Pregnancy and Childbirth

Birthing is a painful process

The body is designed for it, We’ll make it a comfortable as possible

Morrison Susan Jane

Pregnancy is the special event not only in the life of the woman but also in the entire family. The labor and birth process is an exciting, anxiety provoking but rewarding time for the women and her family. (Burroughs, 2001)

Childbirth is a natural biological process. The nature of pain experienced during labor depends on the cervical dilatation (Sr.cyriac, 1999) the study was conducted with 78 women labour to find out the ways does labour pain changes as cervical dilatation increases.

They were asked to describe the nature of their pain using 3 self report scales. Pain was typically characterized as “discomforting”,” excruciating” and horrible when closer to delivery. Study was concluded that when the cervical dilatation increases, the pain intensity also increases. (Brown, campall Kurtz, 1989) More women are now requesting a pain free labour and ask for epidural analgesics. The disadvantage of epidural analgesics are lengthening of first stage of labour, less sensation of expulsive efforts and lengthens second stage of labour and increased instrumental delivery.

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(Howell, 2002)

Pharmacological pain relief methods include administration of narcotics, sedatives, inhaling analgesic, pudendal, paracervical and spinal blockage and epidural anesthesia which has side effect. Fetal respiratory depression is the side effect of pethidine is a common labour pain relief; especially if it is used 2 to 4 hour during labour prior to birth. Epidural anesthesia could lead to sympathetic blockage and consequently, decreased maternal cardiac output, bladder distension, prolongation of several stages of labour and catheterization.

To relive labour pain perception, nitroxide also could be administered. It would not cause second stage prolongation, but as all other anesthesia drugs, would pass the placenta and suppress fetal central nervous system. (Fries, 2002)

Non-pharmacological labour pain relief measures such as continuous labour support, baths, touch and massage, maternal movement and positioning, and intradermal water blocks for back pain (O’Hara M 2002) Massage is a cost effective nursing intervention that can decrease pain and anxiety during labour and partner’s participation in massage can positively influence the quality of women’s birth experience. (Chung-hey Chen, 2002)

A clinical trial study was conducted to assess the effect of massage on the duration of first stage of labour among 62 primi parous women with normal delivery. The results of the massage group was 5.75 hours and for the routine nursing care group 9.15 hours (P=0.001). (Abedian Zahra, fadaie 2008) A study was conducted with 710 women regarding the worries about pain in labour and the study revealed that 67%of women were “bit worried” 12% “very worried” and 23% “not at all worried” .the pain in childbirth active the sympathetic nervous system and resulting in changes in the blood pressure, respiration, skin colour and diaphoresis. (Green1993) Labour pain is often described as the worst pain in a women’s life, but the experience is highly variable. Although many factors have linked to the labour pain, it is difficult to assess the individual affects of these factors because labour is a dynamic process and pain intensity changes over the course of labour. (Connell price, Evans 2008)

Massage would cause the endorphins release and reduce the ischemia by amplification of local blood supply. endrophins are endogenous opioid polypeptide compounds. They are produced by the pituitary gland and the hypothalamus in vertebrates during strenuous exercise, and they resemble the opiates in their abilities to produce analgesia and sense of well being. Endorphins called as “enkephalins” (derived from Greek word egkephaos “in the head”).the word endorphins itself are abbreviated from endogenous morphine, which means morphine produced naturally in the body. All of these would stimulate the sympathetic system and relax the skeletal muscle. (Klosterman 2005).

Massage is found to be an effective therapy to decrease the pain, anxiety, and a depressed mood during labour. In addition, it is reported that massaged mothers had significantly shorter labors and decrease pain level. (Change et ai..,2002).so massage therapy can change the labour into a pleasant and delivery to reduce the labour pain .the current study was fulfilling to evaluate the effect of massage therapy on severity of labour pain.

BACKROUND OF THE STUDY

Non-pharmacological approach to pain includes a wide variety of techniques to address not only the physical sensations of pain but also to prevent suffering by 27 enhancing the psycho emotional and spiritual components of care. The ideal environment for this approach fosters a sense of comfort and privacy and reflects expectation that the women will remain active and use a variety of techniques. It contains comfort aids and places to walk, bathe, rest. Satisfaction, fulfillment and a sense of accomplishment are often high, and suffering avoided even when pain is great. In fact these positive reactions to child birth are associated more with how the women believes she was treated by her caregivers, her involvement in decision making, and whether her expectations were met, than with the amount of pain she feels. Mander K., (1998)

Touch therapies are used by over 30,000 nurses in hospitals each year and documented as legitimate medical techniques (Keegan, 2001). Acupressure is one form of touch therapy that has been used for over 5000 years. Described by Keegan (2001) as possibly the earliest form of physical therapy, this ancient Chinese technique involves the use of finger pressure along the body‟ s energy meridians in order to regulate the flow of qi. Traditional Chinese medicine focuses on the belief that all life has two parts that must be in balance, the yin and the yang. The principals of yin and yang go beyond the Western implications of male versus female; light versus dark; hot versus cold. “Yin and yang express the idea that everything has a defining link to its surroundings” (Hart &Goh, 1997). In other words, the belief that each living and non-living thing exerts an influence on its surroundings to maintain balance, each existing in dependence of one another. Hart and Goh (1997) provide the following analogy, “if one considers the yin aspect of a candle to be the wax and the yang aspect to be the flame, it is easy to see how the yin nourishes and supports the yang, when the wax is gone so is the flame” .In regards to health and the body there are five main principles presented by(Hart and Goh 1997)

Fig-Yin Yang symbol

All things have a yin aspect and a yang aspect .

Any yin or yang aspect can be divided into another pair of yin and yang aspects . Yin and yang are mutually dependent. Neither has meaning without the other.

Yin and yang control each other. Where yin is weak, yang will be strong, and vice versa; where yin is excessive, yang will cause health problems, and vice versa.

Under certain circumstances yin and yang can transform into each other.

Qi often referred to as chi in Western culture represents the life energy or life force of the individual and is the core concept of traditional Chinese medicine. Traditional Chinese medicine believes that chi provides protection from illness. “Described as a mix of inherited energy, passed from parents to children at the time of conception and energy derived from the food and air that sustain us throughout life” (O‟ Mathúna& Larimore, 2001, p. 144), chi is thought to travel along meridians or pathways throughout the body . Each organ is affected by one of the twelve major meridians which are further grouped into six yin or yang pairs and influenced by the five elements (fire, metal, wood, water, and earth). The six yin organs include the lung, spleen, heart, kidney, pericardium, and liver and the six yang organs include the stomach, small intestine, large intestine, bladder, gallbladder, and triple burner (not an anatomical 4organ); it represents the pathway connecting other organs primarily the lungs, spleen, and kidneys). As long as chi is flowing uninterrupted through the meridians one is believed to be in good health (O‟ Mathúna& Larimore, 2001).

Pain in labor is a nearly universal experience for child bearing women. Labor pain is a challenging issue for nurses designing intervention protocols. Pain during labor is caused primarily by uterine muscle contractions and somewhat by pressure on the cervix. This pain manifests itself as cramping in the abdomen, groin, and back. Other causes of pain during labor include pressure on the bladder and bowels by the baby’s head and stretching of the birth canal and vagina. Labor events have got great psychological, emotional, and social impact to the women and her family. She experiences stress, physical pain, and fear of dangers. The care giver should be tactful, sensitive and respectful to her. Throughout labor she is given continued encouragement and emotional support and assurance are given to keep up the morale. Jeyalakshmi S. et.al., (2008)

Massage is an ancient technique that has been widely employed during labor. Massage is a cost effective nursing intervention that can decrease pain and anxiety during labor and psychological support during labor. Using essential oils, olive oil, and relaxation techniques are reducing the labor pain, perception without any side effects and any health professional could give it. Jeyalakshmi S., (2008) Massage and pain Massage stimulates the body to release endorphins, which are natural pain killing and mood lifting substances. Endorphins are the responsible for the “feel good” factor. Massage is recommended by child birth experts because it has been shown to ease pain and reduce anxiety in the first stage of labor. It is also linked with the shorter labors and a low risk for postpartum depression. Reader S.J., (1990)

Fields., (1997) demonstrated that massage therapy during labor was highly correlated with decreased labor pain, decreased anxiety, and shorter labors. Massage can also assist the new mother. Olive oil contains palmatic acid, oleic acid, linoleic acid, steanic acid, myristic acid and glycerides. The olive oil is extracted from the ripened fruits. The fruits are processed three times. Successfully the first round oil is the best in quality, golden in color, with a light fragnance and known as virgin oil. It contains therapeutic potential even it is thousand years old. The massage of olive oil over the body tones up the muscles and organs, it relieves muscular pains. Olive oil has pain killing properties. Scientists were discovered that a new compound in extra virgin oil that acts the same way as anti inflammatory drugs. The compound, which they named oleocanthal, has the same pain relieving qualities as ibubrufen and other non steroidal anti-inflammatory drugs,. The researchers estimated that 50 grams of olive oil provides about 10% of the ibuprofen needed for adult pain relief. Fields., (1997)

NEED FOR THE STUDY

“ Stress is the physical and psychological effects we experience as a result of the way we react to change in the surrounding environment” Pain is a universal experience but is difficulty to define. Labour purely in the physical sense may be described as the process by which the fetus, placenta and membranes are expelled through the birth canal into the outer world. During this process a mix of hormones that induce uterine contractions and pain.

In the labour during dilatation (First stage) visceral pain predominated due to mechanical distension of the cervix and of the lower part of the uterus. These stimuli are transmitted to the spinal cord at the level of the 10th thoracic to first lumbar root. Uterine contractions may be felt as back pain because the nerves that supply the uterus also supply the skin on the lower back or lumbo sacral area. During the descent phase (Second stage) pain is also caused by distension and stretching of the pelvic floor and perineum. These stimulative are transmitted via podental nerve to the second to fourth sacral nerves.

During labour, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for child bearing women, but nowadays owing to some well-known limitations and serious side effects non-pharmacological methods such as music therapy hot and cold application, massage homeopathy and hydro therapy are being broadly recommended. Even though there are different alternative and complementary therapy for the management of labour pain like massage therapy, hot application, and massage are the most convenient and effective method. Moreover massage helps to induce relaxation and also evokes an atmosphere of acceptance, respect for the body and being caring for. Hence this close personal interaction implicit massage strengthens the nurse-patient relationship and this in turn creates ambience towards health and healing.

It was found by the investigator during her experience that the mothers who are admitted in labour have severe pain and discomfort. This being the major problem among every mothers, hence forth the investigator personally felt that there is a need for the above studies and statistics and was inspired in selection of this dissertation. Mothers may experience significant pain during labour may be minimized by sacral massage therapy and this can experience great satisfaction afterwards.