. The gathered data were analyzed by using descriptive and inferential statistics. Results: Results: Independent “t” value for level of pain perception was 16.08(table value=2.001) which was significant at P<0.05 level. The independent “t” value for level of anxiety was 5.08(table value=2.001) which was significant at P<0.05 level. The independent “t” value for progress of labour was 9.86 (table value=2.001) which was significant at P<0.05 level. Regarding the level of satisfaction on Lamaze method of experimental group all 30(100%) primi mothers were adequately satisfied. There was no significant association existing between pain perception, anxiety and progress of labour with demographic variables such as age, education, occupation, monthly income and residence except for pain perception and demographic variables such as religion (χ^{2 =}45.44) and family type (χ^{2 =}4.33) among experimental group. The study findings revealed that Lamaze method was effective in reducing labor pain perception, anxiety and promote labour progress among primi mothers in active first stage of labour.

KEYWORDS: Lamaze method, Pain perception, anxiety, progress of labor, primi mothers.

INTRODUCATION:

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of Lamaze method in terms of pain perception, anxiety and progress of labour among primi mothers in first stage of labour admitted at Christian fellowship hospital, Oddanchatram.

OBJECTIVES

1) To assess the post-test level of pain perception, anxiety and progress of labour among primi mothers in first stage of labour in experimental group and control group.

2) To compare the post-test level of pain perception, anxiety and progress of Labour among primi mothers in first stage of labour between experimental group and control group.

3) To assess the level of satisfaction on lamaze method among primi Mothers in first stage of labour in experimental group.

4) To find association between the post-test level of pain perception, anxiety and progress of labour among primi mothers in first stage of labour in experimental group with their selected demographic variables.

HYPOTHESIS

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.

H₂: The mean post-test level of anxiety score in experimental group is significantly lower than the mean post-test level of anxiety score in control group.

H₃: The mean post-test level of progress of labour score in experimental group is significantly higher than mean post-test level of progress of labour in control group

H₄: There will be a significant association between post-test level of pain perception in experimental group with their selected demographic variables.

H₅: There will be a significant association between post-test level of anxiety in experimental group with their selected demographic variables.

H₆: There will be a significant association between post-test level of progress of labour in experimental group with their selected demographic variables.

OPERATIONAL DEFINITION:

Lamaze Method:

Lamaze method is a prepared labour and delivery technique. It is often called as psych prophylaxis method as it uses the mind (psyche) to prevent labor pain perception. It uses auditory stimuli, visual stimuli and tactile stimuli as distractions of pain perception.

- Daisy Jane (2004)

In this study Lamaze method consist of giving antenatal teaching on labour process and Lamaze pain management techniques for term (above 37 weeks of gestational age) primi mothers in antenatal OPD. For the same mother during her first one hour of active first stage of labour photographs of natural sceneries (visual stimuli) was shown during each contraction, for next one hour music therapy (auditory stimuli) was provided using ear phone, abdominal effleurage stroke was done during third hour for each painful contractions followed by hot water bag application to the sacral region (tactile stimuli) which was continued up to delivery.

2. Pain Perception:

Pain perception occurs when pain is recognized, defined and responded by the individual experiencing the pain.

Sharon Lewis.L (2004)

In this study it refers to level of pain perception defined and responded by primi mothers during active stage of labour which is measured by Universal pain assessment scale.

3. Anxiety:

Anxiety "is characterized by a diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms, such as headache, perspiration, palpitations, tightness in the chest, and mild stomach discomfort".

Kaplan, H. and Sadock, (1996)

In this study it refers to level of anxiety that results from process of labour which is measured by Anxiety assessment scale adopted from Max Hamilton anxiety rating scale.

4. Progress of Labour:

Progress in labour occurs as the cervix moves from a posterior to an anterior position; ripens or softens; and effaces; the fetal head rotates, flexes and moulds; the presenting part descends.

National Institute for Health and Clinical Excellence (NICE) (2007)

In this study it refers to cervical dilatation at a rate of 1cm /1hour, head decent at a rate of 1 station decent /2 hour with good effacement of cervix is considered as good progress.

5. First Stage of Labour:

The first stage of labour starts from the onset of true labour pain and ends with full dilatation of the cervix. Its average duration is 12 hours for primi gravidae and 6 hours in multi gravidae. -Dutta.D.C (2011)

In this study it refers to active first stage of labour which starts from 3-4cm cervical dilatation and ends with full dilatation of cervix.

Research Design

The research design selected for this study was quasi experimental non-equivalent control group post-test only design.

Groups

Intervention

Post Assessment

Experimental group

Control group

Sample:

Primi mothers who are in active first stage of labour admitted in labour room at Christian Fellowship Hospital, Oddanchatram and who met the inclusion criteria.

Sample Size:

The sample size of the study was 60 out of which 30 samples were in experimental group and 30 were in control group.

Sampling Technique:

Non- probability purposive sampling technique was the sampling technique used to select the samples. Samples who were fulfilling inclusion criteria were taken for experimental group and other term primi mothers who did not had antenatal Lamaze teaching were taken for control group.

Description of The Instrument:

In this study the Instrument consist of five part

Part 1. Demographic data like the age, education, residence, type of family, income and religion.

Part 2. Universal pain assessment scale was used to measure the level of pain perception among primi mothers in active first stage of labour. Total score was 10

Part 3. Anxiety assessment scale adopted from Max Hamilton anxiety rating scale (1959) was used to assess the level of anxiety of primi mothers. This rating scale consists of 10 questions.The total score was 40.

Part 4. Progress assessment scale was used to assess progress of labour among primi mothers in labour. This scale consists of 2 observations such as cervical dilatation and head decent. The total score was 4.

Part 5: Five point Likert scale on satisfaction of Lamaze method was used to assess level of satisfaction level among primi mothers who were given Lamaze interventions. This rating scale consists of 10 questions. It was rated as dissatisfied 0-13, moderately satisfied 14-26 and satisfied 27-40. Total score was 40.

Data Collection Procedure:

The main study was conducted in Christian Fellowship Hospital, Oddanchatiram. The data collection period was for about 5 weeks. The investigator obtained written permission from the Medical officer and the oral consent was obtained from the samples prior to the study. Primi mothers at term were selected and was given antenatal teaching on Lamaze method in the antenatal OPD. In the labour room based on purposive sampling technique 60 samples were selected out of which 30 were in experimental group and 30 were in control group. In that primi mothers who attended Lamaze method teaching in antenatal OPD were selected for experimental group. The purpose of the study was explained to the subjects. During the first hour of active first stage of labour Lamaze intervention of visual stimuli was provided by showing natural sceneries during each contraction. For the second hour auditory stimuli was provided by making the mother to listen to light music by using ear phone. During the 3^rd hour of active first stage of labour abdominal effleurage stroke was done during each painful contractions. Followed by that hot water bag application on the sacral region was provided and was continued till the child birth. The mothers in labour who did not had antenatal Lamaze method teaching were taken as control group and routine care was given. Post-test was done in both the group to assess pain perception, progress of labor during labour process and anxiety level was assessed after 2hours of delivery.

In the experimental group mother’s satisfaction level of using Lamaze method was done after 2 hours of delivery. The gathered data were analysed by using descriptive and inferential statistics

Data Analysis and Interpretation:

Section A-

Assess the post-test level of pain Perception, anxiety and progress of labour Among primi mothers in first stage of Labour in experimental group and control Group

Table: 1 Frequency and percentage distribution of post-test level of pain perception among primi mothers in first stage of labour in experimental and control group n₁=30,n₂=30

SL. No

Level of Pain Perception

Experimental Group

Control Group

No pain

Mild pain

Moderate pain

Severe pain

Worst pain

Table-2 Frequency and percentage distribution of post-test level of anxiety among primi mothers in first stage of labour in experimental and control group n₁=30, n₂=30

Sl. No

Level of Anxiety

Experimental Group

Control

Group

Mild anxiety

Moderate anxiety

Severe anxiety

Table-3 Frequency and percentage distribution of post-test level of progress of labour among primi mothers in first stage of labour in experimental group and control group. n₁=30, n₂=30

Sl. No

Progress of Labour

Experimental Group

Control Group

Slow progress

Moderate progress.

Good progress

Section B: Comparison of the Post Test Level of Pain Perception, Anxiety and Progress of Labour Among Primi Mothers in First Stage of Labour Between experimental and Control Group.

Table: 4 Comparison of mean score, standard deviation and independent t value of post-test level of pain perception scores among primi mothers in first stage of labour between experimental group and control group. n₁=30, n₂=30

Group

Mean

Standard deviation

Mean difference

Independent ‘t’ value

Table value

Inference

Experimental group

Control group

2.83

4.63

0.44

0.47

1.88

16.08

2.001

Significant

df=60, (p<0.05)

Table: 5 Comparison of mean score, standard deviation and independent t value of post-test level of anxiety scores among primi mothers in first stage of labour between experimental group and control group. n1=30,n2=30

Group

Mean

Standard deviation

Mean difference

Independent t test

Table value

Inference

Experimental group

Control group

7.83

14.8

0.12

6.45

6.97

5.08

2.001

Significant

df=60 (p<0.05)

Table: 6 Comparison of post-test mean score, standard deviation and independent “t” value of progress of labour among primi mothers in first stage of labour between experimental group and control group. n₁=30, n₂=30

Group

Mean

Standard deviation

Mean difference

Independent t value

Table value

Inference

Experimental group

Control group

3.7

1.93

0.70

0.02

0.68

9.86

2.001

Significant

df=60 (p<0.05)

Section C To assess the level of Satisfaction on Lamaze method among primi mothers in first stage of labour in Experimental group n=30

Level of Satisfaction

Dissatisfied

Moderately Satisfied

Adequately Satisfied

100%

CONCLUSION:

Pain in labour is nearly universal experience for all mothers. Some perceive it as tolerable and many as intolerable pain. Planning and implementing nursing interventions to tackle labour pain is a challenging issue for most of the nurses. The present study assessed the effectiveness of lamaze method in terms of pain perception, anxiety and progress of labor among primi mothers in first stage of labour in Christian Fellowship Hospital, Oddanchatram. Based on the statistical findings, it is evident that Lamaze method reduced the level of pain perception (Independent ‘t’ value =16.08), the level of anxiety (Independent‘t’ value = 5.08) and promoted good progress of labour (Independent ‘t’ value =9.86) in the experimental group with compared to control group. Therefore the investigator felt that the non-pharmacological therapies like Lamaze method may be used for women in labor as it helps to reduce labour pain perception, anxiety and improves the progress of labour.

RECOMMENDATIONS:

· Similar study can be conducted for a large group.

· A comparative study can also be conducted between prime and multi mothers.

· The effect of Lamaze method can be assessed in combination with other non-pharmacological measures like bradely method, hypnosis, yoga therapy, guided imagery for the good labour outcome.

ACKNOWLEDGEMENT:

The author like to acknowledge Dr. Paul Emmanuel Medical Superintendent, Christian Fellowship hospital, Oddanchatram, Tamil Nadu for his valuable support in conducting the research. The researcher also likes to acknowledge Principal Prof. Mrs.Vijayarani Prince, Research guide Mrs.Hepsi Sujatha and research committee of Bishop college of nursing, Dharapuram, Tamil Nadu for there valuable guidance and support throughout the research process. And researcher also like to acknowledge all the study participants, duty doctors and nurses for their cooperation.

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Received on 21.04.2022 Modified on 05.07.2022

Int. J. of Advances in Nur. Management. 2023; 11(1):31-35.

DOI: 10.52711/2454-2652.2023.00007