Study to assess the effectiveness of Kegal Exercise and Prone Position on after pain and Involution of Uterus among Post Natal Mothers at Private Hospital Rajkot
Bhagvati Mahavadiya, Jeenath Justin Doss K.
Shri Anand Institute of Nursing, Opp. Ghanteshwar Park, B/H Shainik Society, Jamnagar Road, Rajkot-360006.
*Corresponding Author E-mail: bhagvatimahavadiya@gmail.com
ABSTRACT:
Health is the level of functional or metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social challenges. An individual with healthy body and mind is an asset to the family and society. But health is not a commodity to purchase; health can be destroyed by various disorders or diseases. Disease broadly refers to any condition that impairs the normal functioning of the body. Some minor disease can be treated at home itself, while some major disorder or severe diseases requires medical therapy or surgical treatments in the health care set-up. Clients with critical condition such as upper GI bleeding, masses or tumors, upper GI stricture and sepsis are required to be treated in endoscopy unit of hospital setting. Endoscopy unit is special department of hospital or health care facility that provides visualization through internal organ with help of different fiber optic scopes to the patient with upper GI problems like bleeding, masses, stricture and foreign body ingestion as well as lower GI problems like intestinal obstruction, bleeding and also for patients with respiratory disorders. Close monitoring and support from special equipment and medications to the patients in order to ensure normal bodily functions. Patients undergoing any procedures have mild to severe anxiety towards the procedure. Decreasing or relieving anxiety help the patient and care giver for procedures. There are different ways to decrease anxiety of patients like posters, charts videos and verbal information. The HAM- A tool was used to assess anxiety. HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms and is still widely used today in both clinical and research settings. It is psychological questionnaires used by clinicians to rate the severity of patient’s anxiety. HAM-A developed by M. Hamilton and it is based on 14 parameters including anxious mood, tension, fears, insomnia, somatic complaints and behavior.
KEYWORDS: Kegal Exercise, Prone Position, Uterus.
INTRODUCTION:
God could not be everywhere and therefore he made mothers
Childbirth is one of the most important events in a woman’s life.
The wonder of motherhood is the enjoyable journey that is felt only by the mother after giving birth of rebirth by giving birth to a child. A mother, even though she is born earlier in this world, perceives an experience. It brings about remarkable changes in her normal life and introduces an exposure to a new role within her.1
Childbirth includes different stages, and in every stage, the mother plays a unique role in experiencing the important events that occur throughout her journey. The different stages are broadly classified into three main aspects, namely, antenatal period, intranasal period, and postnatal period.2 postnatal period is the most vulnerable period for the mother and the newborn baby. Many mothers experience physiological, psychological and social changes during this period. There are many types of postnatal ailments experienced by the mother such as after pains, irregular vaginal bleeding, leucorrhoea, cervical ectopic (erosion), and backache, retroversion of the uterus, anemia, breast problems and episiotomy discomforts.2
The first 6 weeks after the birth of the baby is known as postpartum period or puerperium. During this time, mothers experience numerous physiological and psychological changes. Main changes occur for uterus is involution of the uterus and descent of the fundus. Involution begins immediately after the delivery of the placenta. During involution uterine muscles contracts firmly around the maternal blood vessels at the area where the placenta is attached. This contraction controls bleeding from the area when the placenta is separate.
There are many reasons for the sub involution of the uterus. Sometimes it can be associated with certain factors such as inadequate breast feeding, lack of maternal care during pregnancy and puerperium. Other complications of puerperium include early postpartum hemorrhage, hypovolemic shock, thromboembolism, puerperal infections. Certain complications may be fatal and would be recognized early and dealt with prompt care. Maternal mortality and morbidity rates measures the risk of women dying from puerperal causes.3
Eventually, after the birth of the baby placenta separates from the wall of uterus and expelled. Immediately the uterus contracts tightly to seal off open blood vessels on uterine wall at placental site. These uterine contractions called after pains. After pains refers to the infrequent, spasmodic pain felt in the lower abdomen after delivery for a variable period of 2-4 days. These abdominal cramps are caused by postpartum contractions of the uterus as it shrinks back to its pre-pregnancy size and location. Presence of blood clots or bits of the afterbirth leads to hypertonic contractions of the uterus in an attempt to expel them. The uterus loses muscle tone during subsequent pregnancies due to its contraction- relaxation cycle and causes after pains, and is vigorous pain in multiparous woman.
Uterine muscle tone decreases with increase in number of pregnancies and this may leads to more severe cramping. Breast feeding the baby stimulates the production of the hormone oxytocin by the pituitary gland. Oxytocin triggers the let-down reflex that releases milk from the breasts and also causes the uterus to contract even more. This effect creates additional abdominal discomfort. Cramping will be most intense during 1st day after the delivery and should tapper off on 3rd day. After pains will be relieved if the womb remains firmly contracted. When the bladder is full it is unable for the uterus to contract and it tends to relax, thus prohibiting relief from after pains.4
Labor is one of the major life-events, a woman will experience. Its memory will remain with her. Any negative impressions may give rise to psychological disturbance with her and the whole family. There are varieties of non-pharmacological methods for pain relief which are important for postnatal period. They are massage, counter pressure, hydrotherapy, breathing patterns, heat and cold packs, position changes, relaxation techniques, music, aromatherapy, birth doulas and acupressure points. Among non-pharmacological methods, position change, abdominal muscle exercise and uterine massage are more effective.
NEED FOR THE STUDY:
The postnatal period is a time of maternal changes that are both retrogressive (involution of uterus and vagina) and progressive (production of milk for lactation, restoration of the normal menstrual cycle, and beginning of a parenting role).Protecting a women’s health as these changes occur is important for preserving her future childbearing function and for ensuring that she is physically fit to incorporate her new child into her family. The physical care a woman receives during the postnatal period can influence her health for rest of her life. Most women experience some degree of discomfort during the postnatal period. Common causes of discomfort include pain from uterine contractions (after pains), perinea lacerations, episiotomy, hemorrhoids, sore nipples, and breast engorgement.
Most women expect and experience after pains after the labor process. Intensity of pain experienced, varies from one woman to another. After pains is managed in various ways according to the following indicators such as frequency, duration and intensity of uterine contractions, the women’s emotional behavior, her response to after pains. Postnatal health problem needs close attention. It is estimated that approximately about 58% women experience tiredness, 23% perinea problems, 42% backache, 24% Hemorrhoids, 13% bowel problems, 23% sexual problems, 20% vaginal Bleeding, 46% urinary incontinence, and 43.5% women experience after pains.
Association of after pains with multiparty and breastfeeding is well known. However, women may experience after pains regardless of their parity and breast feeding. Women themselves have described the pain equal to the severity of moderate labor pains. A survey on childbearing experiences showed that 71% of women finding difficulty while feeding the baby. The most common reason they gave was cramping pain during breast feeding. Cramping intensity may vary with parity, in which multipara mothers are more prone to get severe after pains than prime mothers.
After pains are the abdominal cramps that are caused by postpartum contractions of the uterus as it shrinks back to its pre-pregnancy size and location. In short, after pains signals the process of involution. Immediately after delivery, the uterus begins the process of involution or reduction in size. A woman can best help her abdominal wall to return to good tone by using proper body mechanics and posture, getting adequate rest and by performing exercises. Deep breathing exercises help to feel better physically and emotionally; alternate leg raising exercises, Kegel exercise and early ambulation will encourage uterine contractions, helps in restoring the muscle strength and conditions the abdominal muscles. Exercises to strengthen abdominal and pelvic muscles and finally hastens the process of involution.5
During the investigator’s clinical experience, it was found that a number of postnatal mothers experienced after pains, which caused great discomfort, making it difficult to adapt to their new maternal role. If after pains are extremely painful or they persist for over a week, it may be a good idea to nurse to explore possible complications which might be causing contractions, such as unexcelled tissue which the uterus is trying to get rid off, So the role of a nurse is to find out an effective way to alleviate pain and make the postnatal period of the mother indeed the happiest period of her life. The happiness is screened by the pain of the uterine contractions (after pains) and thus it motivated the investigator to undertake an experimental study to portray the effectiveness of Kegel exercise and prone position on reduction of after pains and involution of uterus among postnatal mothers.
OBJECTIVES OF THE STUDY:
1. To assess the pre-test and post-test and post – test scores of after pain and involution of uterus among postnatal mother in experimental & control group.
2. To determine the effectiveness of kegal exercise and prone position on after pains and involution of uterus among postnatal mother in experimental group.
3. To compare the effectiveness of kegal exercise and prone position on after pain and involution of uterus among postnatal mother in experimental and control group.
4. To find out the association between pre- test level of after pain and involution of uterus among postnatal mother with their selected demographic variable.
RESEARCH HYPOTHESES:
H1: There will be significant difference between the mean pre-test and post- test scores of after pains and involution of uterus among postnatal mothers in experimental group.
H2: There will be significant association between the pre-test level of after pains and involution of uterus with selected demographic variables of postnatal mothers
METHODOLOGY:
The modified conceptual framework of the present study is including schematic presentation of methodology. In this study, evaluative approach was selected and pre- experimental one group and posttest design was adopted. HAM-A scale was used to collect the data. The main study was conducted at PRATHAM Hospital, Rajkot, with the sample size of 30 patients, selected by using simple random sampling technique and the collected data were analyzed and interpreted based on descriptive and inferential statistics.
RESEARCH APPROACH:
Quantitative research approach
RESEARCH DESIGN:
True Experimental designed pre- test & posttest control group designs
VARIABLES:
Independent Variable:
Video assisted teaching on upper GI Endoscopy.
Dependent Variable:
Anxiety level of patients undergoing upper GI Endoscopy.
Demographic Variables:
demographic variable such as age, gender, Educational status, religion, marital status, diagnosis of patients, previous hospital stay Of patients, previous hospital stay duration of patients and personality of patients Undergoing upper GI Endoscopy.
Setting of The Study:
The study will be conducting in selected hospital – Rajkot
Study Population:
Target population:
Postnatal mothers at selected hospital at Rajkot.
Accessible population: Postnatal mother at selected hospital at Rajkot.
Sample Size:
The sample size for the study will comprise of 60 postnatal mothers. Out of which, 30 will be in experimental group and 30 in control group.
SAMPLING TECHNIQUE
Non probability purposive sampling will be used to select the samples.
MAJOR FINDING OF THE STUDY:
The study shows that among the study participants of post natal mothers according to their Age of post natal mothers in experimental group 11(36.7%) belonged to < 20 years age group while in control group 10(33.3%) and also 10(33.3%) in 21 – 25 years age in control group. With record to Religion majority belonged to Hindu 19 (63.3%) in experimental group and 16(53.3%). Mostly post natal mothers are educated at the level of primary school in both the experimental 12(40.0%) and 13 (43.3%) in control group. Most of women’s are house wife in experimental group 21(70%) and also same 21 (70%) in control group. Monthly income of the majority of post natal mothers ranges from RS 2000 to 3000 experimental group 18(60.0%) and control group 14 (46.7%). Majority of the women come from joined family. In experimental 13(43.3%) and control group 15 (50.0).
Most of the women came from urban experimental group 18(60.0%) and control group14(46.7%). Majority of the women close relative marriage in experimental group 18 (60.0%). In control group17(56.7%) Most of the women are non-relative marriage. Most of the women height 146 to 150 cm in both the experimental group 13(43.3%) and control group 15(50.0%). Most of the women weight 50 to 55kg in both group. In experimental group 13(43.3%) And control group 16(53.3%). Their diet pattern mostly were non vegetarian, in experimental group 26(86.7%) and control group 27(90.0%).
Most of the women age at the menarche 12 to 15 years, in experimental group 22(73.3%) and control group 22 (73.3%).
When analyzing the association between level of pain reduction score and mother’s demographic variables in experimental group. There is a statistical significance between age of the mother and reduction of fundal height p=0.01**) specifically in mothers between 26-30 years, and also there is a marked reduction of fundal height among educated who are graduates
CONCLUSION:
After pains is a major problem remains in mothers after delivery problem in India. Since nurses have a key role in preventive, curative, rehabilitative aspects of healthcare. Nursing personnel should educate the mothers so that the quality of life will be improved. The intervention was found to be very effective in prevention of pains in mothers and fast involution of uterus
REFERENCE:
1. Avidson AB, Chintu K, Erikson B. Maternal and infant health problems after normal childbirth – a randomised controlled study in Zambia. Journal of Epidemiology and Community Health. 1998; 52:385-91.
2. Babu M. A study of the postnatal and neonatal health problems and home remedies used during puerperium in an urban community of New Delhi. The Indian Journal of Nursing and Midwifery. 1998; 1(3): 49-52.
3. Benett RV, Brown LK. Myles Textbook for Midwives. 14th ed. Edinburgh: Churchill Livingston. 2003.
4. Dutta DC. Textbook of Obstetrics. 6th ed. Calcutta: New Central Book Agency (P) Ltd. 2004.
5. Gamble J, Creedy D. Midwifery Preparation for Practice. Marrickville: Churchill Livingstone. 2006.
Received on 06.02.2023 Modified on 09.05.2023
Accepted on 02.08.2023 ©A&V Publications All right reserved
A and V Pub J. of Nursing and Medical Res. 2023; 2(3):73-76.
DOI: 10.52711/jnmr.2023.19