INTRODUCTION:

Pregnancy is the period from conception to the birth of the baby during which the women undergoes many bodily changes to accommodate the growing fetus. Every women giving birth is an embellishment to her wondrous journey.⁴For most of women, labour pain is the most severe pain they will ever experience. Women regularly use medications or natural methods for labour pain relief. For many women, the pain they experience during labour and childbirth will be the most severe form of pain they have ever experienced.⁵ The Child birth is a natural process that can be generally managed without any medical interventions. Natural delivery is now recommended in many countries because it is cost effective, has shorter length of hospital stay, does not need anesthetic requirement and leads lower rates of infection and hemorrhage after delivery compared to cesarean section.³

The experience of childbirth is a subjective and multidimensional issue and each woman passes through it in a different way. However, a delivery is also related to negative emotions: fear, anxiety, low sense of security, and the expectation of pain.⁶

Unrelieved labour pain can result in negative consequences for the expectant mother, her family, healthcare providers and healthcare systems at large. Apart from maternal consequences such as heightened stress, fear, depression, confusion. These create feelings of guilt and helplessness for the woman’s family as well as a lack of confidence in the abilities of healthcare providers and systems in general.⁷Owing to a large number of factors present during pregnancy, many women consider some aspects of pregnancy stressful to which they respond with anxiety. The main causes of maternal anxiety about childbirth are due to fear of damage to mother and baby and lack of trust to the quality of maternity care and staff commitment.¹

Women often mention, that because of their anxiety they would prefer a caesarean section rather than a natural delivery. 4)World Health Organization (WHO) conference in 1985 that ‘Countries with some of the lowest perinatal mortality rates in the world have caesarean section rates of less than one tenth and the higher percent is for normal mode of delivery.⁶

The prevalence of C-section deliveries are far from the normal range of 5–15% and have been emerging as a matter of concern in a number of developed as well as the developing countries.⁸Caesarean-Section prevalence is representative 52% among women in Egypt, Caesarean-Section rate is 3.5 times higher than it should be, and World Health Organization has set the target caesarean-section rate at 15%.20 in the last decade or so, the numbers have escalated in many parts of the country—reaching as high as 41% of deliveries in Kerala, and 58% in Tamil Nadu, says a report (pdf) by the ICMR School of Public Health. And it’s happening across both urban and rural areas: Mumbai saw an exponential growth in C-sections in both private and public hospitals, while one demonstrated a spike from 31% to 51% over just six years in rural Haryana.⁹

Certain maternal positions during labor have potential benefits in promoting optimal maternal and neonatal outcomes.¹⁰ Women instinctively use a variety of positions and movements to cope with the discomfort during first stage of labor. These include walking, leaning forward, gentle lunging, four-point kneeling (kneeling on hands and feet), rocking and swaying under supervision of health care professionals.⁴ Women who were upright or mobile had a shorter first stage of labour compared with women who were supine (MD −0.99, 95% CI −1.60 to −0.39). Shorter length of labour is an important outcome.¹¹

The attitudes and expectations of health care staff, women and their partners have shifted with regard to pain, pain relief and appropriate behavior during labour and childbirth. A woman semi-reclining or lying down on the side or back during the first stage of labour may be more convenient for staff and can make it easier to monitor progression and check the baby. Fetal monitoring and use of intravenous infusions also limit movement.¹¹

Specific movements can be used to achieve specific goals that is pelvic rocking can reduce the pain of a sore back. Understanding which movements and positions help to encourage specific outcome that can help labour move problem free and as quickly as possible. Rocking in a rocking chair during first stage of labour can facilitate fetal decent in lower uterine segment in turn reducing length of labour and minimizing chances of complications which occur due to delayed labour.³Within the limits of an observational and preliminary study, we observed that rocking motion during the procedure was associated with a significant decrease in labour pain and that patient satisfaction was high. Several hypotheses are proposed to explain these effects, i.e. patient's involvement in an action that focuses attention, loss of parturient's landmarks and stimulation of the vestibular system which might lead to a change in the cognitive perception of the body.¹²

Rocking Movement Tips:

Rocking movement is effective in 1^st stage of labour with 3 cm cervical dilatation than comfortably rocking on chair upto to 6cms of cervical dilatation only, as tips given for movement Keep weight on one foot (plant) while the other foot does all the work around it. IE: for a right rocking chair, your left foot shouldn’t leave the ground (except perhaps a heel or toe for styling).¹³

Rocking movement in following direction -

I: With weight planted on left foot use the right foot to step forward, rocking your weight towards the right foot.

II: Then rock weight back on the left foot (recover).

III: Step right foot backward.

IV: Rocking weight onto left foot then recover weight back onto right planted foot.

V: Recover as normal sitting position in the chair and repeat the same steps as earlier for 10 minutes then rest for 10 minutes. 3 such sets should be repeated hourly till 6 cms of dilatation.³

Figure 1. Steps to rock in rocking chair during first stage of labour

PROBLEM STATEMENT:

A study to assess the effectiveness of planned teaching programme on non pharmacological measure (Rocking chair) for progress of 1st stage of labor in primigravida women among B.Sc. Nursing students in selected College of Nursing at Bhilai (C.G).

OBJECTIVES:

1. To assess pre-test and post-test knowledge score regarding nonpharmacological measure (Rocking chair) for progress of 1st stage of labour in primigravida women among nursing students.

2. To assess the effectiveness of planned teaching programme regarding nonpharmacological measure (Rocking chair) for progress of 1st stage of labour in primigravida women among nursing students.

3. To find out the significant association between pre-test knowledge score with selected sociodemographic variables.

HYPOTHESIS:

At 0.05 level of significans.

H₀ There will be no significant effectiveness of planned teaching programme on non-pharmacological measure (Rocking chair) for progress of 1st stage of labour in primigravida women among B.Sc. Nursing students.

H₁ There will be significant effectiveness of planned teaching programme on non-pharmacological measure (Rocking chair) for progress of 1st stage of labour in primigravida women among B.Sc. Nursing students.

H₂ There will be significant association between pretest knowledge with selected socio-demographic variables.

MATERIAL AND METHODS:

A pre-experimental research design was adopted to conduct the study. Target population was B.Sc. nursing 4^th year students who fulfilled the inclusion criteria. A non-probability convenient sampling technique was utilized for selection of sample. Accessible population was 60 B.Sc. Nursing students of Shrishankarcharya College of Nursing Bhilai (C.G.). A self-structured questionnaires were used to assess the knowledge regarding non-pharmacological measure (rocking chair) for progress of 1st stage of labour in primigravida women among B.Sc. nursing 4th year students at selected college of nursing Hudco, Bhilai (C.G.)

STUDY VARIABLES:

1. Independent variable:

Planned teaching programme on non-pharmacological measure (Rocking chair) for progress of 1st stage of labour.

2. Dependent variable:

Knowledge of B.Sc. Nursing 4^th yr. students regarding (Rocking chair) for progress of 1st stage of labour.

Inclusive criteria:

· Student those who are willing to participate in study.

· Student those are available during time of study.

Exclusive criteria:

Student those who absent on that day.

Development and description of research tool:

The multiple choice self-structured knowledge questionnaires was used to assess the effectiveness of planned teaching programme on non-pharmacological measures (Rocking chair) for progress of 1st stage of labour in primigravida women among B.Sc. nursing 4th year students.

A review of the published as well as unpublished literature concerning the effect of planned teaching programme on non-pharmacological measures (rocking chair) for progress of 1st stage of labour in primigravida women among B.Sc. Nursing 4^th yr. students and it’s relation with selected sociodemographical variables were undertaken to get cues for the development of scientific instrument. Tool was finalize after testing of reliability and validity from different expert.

The tool used for the study comprises of two sections:

Section A:

Deal with the socio demographic variable such as Age, Gender, Residence, Previous knowledge on related topic and main source of information.

Section B:

Deal with multiple self-structured knowledge questionnaire to assess the knowledge of non-pharmacological measures (Rocking chair) for progress of 1st stage of labor in primigravida women among B.Sc. Nursing students.

Criterian measures:

There were total 30 questions to evaluate the knowledge of non-pharmacological measures (Rocking chair) for progress of 1st stage of labor among B.Sc. Nursing students. Each correct answer score 1mark and incorrect answer gives 0. The maximum score was 30 and minimum score was 0.

Score was categorized in 3 levels-

· Good – (21-30 score)

· Average – (11-20 score)

· Need to improvement - (0-10 score)

Data analysis:

The data obtained from study were analyzed and interpreted in terms of objective. Descriptive and inferential statistics used for data analysis, socio demographic data was analyzed in frequency and percentage. Analysis of the knowledge regarding non-pharmacological measures (Rocking chair) for progress of 1st stage of labor among B.Sc. Nursing students was done in frequency and percentage. Chi square analysis was used for the association between Pre test knowledge score with selected socio-demographic variables among B.Sc. nursing student’s. T-test analysis was used to find out the effectiveness of planned teaching programme on knowledge regarding non-pharmacological measure (Rocking chair) for progress of labour in primi gravida women.

MAJOR FINDINGS OF THE STUDY:

Description of socio-demographic variables in frequency and percentage.

· Age-majority of student 55 % (33) were in age group of 20-21 year, 45.33% (20) were in 22-23year and 1.6% (1) were between 24-25 year.

· Gender- majority of subjects86.67% (52) were female and 13.33% (8) were male.

· Area of residence-majority of subjects 34 (57%) were hosteller whereas 26 (43 %) were day scholar.

· Maximum clinical exposure during B.Sc. Nursing 4th year- majority of subjects 45%(27) had maximum clinical exposure in OBG ward, 30% (18) had pediatric ward exposure and 25% (15)had maximum medical and surgical ward.

· Previous knowledge.- majority of subjects 58.33% (35) had previous knowledge and 41.67% (25) had no previous knowledge.

· Main source of information - majority of subject’s 40% (24) source of information was family and friend, 42% (25) was no information, 10% (6) from media and internet, 8% (5) acquired information from health care professionals.

Section II: Total area wise analysis using mean, mean percentage and standard deviation:

knowledge regarding Non pharmacological measure (Rocking chair) of pretest mean is 10.11, mean % is 33.7% and SD is 3.51 where as in post- test mean is 21.35, mean % is 71.16 % and SD is 2.99.

Section III: Over all analysis between pre-test and post-test knowledge score in frequency and percentage according to criteria.

Analysis of pre-test and post- test knowledge score using frequency, percentage and total score indicates that out of 60 B.Sc. Nursing 4^th yr. students in pre-test and post-test knowledge score of planned teaching programme 0 (0%) were good, 60% (36) were average and 40% (24) was need for improvement in pre-test and post-test majority 55% (33)students were in good, 45% (27) were in average and 0 (0%) was need for improvement.

Section IV: paired t test analysis to assess the effectiveness of planned teaching programme.

There was highly significant difference between the pre-test and post -test knowledge score of planned teaching program as calculated value 16.94, (df.59) was greater than table value 2.02 at 0.05 level of highly significance. Hence, H1 is accepted and Hence, H0 is rejected.

Section V: chi-square analysis for association between pre-test knowledge score of B.Sc nursing 4th year students with selected socio demographic variables.

Findings reveals that there was no significant association between knowledge and age, gender, residence, maximum clinical exposure during B.Sc.Nursing 4th year of subjects. Only significant association between knowledge and previous knowledge of subjects, source of information of subject.

DISCUSSION:

The overall percentage in pre-test knowledge score of planned teaching programme was 0 (0%) in good, 60% (36) were average and 40% (24) was need for improvement and post-test majority 55% (33) students were in good, 45% (27) were in average and 0 (0%) was need for improvement. So the hypothesis (H₁) is accepted that means there was a significant difference in the knowledge between pre-test and post- test.

The above finding was supported by a study conducted by Archana Selvan on Effect of Computer-Assisted Instructions on the Students about Rocking In the Chair during First Stage of Labour at Bhopal, (M.P.). A true experimental research design with pre-test and post-test of experimental and control group was used during the study. The study was conducted at selected colleges of Nursing at Bhopal, M. P., India for 6weeks. The samples were 60 B.Sc. Nursing IV year students out of that 30 were taken in the experimental group and 30 were taken as control group. Sample were selected by systematic random technique. The study revealed that there was a significant difference (t(29)=3.66, p<0.001) between pre-test and post-test knowledge scores of the respondents indicating significant increase in knowledge after planned teaching programme³

Another study was conducted by J. Jayasree et al. on Effectiveness of Structured Teaching Programme on Knowledge and Attitude Regarding Health Promoting Practices in Primigravida Mothers. SVIMS, Tirupati, India. Quasi experimental one group pre-test and post-test design was used the sample size was 60 were selected by using convenience sampling technique. Pretested structured interview schedule on knowledge, attitude scale was used for data collection. The study findings in the pre-test revealed that majority (41.7%) had moderate knowledge, (35.0%) had inadequate knowledge, (23.3%) had adequate knowledge and post-test knowledge majority (46.7%) had adequate knowledge whereas, (35.0%) had moderate knowledge and (18.3%) had inadequate knowledge on health promoting practices. study finding imply that such a teaching programme contribute to increased knowledge towards on health promoting practices among primigravida mothers.¹⁴

ETHICAL CONSIDERATION:

The study was accepted by the research committee prior permission was obtained from Principal of Shri Shankaracharya College of Nursing Hudco, Bhilai (C.G.) the permission was also taken from the Mrs. Shailaja Anik, Principal of Shankaraharya Swami Swaroopanand college of Nursing Junwani, Bhilai to conduct Pilot study. Written consent was taken from the subjects who formed the sample group.

CONCLUSION:

The study conducted on planned teaching programme regarding non pharmacological measure (Rocking chair) for progress of 1st stage of labour in primigravida women was effective in increase knowledge among B.Sc. Nursing students. findings suggest that need for educating B.Sc. nursing students on appropriate and effective way of managing normal delivery can helpful to reduce labour pain of parturient mothers and review suggest that the first stage of labour may be approximately an hour shorter for women who are upright or walk around during the first stage of labour.

ETHICAL APPROVAL:

Research Committee College of nursing SVIMS approved the study. Informed consent was obtained from participants. They had the freedom to select any option from the question and they can withdraw from the study at any time without giving any reason.

CONFLICT OF INTREST:

Nil .

ACKNOWLEDGEMENT:

Investigators acknowledge the cooperation extended by the B.Sc. Nursing 4^th Yr. students during the time of data collection.

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Received on 28.10.2020 Modified on 26.11.2020

Int. J. of Advances in Nur. Management. 2021; 9(1):78-83.

DOI: 10.5958/2454-2652.2021.00020.2

Planned teaching programme	Mean	Standard deviation	DF	Paired ‘t’ value	Table value	Inference at 0.05
Pre – Test	10.11	3.51	59	16.94	2.00	Highly Significance
Post – Test	21.35	2.99	59	16.94	2.00	Highly Significance

S. No	Knowledge score	Pre-test		Post test
S. No	Knowledge score	Frequency	Percentage	Frequency	Percentage
1.	Good (21-30)	0	0%	33	55%
2.	Average (11-20)	36	60%	27	45%
3.	Need to improvement (0-10)	24	40%	0	0%