A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF STAFF NURSES REGARDING SELECTED ALTERNATIVE AND CONTEMPORARY MODALITIES OF PAIN RELIEF DURING FIRST STAGE OF LABOUR IN SELECTED MATERNITY HOSPITALS, BANGALORE By SHANTI SONU SAM Dissertation Submitted to RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN OBSTETRICS AND GYNAECOLOGICAL NURSING Under the guidance of Mrs. Gowri Sayee Associate Professor & HOD Department of Obstetrics and Gynaecological Nursing 1
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A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF STAFF NURSES REGARDING
SELECTED ALTERNATIVE AND CONTEMPORARY MODALITIES OF PAIN RELIEF DURING
FIRST STAGE OF LABOUR IN SELECTED MATERNITY
HOSPITALS, BANGALORE
By
SHANTI SONU SAM
Dissertation Submitted to
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
IN PARTIAL FULFILLMENTOF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCEIN
OBSTETRICS AND GYNAECOLOGICAL NURSING
Under the guidance ofMrs. Gowri Sayee
Associate Professor & HODDepartment of Obstetrics and Gynaecological Nursing
FORTIS INSTITUTE OF NURSING20/5, Yelachenahalli, Kanakapura road, Bangalore-560078
YEAR2010-2012
1
Rajiv Gandhi University Of Health Sciences, Bangalore, Karnataka.
DECLARATION BY THE CANDIDATE
I hereby declare that this thesis entitled “A STUDY TO
ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF STAFF NURSES
REGARDING SELECTED ALTERNATIVE AND CONTEMPORARY
MODALITIES OF PAIN RELIEF DURING FIRST STAGE OF
LABOUR IN SELECTED MATERNITY HOSPITALS,
BANGALORE.” is a bonafide and genuine research work carried out by me
under the guidance of Mrs. Gowri Sayee, Associate professor and HOD,
Department of obstetrics and gynaecology, Fortis institute of nursing,
Bangalore.
Signature of Candidate
SHANTI SONU SAM
Date:
Bangalore:
2
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation titled “A STUDY TO
ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF STAFF NURSES
REGARDING SELECTED ALTERNATIVE AND CONTEMPORARY
MODALITIES OF PAIN RELIEF DURING FIRST STAGE OF
LABOUR IN SELECTED MATERNITY HOSPITALS,
BANGALORE.” is a bonafide research work done by Ms. Shanti Sonu
Sam in partial fulfilment of the requirement for the degree of Masters of
Science in Nursing (Obstetrics and Gynaecology).
Signature of Guide:
Mrs. Gowri SayeeAssociate professor& HODObstetrics and gynaecological nursingFortis institute of nursingBangalore- 560078
Date:
Bangalore
3
ENDORSEMENT BY THE
HOD, PRINCIPAL/ HOD OF THE INSTITUTION .
This is to certify that the dissertation entitled “A STUDY TO
ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF STAFF NURSES
REGARDING SELECTED ALTERNATIVE AND CONTEMPORARY
MODALITIES OF PAIN RELIEF DURING FIRST STAGE OF
LABOUR IN SELECTED MATERNITY HOSPITALS,
BANGALORE.” is a bonafide research work done by Ms. Shanti Sonu
Sam under the guidance of Mrs. Gowri Sayee, Department of Obstetrics
and Gynaecological Nursing, Fortis institute of nursing, Bangalore.
Signature of the HOD Signature of the Principal
Mrs. GOWRI SAYEE Prof. SRIDHAR K.V
Associate Professor
Date: Date:
Bangalore Bangalore
4
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the right to preserve, use and disseminate this
dissertation thesis in print or electronic format for academic or research
28. Payant L, Davis B, Graham ID, Peterson WE, Clinch J. Nurse’s intentions to
provide continous labour support to women. Journal of obstetrics and neonatal
nursing. July 2008; 37(4):405-414.
29. Kim SS, Exlen JA, Kim KB. Nursing students and faculty member’s
knowledge of experience with an attitude toward complementary and
alternative therapies. Journal of nursing education 2006 September; 45(a):375-
378.
30. Gowri N. Effectiveness of STP on knowledge and practices regarding tobacco
consumption in rural health setting. The nursing journal of India. Feb 2010;
vol(2).
31. Yanichin. Study to assess the effectiveness of organized instruction on
knowledge , skill and attitude of practice of breast feeding in CMC, Vellore
2002.
32. Sarojamma. Study on the knowledge and practice of breast feeding in mothers
of hospitalized infants in Vanivilas hospital, Bangalore 2000
33. Shailaja KG. A study to assess the knowledge and confidence of the primi-
para mothers regarding exclusive breast feeding. Nightingale nursing times.
March 2008 Vol 3(12).
34. Denise F Polit, Cherry Tatano Beck. Nursing research: generating and
assessing evidence for nursing practice. Lippincott publications. 8th edition.
Pg: 105, 139, 337-341, 367, 712.
35. Basavanthappa BT. Nursing research. Jaypee publishers. First edition 2003.
Pg: 49, 66, 93, 215, 219.
104
ANNEXURE A
ETHICAL CLEARANCE CERTIFICATE
105
ANNEXURE B
LETTER SEEKING PERMISSION TO CONDUCT THE STUDY
106
ANNEXURE C
LETTER REQUESTING CONSENT TO VALIDATE THE TOOL
107
Date:
FROM,
MS. SHANTI SONU SAM 2nd year M.Sc NursingFortis Institute of NursingBangalore-560078To,
………………………………..........
……………………………...............
Forwarded through:
THE PRINCIPAL,Fortis Institute of Nursing,Bangalore.
Sub: - Requisition for expert opinion on content validity of the research tool.Respected Sir/Madam,
I, Ms. Shanti Sonu Sam, 2nd year M.Sc nursing student of Fortis
Institute of Nursing Bangalore, have selected the topic “a study to assess the
effectiveness of structured teaching programme on knowledge of staff
nurses regarding selected alternative and contemporary modalities of
pain relief during first stage of labour in selected maternity hospitals,
Bangalore” for dissertation to be submitted to Rajiv Gandhi University of
Health Sciences, Bangalore as a partial fulfillment of university requirement
of awarding M.Sc Nursing degree.
Here with I am enclosing a copy of
a) Acceptance form
b) Letter requesting opinions and suggestions from experts
c) Statement of problem, objectives and hypothesis
d) Tool
e) Answer keys
108
f) Blue print
g) Evaluation criteria check list
h) Lesson plan
i) Certificate of content validity
I kindly request you to examine the structured teaching programme and
tool and give your valuable opinion and suggestions for further improvements.
I would be highly obliged and remain thankful for your great help if
you could kindly return this structured teaching programme and tool, after
signing the “ContentValidity Certificate” attached here with, as early as
possible.
Thanking you
Yours sincerely,
Shanti Sonu Sam
Forwarded for expert validation
and approval through, Principal.
109
ANNEXURE D
ACCEPTANCE FORM FOR TOOL VALIDATION
Problem statement:
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE OF STAFF NURSES
REGARDING SELECTED ALTERNATIVE AND CONTEMPORARY
MODALITIES OF PAIN RELIEF DURING FIRST STAGE OF LABOUR IN
SELECTED MATERNITY HOSPITALS, BANGALORE.”
I……………………………………………….....would/ would not agree upon in
validating the tool.
Name:
Designation:
Address:
Signature:
Date…………….
Place……………
110
ANNEXURE E
CONTENT VALIDATION CERTIFICATE
I hereby certify that, I have validated the tool of Shanti Sonu Sam, IInd year
M.Sc.Nursing student, Fortis Institute of Nursing, Bangalore who is under taking this
study: “A study to assess the effectiveness of structured teaching programme on
knowledge of staff nurses regarding selected alternative and contemporary
modalities of pain relief during first stage of labour in selected maternity
hospitals, bangalore.”
Place:Signature of the Expert.
Date:
Designation and Address.
111
ANNEXURE F
LETTER TO THE PARTICIPANTS REQUESTING CONSENT TO PARTICIPATE IN THE STUDY
Dear participants,
I, Miss. Shanti Sonu Sam, IInd year M.Sc. nursing student of Fortis
institute of nursing, Bangalore, am planning to conduct a research project on “A
study to assess the effectiveness of structured teaching programme on knowledge
of staff nurses regarding selected alternative and contemporary modalities of
pain relief during first stage of labour in selected maternity hospitals,
Bangalore”. I request you to participate in the study.
The information provided will be kept confidential and anonymity will be
maintained throughout and after the study.
Thank you for participating in the study
Yours faithfully
Miss. Shanti Sonu Sam
Date:Place:
112
ANNEXURE G
LIST OF EXPERTS FOR TOOL VALIDATION
1. Mrs. P. Swarnalatha
Principal
BMS Hospital Nursing College
N.R. Colony, Bangalore-560019.
2. Mrs. Reddamma
Professor
Government College Of Nursing, Fort
Banglore-2
3. Mrs. saraswathi
Principal
VenkateshwaraCollege of nursing
Bangalore.
4. Mrs. Balalakshmamma,
Lecturer
The Oxford College of nursing
Bangalore.
113
5. Mrs. D. Kanitha
Lecturer
NIMHANS College of nursing
Bangalore.
6. Mrs. Kamala J
Associate Professor
Kempegowda College of nursing
Bangalore.
7.Dr. GayathriKamath
Dept. of Obstetrics and Gynaecology
Fortis Hospitals
Bangalore.
114
ANNEXURE H
BLUE PRINT FOR DISTRIBUTION OF ITEMS
The blue print of the structured questionnaire for assessing knowledge
regarding alternative and contemporary modalities is given below:
AREAS
KNOWLEDGE ASSESSMENT QUESTIONNAIRE
Knowledge Comprehension Application Total items
Percentage
Item no.
No. of items
Item no.
No. of items
Item no.
No. of items
Normal labour 1,2,4,7,8 5 3,5 2 7,9 2 9 22.5
Labour pain 10,11,12 3 - - - - 3 7.5
Alternative modalities 17,18 2 - - - - 2 5
Aromatherapy 15,16,17,19,20 5 18 1 - - 6 15
Massages 21,22,24,25 4 23 1 - - 5 12.5
Breathing exercises 26,29,30 3 27,28 2 - - 5 12.5
Intra-dermal water blocks
31,32,33,34 4 35 1 - - 5 12.5
Hydrotherapy 36,38,39 3 37,40 2 - - 5 12.5
Total no 29 9 2 40
Percentage 72.5% 22.5% 5% 100%
115
ANNEXURE I
TOOL FOR DATA COLLECTION
INSTRUCTIONS
Read the questions carefully
Answer all the questions to the best of your ability
Please tick for the appropriate answer.
Part 1-Details with demographic data.
Part2-Details with structured questionnaire to assess the knowledge
regardingalternative and contemporary modalities of pain relief.
Part 1: Demographic profile
Participant No: _________________________
Date: _________________________
1. Age:______________________
2. Qualification: _____________________
3. Working experience: _____________________
3. Religion: ____________________
116
Part II Structured Questionnaire
Section A: General information regarding labour
1) What is normal labour?
a. It is the expulsion of viable products of conception through
vagina.
b. It is the expulsion of viable products of conception through
womb.
c. It is the removal of viable products of conception through
abdomen.
d. It is the expulsion of products of conception before 28 wks.
2) What is the other name for normal labour?
a Dystocia
b Eutocia
c Delivery
d Caesarean
3) Who is a parturient?
a Postnatal mother
b Person supporting woman in labour
c Person conducting labour
d Woman in labour
4) How many stages are there in normal labour?
117
a One
b Two
c Three
d Four
5) The first stage of labour starts with the onset of:
a Cervical effacement
b True uterine contractions
c Rupture of membranes
d Show
6) What is the duration of first stage of labour in primi
mothers?
a 8-12 hours
b 4-8 hours
c 14-16 hours
d 6-8 hours
7) What is second stage of labour?
118
a It is the stage of full dilatation of cervix
b It is the stage of rupture of membrane
c It is the stage of foetal descend
d It is the stage of foetal expulsion
8) Which stage is characterized by the expulsion of placenta?
a First stage
b Third stage
c Fourth stage
d Second stage
9) Which is the most important aspect of management during
first stage of labour?
a Aseptic precautions
b Psychologicsupport
c Minimizing labour pain
d Maintaining body temperature.
Section B: General information on labour pain
10) Who brought out the concept of gate control theory?
a RonaldMelzack and P D Wall
119
b Penny Simkin and Ronald Melzack
c P D Wall and PennySimkin
d Penny Simkin and April Bolding
11) Where is the pain modulation gate situated?
a Cerebrum
b Cerebellum
c Spinal cord
d Medulla oblongata
12) What are the characteristics of true labour pain?
a Pain is from abdomen, back and then thigh.
b Pain is from back, abdomen and then thigh.
c Pain is felt over lower abdomen and then thigh.
d Pain is felt from lower back to thigh.
Section C: Alternative and contemporary modalities
13) What do you mean by alternative and contemporary
modalities?
a Modalities using medical interventions
120
b Modalities used along with medical interventions
c Modalities other than medical interventions
d Modalities providing permanent relief
14) How do alternative modalities help in minimizing labour
pain?
a By blocking pain receptors
b By blocking pain modulation gate
c By blocking nerve impulses
d By using medical interventions.
Section D: Aromatherapy
15) What is aromatherapy?
a Use of essential oils
b Use of drugs
121
c Use of perfumes
d Use of flowers
16) How does aromatherapy works?
a Stimulates chemo-receptors in oro-pharynx
b Stimulates chemo-receptors in naso-pharynx
c Stimulates pain receptors in naso-pharynx
d Stimulates receptors in naso-pharynx
17) How are essential oils extracted?
a Steam distillation
b Churning leaves
c Blending flowers
d Mixing oils
18) What is usually mixed with essential oils to dilute them?
a Water
b Rose water
c Vegetable oil
122
d Perfumes
19) Which oil can be used in latent phase of first stage of
labour?
a Lavender, rosemary
b Rosemary, jasmine
c Jasmine, lavender
d Lavender, neroli
20) Which oils can be used in active phase?
a Lavender, jasmine, rosemary
b Lavender, neroli, rose
c Jasmine, lavender, sage
d Peppermint, lavender, neroli
Section E: Massage
21) Define massage
a Rubbing muscles
b Pressing the body muscles
c Rubbing and kneading muscles
123
d Stroking body parts
22) How does massage help in minimizing labour pain
a By stimulating the release of endorphin
b By blocking the production of adrenaline
c By promoting uterine contractions
d By promoting muscle relaxation
23) Which massage can be used to warm up women in labour?
a Back massage
b Foot massage
c Shoulder massage
d Sacral massage
24) What is effleurage?
a Making small circles in palm
b Simple stroking of hand, abdomen and back
c Stroking feet and hands firmly
d Light, circular stroking of abdomen, lower back
124
25) What are meissner’s corpuscles?
a Nerve endings
b Sensory receptors
c Nerve fibres
d Pain receptors
Section F: Breathing Exercises
26) How does breathing exercises help in minimizing labour
pain?
a Relieves anxiety and pain
b Relaxes the mother
c Redirects from the painful response
d Reduces pain
125
27) How are breathing exercises beneficial to the baby?
a Provides more oxygen
b Promotes well being
c Promotes health
d Promotes breathing
28) What is the ideal time for breathing exercises?
a During and at the end of contractions
b At the beginning and at the end of contractions
c At the beginning of each contractions
d In between contractions
29) What is slide breathing?
a Four, short, light puffing breaths
b Deep breaths and exhale slowly
c Deep abdominal breaths
d Inhale and exhale with relaxed lips
30) When is light accelerated breathing done?
126
a Latent phase
b Transitional phase
c Active phase
d Expulsive phase
Section G: Intra-dermal water blocks
31) What are intra-dermal water blocks?
a Injecting sterile water
b Sterile water injections intra-dermally
c Sterile injections
d Water injections
32) What is the site for intra-dermal water block?
127
a Posterior inferior iliac spine
b Anterior superior iliac spine
c Posterior superior iliac spine
d Anterior inferior iliac spine
33) How many points are used for intra-dermal water blocks?
a Two
b Three
c One
d Four
34) How does intra-dermal water block minimizing labour
pain?
a By blocking pain transmission
b By stimulating endorphin release
c By reducing anxiety and stress
d By blocking pain receptors
35) What is the precaution to be taken after water blocks?
128
a Avoid wiping
b Avoid massaging
c Avoid repeat injections
d None of the above
Section H: Hydrotherapy
36) What is hydrotherapy?
a Therapy that uses medicines
b Therapy that uses drugs
c Therapy that uses water
d Therapy using massages
37) What is the ideal time to start water immersions?
129
a Cervical dilatation greater than 5 cm
b Cervical dilatation greater than 3 cm
c Cervical dilatation less than 5 cm
d Cervical dilatation less than 3cm
38) What kind of water is used for water immersions?
a Lukewarm water
b Cold water
c Clean water
d Warm water
39) How long should mother stay in water tub during
immersion?
a 2 hours
b 3hours
c 20 min
d 4 hours
40) How does buoyancy help in minimizing labour pain?
a Relieves pressure on joints and muscles
130
b Reduces pain on muscles
c Increases circulation
d Decreases fluid retention.
131
LESSON PLAN ON
ALTERNATIVE AND CONTEMPORARY MODALITIES OF PAIN RELIEF DURING FIRST
STAGE OF LABOUR
GUIDED BY, SUBMITTED BY,
MRS. GOWRI SAYEE MS. SHANTI SONU SAM
ASSOCIATE PROFESSOR 2ND YEAR M.Sc NURSING,
OBSTETRICS AND GYNAECOLOGICAL NURSING OBSTETRICS AND GYNAECOLOGICAL NURSING
FORTIS INSTITUTE OF NURSING FORTIS INSTITUTE OF NURSING
NAME OF THE INSTITUTION Fortis institute of nursing
132
COURSE M.Sc. nursing 2nd yearSUBJECT Obstetrics and Gynaecological NursingTOPIC Alternative and contemporary modalities
NAME OF THE RESEARCH GUIDE Mrs. Gowri Sayee Associate Professor
NAME OF THE CO-GUIDE Mrs. Sabitha Sibbala Associate Professor
NAME OF THE RESEARCHER Ms. Shanti Sonu SamPARTICIPANTS OF THE STUDY Staff nursesDURATION 1hourMETHOD OF TEACHING Lecture cum discussionMEDIA OF TEACHING Power point, Black board
133
GENERAL OBJECTIVES
At the end of the class the participants will be able to gain knowledge regarding alternative and contemporary
modalities of pain relief during first stage of labour and will be able to apply that knowledge in their practical life situation.
SPECIFIC OBJECTIVES
At the end of the class participants will be able to:
• Introduce the topic
• Define alternative and contemporary modalities
• Describe about aromatherapy
• Describe the process of massaging
• Explain the different types of massages
• Explain the different types of breathing exercises
• Explain about intra-dermal water blocks
• Describe about hydrotherapy
134
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
135
1 2 min To
introduce
the topic
INTRODUCTION:
Birth is a normal, healthy part of a woman’s
life. This unexplainable happiness is usually
accompanied by severe pain due to contractions.
The amount of pain a woman experiences is
influenced by many individual, physical,
emotional and environmental factors. There are
several measures used for relieving pain during
labour. Alternative and contemporary modalities
are one among them; it refers to all those
therapies not provided by the conventional
methods. These modalities boosts up the
confidence of the women, hence these modalities
should be made available.
Introducing
the topic
Listening
136
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
2 2 min To review
about
normal
labour.
PHYSIOLOGY OF NORMAL LABOUR
The precise mechanism of initiation of labour is
still obscure. Series of events that take place in the
genital organs to expel the viable products of
conception out of the womb through the vagina
into the outer world is called normal labour. It’s
otherwise called eutocia.
Stages of labour:
Normal labour is divided into 4 stages.
First stage of labour starts from the onset of
true labour pains and ends with full dilatation of
cervix. Its average duration is about 12 hrs in
primi-gravida and about 6 hrs in multi-gravida.
Reviews
about
normal
labour
Listens What is
normal
labour?
137
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
Second stage starts from full dilatation of
cervix till expulsion of fetus. Full cervical
dilatation is upto 10 cm.
Third stage begins after the expulsion of fetus
and ends with the expulsion of placenta and
membranes.
Fourth stage is the stage of observation for at least
one hour after the expulsion of placenta and
membranes.
138
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
3 2 min To explain
about
labour pain
PHYSIOLOGY OF LABOUR PAIN
The first symptom to appear in first stage of labour
is painful intermittent contractions. This pain is felt
anteriorly with simultaneous hardening of the
uterus. Initially the pain is not strong enough and
come at various intervals of 15-30 min with
duration of about 30 sec. The pain starts from the
abdomen, back and then radiates to thigh.
Probable causes of labour pain are:
• Myometrial hypoxia.
• Stretching of perineum over the fundus.
• Stretching of cervix during dilatation.
• Compression of nerve ganglion.
Explaining
about
labour pain
Listening What are the
causes of
labour pain?
139
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
4 2 min To explain
about pain
relief
measures.
PAIN RELIEF MEASURES
Normal labour may be easy and trouble free
provided a rational approach is made with the
beginning of pregnancy. Pain can be relieved by
various measures:
Sedatives and analgesics.
Epidural analgesia.
Inhalation agents.
Alternative and contemporary modalities.
Due to various research evidences of their
effectiveness, popularity among patients, no side
effects, natural pain relief alternative and
contemporary modalities can be considered much
effective.
Explaining
about pain
relief
measures
Listening slide Name the
different
pain relief
measures?
140
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
141
5 2 min To introduce
about various
modalities
ALTERNATIVE & CONTEMPORARY
MODALITIES
Alternative and contemporary modalities are
those therapies given other than the usual
medical interventions. Some of the benefits:
It considers human body as a whole.
There are no side effects.
They are easily affordable.
Simple to prescribe and practice.
It does not interfere with the progress of
labour.
Promotes a sense of accomplishment.
They have no effect on state of
consciousness.
Introducing
about
alternative
modalities
Listening Board What are the
advantages?
142
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
GATE CONTROL THEORY
• It implies that a non-painful stimulus can
block transmission of a noxious stimulus.
• It is based on the premise that the gate
modulates the pain impulses.
• There are three types of nerve fibres: A-Delta
fibres(sharp pain), C fibres(dull pain), A-Beta
fibres(light touch).
• The substantia gelatinosa acts as the
modulating gate.
• A-Delta and C firbres open the gate and A-
Beta fibres close the gate.
• Alternative modalities activate the A-Beta
fibres and thus the gate is closed.
143
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
6 10
min
To explain
about
aromatherapy
AROMATHERAPY
Aromatherapy is the science of using highly
concentrated essential oils or essences distilled
from plants in order to utilize their therapeutic
properties. The use of aromatic substances
stimulates the chemoreceptor sites in the naso-
pharynx and directly affects the hypothalamic-
pituitary,adrenal axis. Administration includes
putting drops in a pillow, in a bath, or in
awoman’s brow. Essential oils are as potent as
drugs and equally open to misuse or abuse.
Explaining
about
aromathera
py
Listening PPT Explain about
aromatherapy
144
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
Important essential oils
(1) Lavender Oil
Lavender oil is extracted from the flower
of lavender primarily through steam distillation.
The benefits of lavender oil are:
It’s balancing and calming.
It relieves tension and stress.
It induces sleep and reduces pain.
145
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
(2) Peppermint Oil:
Peppermint is a cross between the watermint
and spearmint and is native to Europe. Some of
the benefits are:
It’s cooling and refreshing.
It relieves nausea and headache.
It also reduces pain.
It improves immunity.
(3) Rosemary Oil:
Rosemary is very popular in the
Mediterranean region as an herb. Some of the
benefits are:
It relieves pain and strengthens the body.
It’s used for hair, mouth and skin care.
It boosts mental activity.
146
It can be used as room freshener too.SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
AV
AIDS
EVALUATION
147
(4) Neroli Oil:
Neroli oil has been widely used across the world
for centuries. Derived from the blossoms of
bitter orange tree. It is extracted by steam
distillation. Some of the benefits are:
It has a soothing and relaxing effect.
It relieves headache and nausea.
It prevents the scarring of skin.
It also improves digestion.
(5) Rose Oil:
Rose oil is extracted from fresh Damascus rose
by steam distillation. Some of the benefits are:
It is an uterine tonic and supports labour.
It is an anti-depressant.
It reduces nausea and fatigue
SL
NO
TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER’S
ACTIVITY
LEARNER’S
ACTIVITY
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(6) Jasmine Oil:
Jasmine oil is extracted from the flowers of
jasmine, the very famous flower. Some of the
benefits are:
It is uplifting and balancing.
It eases birth and reduces pain.
It also acts as a sedative.
It relieves anxiety.
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Aromatherapy can be used according to
different phases of first stage:
Latent Phase:
During the early phase of labour when
contractions begin, the mother should relax and
take a nap if possible. In a 10ml bottle pour
4drops of lavender, 2 drops of neroli and add
vegetable oil. Massage temples, forehead and
chest and advice to take deep breaths.
Active Phase:
During this phase, contractions become intense
and frequent. In 10ml bottle pour 6 drops
lavender, 1drop neroli, 1drop rose oil and add
vegetable oil. Massage and advice to breathe
and relax.
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7 5 min To explain
about various
massages.
TOUCH AND MASSAGES:
Touch and massages stimulates the body to
release endorphins which are natural pain killing
and mood lifting hormones. Some of the
massages are:
(1) Hand massages:
Simply stroke each hand in turn, first on the
back, then on the palm, sweeping firmly down
from wrists to fingertips. Make small circles all
over the palm.
Explaining
about
various
massaging
techniques
Listening PPT What are the
different
types of
massages?
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(2) Foot massages:
Simply stroke feet firmly from ankle to toes or
make circles with thumb all over the soles of
feet. Feet become cold during labour and a foot
massage can help to warm up.
(3) Effleurage:
Light circular stroking of abdomen and lower
back. It stimulates nerve endings called
meissner’s corpuscles which travel faster than
signals of a pain thereby blocking pain
transmission. Use a flat hand stroke on the arms,
legs and broad flat surface of the back.
Effleurage with only fingertips gliding is called
feathering.
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(4) Back massage:
Firm massage can be applied on lower back to
relieve contraction and discomfort from long
hours of labour.
(5) Shoulder massage:
This massage can be performed to facilitate
breathing and relaxation.
(6) Knee press:
Make the woman to sit on a firm chair with
feet touching the floor. Kneel on the floor and
extend hands out to her knee and cover her
knees. During a contraction lean on body weight
and apply pressure to her knees.
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(7) Sacral massage:
Use the palm of hand over the sacral area and
massage firmly. The hand not being used is
supporting the woman either on hip or shoulder.
(8) Circular hip massage:
Either the woman kneels on the floor or against
the head of a bed and supported by pillows.
Two hands are placed on either side of the spine
in the sacral region with the hands pointing in
an upward direction.
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8 5 min To explain
about
breathing
exercises.
BRETHING EXERCISES:
It simply means breathing at any number of
possible rates and depths. The theory behind
breathing patterns is that the thought process is
redirected from the painful response. Breathing
exercises should be done at the beginning and at
the end of each contraction. Some of the
breathing exercises are:
(1) Slow breathing:
Begin slow breathing when contractions
are intense enough.
Take an organizing breath.
Release all tension and breathe out.
Focus attention.
Explaining
about
breathing
exercises
Listening PPT What are
breathing
exercises?
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(2) Light accelerated breathing:
Keep breathing shallow and light.
The inhalation should be quiet, but
exhalation clearly audible.
Take a deep breath, release all tension
and breathe out
Focus attention.
Exhale through mouth.
(3) Variable transition breathing:
Referred as pant-pant-blow breathing.
Take an organizing breath, release all
tension and breathe out.
Breathe out through mouth in light
shallow breaths.
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After every second, third, fourth or fifth
breaths blow out a longer breath.
(4) Slow relaxed abdominal breathing:
Inhale slowly through nose, allowing
belly to expand first then chest.
Exhale slowly through mouth pursing
lips.
6-9 breaths to be taken.
(5) Slide Breathing:
Four, short, light puffing breaths.
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9 5 min To explain
about intra-
dermal water
blocks.
INTRA-DERMAL WATER BLOCKS
It is a new technique for non-narcotic pain relief
originally developed to relieve pain from kidney
stones. With slight modifications it can be used
in labour, especially for posterior positions.
Procedure:
• Fill a small tuberculin syringe with sterile
water
• Identify the posterior superior iliac spine
and mark them
• Approx. 3 to 4 cm down and 1 to 2 cm in
identify other two points and mark them.
• During a contraction inject a small
amount of sterile water into the skin
raising a bleb.
Explaining
about intra-
dermal
water
blocks
Listening PPT What is intra-
dermal water
blocks?
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• Repeat at the other three sites as quickly
as possible.
• During the injection the woman will feel
a sharp stinging pain.
• The stinging will fade in 10 to 15 sec.
• Avoid back massage after the water
block as it could shorten the duration of
action.
• The small blebs block the pain
transmission as explained by gate control
theory.
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10 5 min To explain
about
hydrotherapy
HYDROTHERAPY
One of the safest and most effective forms of
pain relief in labour is the immersion in deep
water or a warm shower. Hydrotherapy has been
used for relaxation, healing and pain relief for
centuries. It relieves the stretching sensations of
ligaments and areas associated with posterior
presentation.
Mode of action
The hydrostatic pressure of water relieves
some of the discomforts of contractions.
Warm water soothes tired and aching
muscles.
Explaining
the use of
hydrothera
py
Listening PPT Explain the
use of
hydrotherapy
in labour.
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There are three factors that contribute to
the benefit of hydrotherapy: heat,
buoyancy and massage.
Immersion in water results in increased
circulation.
It lowers the blood pressure and decrease
any fluid retention or swelling.
The buoyancy of water creates a
weightless feeling and promotes
relaxation.
The mother should get into bath tub at around
4 to 5cm cervical dilatation. Time in tub should
be limited to 2 hours. Warm water should be
used.
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11 2 min To conclude
the topic
CONCLUSION
Alternative and contemporary modalities are the
techniques which imparts a sense of well being
in an individual with the desired effect. The
main advantage is that it can be discontinued at
any time without any side effects. Midwives
should possess adequate knowledge about these
modalities.
Concluding
the topic,
asking
questions.
Asking
doubts.
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12 BIBLIOGRAPHY
1. Dutta D.C. Textbook of obstetrics. 1st edition,