The effectiveness of slow paced breathing on pain perception during first stage of labour among primigravida mothers

Introduction

Childbirth is one of the most marvelous and memorable segment in a woman‟s life. It does not really matter if the child is the first, second or the third one. Each experience is unique and calls for a celebration. The fear and anxiety about child birth often prevents most women from enjoying this experience.1

Events of labor are divided into three stages. First stage starts from onset of true labor pain and ends with the full dilatation of cervix. Second stage starts from full dilatation of cervix and ends with the expulsion of the fetus from the birth canal. Third stage involves separation and expulsion of placenta and its membranes and fourth stage involves observation for at least one hour after birth.2

The first stage of labor averages about 13-14 hours for a nullipara and about 6 – 7 hours for a multipara. Latent phase (early) involves dilatation from 0-3cm in which contractions are usually every 5-30 minutes, lasting for 10-30 seconds and of mild intensity. Active phase involves dilatation from 4-7cm, contractions are usually every 3-5 minutes; lasting 40-60 seconds and of mild to moderate intensity. Transitional phase involves dilatation from 8-10 cm, contractions are every 2-3 minutes, lasting 50-60 seconds and of moderate to strong intensity. Some contractions may last up to 90 second.3

Specific exercises and postures can help the pregnant women to adapt to the physical changes in her body during the childbearing years. They will help to ease the minor aches and pains during pregnancy and may also help to prevent long term postpartum problems. In addition, coping skills such as relaxation, positioning and breathing awareness will provide the mother with the practical means of managing labour.4

Breathing properly is vital for having an untroubled labour. Shallow and panic breathing are common when a person is frightened or is in a state of stress. During labour, pain makes the mother stressed and leads to panic breathing which would means less flow of oxygen to the mother as well as for the baby. This may cause lose control of the body and make labour a very hard process. However, breathing in a rhythmic manner during labour helps in increasing the flow of oxygen in the body. This ensures that there is plenty of oxygen available for both mother and baby during the crucial phase.5

Need for the Study

Pregnancy is a time of great change for a woman, not only for the obvious physical change in her body, even her emotional state changes several times throughout the day.6 Each woman comes into labor with a set of expectations: fear, preparation, pain threshold, personality and behavioral makeup, and ways of experiencing what is happening to her, which has to be maintained effectively. The time of labor and birth, though short in comparison with the length of pregnancy, is the most dramatic and significant period of pregnancy.7

Labor pain is the most severe pain experienced by the women. Parity also influences labor pain, that is, primigravida women experience more pain during labor than multigravida mothers.8 Recent studies have shown that the incidence of caesarean sections is increasing throughout the developed and developing countries. Majority of women (68%) are requesting for caesarean section because of psychological indications. Women with adequate psychological support and relaxation techniques had reduced the incidence of caesarean section and 38% of them agreed for normal vaginal delivery.9

The investigator during her clinical posting and interaction with mothers in labor had observed various behavioral responses like crying, hitting the labor table, biting of teeth tightly, etc. Mainly, mothers are not prepared mentally and physically to deal the happenings of pregnancy. Moreover, they sink into panic during the progress of labor. This could be controlled by relaxation technique like slow paced breathing. Hence, the investigator is interested to evaluate the effectiveness of slow paced breathing on pain perception among primigravida mothers. This study will help in providing better care during intrapartum period which gives a positive childbirth experience to the mother.10

Objectives of the Study

Materials and Methods

Sampling Criteria

Result

The distribution in number and percentage of study samples according to their demographic variables. The distribution of sample according to the age in experimental group, out of 30 samples (43.3%) were 21-24 years, 53.3% were 25-27 years and 3.3% were 28-30 years of age. And in control group, 36.67% were 21-24 years, 53.3% were 25-27 years and 10% were 28-30 years of age.

With regard to educational status of mother in the experimental group out of 30 samples, 0% were illiterate, 46.67% belonged to school level and 53.3% belonged to graduate level. And in control group, 0% were illiterate, 43.3% belonged to school level and 56.67% belonged to graduate level.

Distribution of samples according to occupation in experimental group, out of 30 samples 40% were sedentary worker, majority of them 56.67 % were moderate worker and 3.3% were heavy worker. And in control group, 23.33% were sedentary worker, majority of them 70% were moderate worker and 6.67% were heavy worker.

Distribution of samples according to monthly family income in the experimental group, out of 30 samples 36.67% has a monthly family income Rs.1000- 5000, 50% has Rs.6000-10000 monthly family income and 13.33% has Rs.11000- 15000 monthly family income. And in control group, majority has Rs. 1000-5000 monthly family income, 30% has Rs. 6000-10000 monthly family income and 10% has Rs. 11000-15000 monthly family income.

Dispersion of samples according to type of family, in the experimental group majority (53.3%) belongs to nuclear family and (46.67%) belongs to joint family. In control group, majority (56.67%) belongs to joint family and (43.33%) belongs to nuclear family.

Distribution of samples according to social support, in the experimental group majority (53.33%) belongs to husband, both parents and relatives has (23.33%) social support. In control group, belongs to (53.33%) were relatives, both husband and parents (23.33%).

That during pre-test, majority of the mothers i.e. 63.33% has mild pain and 36.67% has moderate pain in experimental group whereas 66.67% has mild pain and 33.33% has moderate pain in control group. None of them has no pain or severe pain during pre-test. The mean score revealed that pre-test score is similar for both group.

The data presented in the Table 4 indicates that majority of the mothers i.e. 50% of experimental group has moderate pain, 43.33% has mild pain and 6.6% has severe pain whereas 56.67% of control group has severe pain, 40% 0f them has moderate pain and 3.33% has mild pain. None of them has no pain and worst pain.

Comparison of post-test level of pain perception among primigravida mothers during labour in experimental group after slow paced breathing and control group after no intervention.

Comparison of pre-test level of pain perception between experimental and control group before intervention.

That the mean pre-test pain perception score of experimental group is 1.37 whereas for control group it is 1.33. Standard Deviation of experimental group is 0.46 and for control group is 0.47. The computed unpaired „t‟ value is 0.39 and table value is 2.02 at 5% significance. This indicates the calculated value is less than the table value. So it is not significant (p>0.05). That means both the groups are similar in nature and homogenous.

Comparison of post-test level of p ain perception among primigravida mothers during labour in experimental group after intervention and control group with no intervention.

The data represented in the above table using unpaired t test shows that there is a significant difference between mean post assessment pain perception of experimental and control group is 1.6 and 2.5 respectively. The computed unpaired t value 5.92 of the mean post assessment score is greater than the table value 2.02 at 5% level of significance. This shows that slow paced breathing exercise is effective in labour pain perception reduction.

This section deals with association between pre-test level of pain perception during labour in experimental and control group with their demographic variables.

Summary

The study adopts quasi-experimental pre and post test research design to assess the effectiveness of slow paced breathing on labour pain perception during first stage of labour. The data was collected from two groups of primigravida mothers, 30 from the experimental group and 30 from control group. Samples were selected by purposive sampling technique. In this study, the independent variable was slow paced breathing exercise and the dependent variable was level of labour pain perception. Modified Ernestine Wiedenbach‟s helping art of clinical Nursing Theory model (1970) systems model was used to evaluate the effect of slow paced breathing exercise on level of labour pain perception. The tools used in the study consist of two parts. Section A was demographic variables and Section B was numeric pain rating scale to assess the pain perception level. The data were collected and analyzed using descriptive and inferential statistics. The level of significance was assessed by p<0.05 to test the hypotheses.

Conclusion

Labour pain is highly unpleasant and very personal sensation that cannot be shared with others. To ease the pain and improve the behavioral response of the mother non-pharmacological management can be used which will give better results.

The study findings revealed that slow paced breathing exercise helps in reducing the level of pain perception among primigravida mothers in the experimental group. So this can be practice in various settings during labour.

Source of Funding

None.

Conflict of Interest

None.