INTRODUCTION:

Labor is a process that is experienced differently by every woman. Pain is both sensory and emotional. As a sensation, pain is interpreted by each of us based on our personal, cultural, and social experiences.

Emotionally, we each select personal coping mechanisms based on our individual experiences. The physiologic basis of pain changes as labor progresses¹. During the first stage of labor, pain results from the uterus contracting and “pulling” on the cervix, which causes effacement and dilatation. Pain intensity increases with the progression of labor. During the second stage of labor, pain is caused by the descent of the baby through the cervix into the vagina. Many women describe this pain as pressure and welcome the opportunity to actively work with the pain/pressure during the pushing phase, which results in the birth of their child. Among factors that influence the severity of pain, we can recognize the individual’s pain threshold, the level of labour’s progress, size of the baby, the mother’s general health condition, pelvic dimensions, position during the delivery, stress and mental factors¹. Labour pain management is not only a crucial concern for future mothers but also a great challenge in modern medicine. A wide range of both pharmacological and non pharmacological labour pain relief techniques are currently available for pregnant women in Poland. The first group includes: epidural analgesia, gas for pain control and intravenous opioids. Non pharmacological techniques contain water birth and water immersion, transcutaneous electrical nerve stimulation (TENS), aromatherapy, acupuncture and acupressure, massage techniques².

NEED FOR THE STUDY:

Labour and childbirth is usually a painful experience and women vary in their response to it. Childbirth is an intense event that involves extreme physical stress and carries emotional, cognitive, social, and cultural significance. Physically, women have to cope with acute changes as the uterus contracts, the cervix dilates, and the baby and placenta are delivered. Some women are keen to avoid drugs or other medical interventions while others are happy to consider all available options. For a woman having her first baby, the experience of labour is unpredictable³.

For this reason, it is a good idea to be aware of the options for pain relief that are available and to know something about the different methods. Research suggests that adequate preparation can help to reduce pain or at least modify the perception of pain and reduce anxiety, which can help to better cope with labour. There are several non-drug pain relief options like Exercise gently and regularly throughout your pregnancy, avoid cigarettes and alcohol, and eat a healthy, balanced diet, Breathing techniques, Using distractions like music, Hot or cold packs, massage, a warm shower or immersion in a warm bath etc. Hypnosis, acupuncture and acupressure are areas in which there has been little research but these may be considered also⁴.

Mwakawanga DL, Mselle LT, Chikwala VZ, Sirili N conducted An exploratory qualitative study using in-depth interviews with 18 purposively recruited nurse-midwives working in labour wards in two selected district hospitals in Pwani and Dar es Salaam regions in eastern Tanzania. Qualitative conventional content analysis was used to generate categories describing the experience of using non-pharmacological methods in managing labour pain. This study revealed that nurse-midwives encouraged women to tolerate labour pain and instructed them to change positions and to do deep breathing exercises as a means to relief labour pain. Nurse-midwives’ inner motives facilitated the use of non-pharmacological strategies for labour pain relief despite the fear of using them and myths that labour pain is necessary for childbirth⁵.

Himanshu Vyas, Aashish Parihar, Naveen Kumar Sharma conducted a Quasi experimental study to assess the effectiveness of a planned teaching program on knowledge regarding Non pharmacological techniques of relieving labor pain in primigravida women in selected hospitals at Gulbarga, Karnataka. The sample consisting of 60 primigravida mothers was selected by using Simple random sampling technique. The tool comprised of knowledge questionnaires. The pre-test was conducted and planned teaching program was administered on the primigravida women immediately after the pretest. The post test was conducted after one week of the pre test with same questionnaires. The data obtained were analyzed using descriptive and inferential statistics. In pre-test the sampled subjects were having poor knowledge on non pharmacological techniques of managing labor pain. i.e. about 34%. Regarding the post-test the sampled subject had an improved knowledge on non pharmacological techniques of managing labor pain i.e. about 83.9%. In relation to Planned teaching program, the paired “t” test showed that, the teaching program was statistically significant at p⁶

The above study have proved that mothers do not have enough knowledge about non pharmacological methods of pain management and they expect adequate information regarding non pharmacological methods of pain management. Therefore it’s a necessity to teach the pregnant mothers about non pharmacological methods of pain management.

PROBLEM STATEMENT:

A study to assess the effectiveness of Planned Teaching program on knowledge regarding non pharmacological techniques for pain relief during child birth among pregnant mothers in selected community area, Satna.

OBJECTIVES:

· To assess the existing knowledge regarding non pharmacological techniques for pain relief during child birth among pregnant mothers.

· To determine the effectiveness of planned teaching program on knowledge regarding non pharmacological techniques for pain relief during child birth among pregnant mothers by comparing pre test and post test knowledge score.

· To find out the association between the pre test knowledge score of mothers with selected demographic variables.

HYPOTHESIS:

H₁: The mean post test knowledge score on non pharmacological techniques for pain relief during child birth among pregnant mothers, who have learned through planned teaching program, will be significantly higher than their mean pretest score at 0.05 level of significance.

H₂: There is a significant association between pre test knowledge score of pregnant mothers regarding non pharmacological techniques for pain relief during child birth with their selected demographic variables

METHODOLOGY:

Research approach:

Quantitative evaluative approach.

Research design:

Pre experimental one group pre test post test design.

Setting:

Data collected from selected community area, Satna.

Sample and sampling technique:

30 pregnant mothers were selected by using simple random sampling method

Variables:

Independent variable:

Planned teaching program regarding non pharmacological techniques for pain relief during child birth

Dependent variable:

Knowledge regarding non pharmacological techniques for pain relief during child birth

Description of Tool:

Part I: Demographic data

Part II: Structured knowledge questionnaire regarding non pharmacological techniques for pain relief during child birth

Validity of tool:

5 experts, comprising of 4 nurse educators from the department of Obstetrics and Gynecology and 1 Statistician, established content validity of the tool.

Reliability of tool:

The data of the structured knowledge questionnaire was analysed by split half method and the reliability coefficient was calculated using Spearman Brown Prophecy formula. The reliability co- efficient of the tool was found to be 0.95. Hence the tool was found to be reliable

Data collection:

A pretest was conducted by using structured knowledge questionnaire and on the same day the planned teaching program regarding non pharmacological techniques for pain relief during child birth was administered to them. After 7 days, post test was conducted with the same questionnaire for the same group of pregnant mothers to assess the effectiveness of planned teaching program.

Analysis and interpretation of data:

The collected data were analyzed in terms of both descriptive and inferential statistics.

RESULTS:

Table.1: Section 1: Analysis of sample characteristics

Sl. No	Demographic characteristics	Frequency	Percentage
1.	Age(yrs)
	18-22	8	26.7%
	23-27	12	40%
	28-32	5	16.7%
	33 and above	5	16.7%
2.	Residential area
	Rural	22	73.3%
	Urban	8	26.7%
3.	Religion
	Hindu	22	73.3%
	Muslim	8	26.7%
	Christian	0	0%
4.	Educational status
	No formal education	12	40%
	Primary and secondary	6	20%
	Higher secondary	4	13.3%
	Graduate	8	26.7%
5.	Occupation
	Government job	5	16.7%
	Private job	5	16.7%
	House wife	20	66.6%
6.	Family income
	<5000	15	50%
	5001-10000	5	16.7%
	10001-15000	4	13.3%
	Above 15000	6	20%
7.	Type of family
	Nuclear	13	43.3%
	Joint	17	56.7%
8.	Availability of health personnales in the family
	Yes	11	36.7%
	No	19	63.3%

The mean score is increased in the post test. The mean score in the post test is 22.8 and the mean score in the pre test is 9.8. The variation is decreased in post test when compared to pre test.SD in the post test is 2.7 and in the pre test is 2.1. The mean is improved by 13. The calculated value of t is 51.1 which is highly significant. The results undoubtedly confirm that the planned teaching program was effective in improving the knowledge on non pharmacological techniques for pain relief during child birth among pregnant mothers.

Table 3: Section III: Association between the demographic variables and knowledge of pregnant mothers regarding non pharmacological techniques for pain relief during child birth in Pre-test.

S. No	Characteristics	Chi-square value	Df	Result	P-value

1	Age	5.3	3	NS	P>0.05
2	Residential area	2.1	1	NS	P>0.05
3	Religion	0	2	NS	P>0.05
4	Educational status	14.3	3	Sig	P<0.05
5	Occupational status	2.1	2	NS	P>0.05
6	Family income	2.8	3	NS	P>0.05
7.	Type of family	4.7	1	Sig	P<0.05
8.	Availability of health personnales in the family	5.7	1	Sig	P<0.05

NS – Not significant at 5% level (i.e., P > 0.05)

Sig – Significant at 5% level (i.e., P < 0.05)

From the table, educational status, type of family and availability of health personnales in the family are significant. The remaining characters are not significant.

DISCUSSION:

· The main objective of the study was to determine the effectiveness of planned teaching program on knowledge regarding non pharmacological techniques for pain relief during child birth among pregnant mothers by comparing pre test and post test knowledge score.

· The pre-test findings of the study revealed that the overall score in the pre-test was mean 9.8, standard deviation 2.1 and mean score percentage was 32.7%. This shows that the knowledge of mothers regarding non pharmacological management of labor was inadequate.

These findings are consistent with the findings of Himanshu Vyas, Aashish Parihar, Naveen Kumar Sharma.

They conducted a Quasi experimental study to assess the effectiveness of a planned teaching program on knowledge regarding Non pharmacological techniques of relieving labor pain in primigravida women in selected hospitals at Gulbarga, Karnataka. The sample consisting of 60 primigravida mothers was selected by using Simple random sampling technique. The tool comprised of knowledge questionnaires. The pre-test was conducted and planned teaching program was administered on the primigravida women immediately after the pretest. The post test was conducted after one week of the pre test with same questionnaires. The data obtained were analyzed using descriptive and inferential statistics. In pre-test the sampled subjects were having poor knowledge on non pharmacological techniques of managing labor pain. i.e. about 34%. Regarding the post-test the sampled subject had an improved knowledge on non pharmacological techniques of managing labor pain i.e. about 83.9%. In relation to Planned teaching program, the paired “t” test showed that, the teaching program was statistically significant at p⁷.

These findings provokes for imparting adequate knowledge and the need for teaching programs to improve knowledge of mothers on non pharmacological management of labor.

CONCLUSION:

Childbirth is an intense event that involves extreme physical stress and carries emotional, cognitive, social, and cultural significance. Physically, women have to cope with acute changes as the uterus contracts, the cervix dilates, and the baby and placenta are delivered. Research suggests that adequate preparation can help to reduce pain or at least modify the perception of pain and reduce anxiety,which can help the mother to better cope with labour⁷.

In this study, pre test findings shows that the pregnant mothers had inadequate knowledge regarding non pharmacologic management of labor. The mean score in the post test is 22.8, SD in the post test is 2.7 and the mean is improved by 13. The calculated value of t is 51.1 which is highly significant. The results undoubtedly confirm that the planned teaching program was effective in improving the knowledge on non pharmacologic management of labor among pregnant mothers. Knowledge of non pharmacologic management of labor will help them to prepare for labor, modify the perception of pain and help them to cope with labor. Therefore, it is very essential to give adequate information to the pregnant mothers about non pharmacologic management of labor.

REFERENCES:

1. Pain During Labor and Delivery. https://www.nwh.org/patient-guides-and-forms/maternity-guide/maternity-chapter-3/comfort-measures-during-labor-and-delivery-pain

2. Nonpharmacologic Pain Management During Labor. https://www.nwh.org/patient-guides-and-forms/maternity-guide/maternity-chapter-3/comfort-measures-during-labor-and-delivery-non-pharmacological-methods.

3. Hosseni S. F, Pilevarzadeh M, Vazirinasab H. Non-Pharmacological Strategies on Pain Relief During Labor. Biosci Biotech Res Asia 2016; 13(2). https://www.biotech-asia.org/vol13no2/non-pharmacological-strategies-on-pain-relief-during-labor/

4. Childbirth: pain relief options. https://www.betterhealth.vic.gov.au/health/healthyliving/childbirth-pain-relief-options

5. Mwakawanga DL, Mselle LT, Chikwala VZ, Sirili N. Use of non-pharmacological methods in managing labour pain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania. BMC Pregnancy Childbirth. 2022; 22(1): 376. doi: 10.1186/s12884-022-04707-x. PMID: 35490235; PMCID: PMC9055707. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9055707/

6. Himanshu Vyas, Aashish Parihar, Naveen Kumar Sharma. Effectiveness of Planned Teaching Program on Knowledge regarding Non pharmacological Techniques of relieving labor pain among Primigravida women. IOSR Journal of Nursing and Health Science. 2013; 2(6): 50-54

7. Childbirth and Stress. S. Ayers, E. Ford, in Encyclopedia of Stress (Second Edition), 2007. https://www.sciencedirect.com/topics/medicine-and-dentistry/childbirth#:~:text=Introduction-, Childbirth%20is%20an%20intense%20event%20that%20involves%20extreme%20physical%20stress,baby%20and%20placenta%20are%20delivered

Received on 05.10.2023 Modified on 10.12.2023

Int. J. of Advances in Nur. Management. 2024; 12(1):7-11.

DOI: 10.52711/2454-2652.2024.00002

Parameter	Mean	S.D	SEM	Range	Mean%	t –value	Result
Pre-test	9.8	2.1	0.38	5-14	32.7%	51.1	Sig P<0.05
Post-test	22.8	2.7	0.49	17-27	76%
Improvement	13