· web viewsetting was danderyd hospital, stockholm, sweden.510 primiparas from three groups:...
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
KARNATAKA
PERFOMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF CANDIDATE Ms. AMALA GEORGE.
2. NAME OF THE INSTITUTION AND
ADDRESS
UNIVERSAL COLLEGE OF NURSING,
NIRMALARAM CAMPUS, AREKERE,
MICOLAYOUT, IIMB POST,
BANERGHATTA MAIN ROAD,
BANGALORE. 560076.
3. COURSE OF STUDY AND SUBJECT M.Sc. NURSING 1ST YEAR IN
OBSTETRICAL & GYNAECOLOGICAL
NURSING.
4. DATE OF ADMISSION TO COURSE 13TH JULY2011
5. TITLE OF THE TOPIC
A COMPARATIVE STUDY TO ASSESS THE
SELF ESTEEM AND PARENTING
BEHAVIOUR BETWEEN PRIMI MOTHERS
WHO UNDERWENT CAESAREAN SECTION
AND NORMAL VAGINAL DELIVERY IN
SELECTED HOSPITALS, BANGALORE
1
6. INTRODUCTION
Before you were conceived I wanted you. Before you were born I loved you. Before
you were here an hour I would die for you. This is the miracle of Mother's Love.1
Every woman feels that becoming a mother is the most gifted position, a
woman could ever achieve at life time. Pregnancy also marks a time in which a great
number of changes and transitions occur. The memories and experiences of labour
and birth remain with women throughout their lives. Clearly, the support and care
they receive during this time is critical. The anticipated overall aim of caring for
women during labour and birth is to engender a positive experience for the woman
and her family, while maintaining their health, preventing complications, and
responding to emergencies. For primi parous women, or first-time mothers-to-be, the
experience of pregnancy in its entirety is new. This may lead to mixed feelings or
ambiguities about pregnancy-related changes as well as concerns about what to expect
at birth and post-birth.2
The addition of a newborn infant to the family brings about more profound
changes than any other developmental stage of the family life cycle. New roles need
to be learned, new relationships developed, and existing relationships realigned.
Raising a child is probably the most challenging responsibility faced by a new parent.
New parents cope with verity of concerns and issues during this period. For most
women and families, labour and birth is a time of excitement and anticipation, along
with uncertainty, anxiety, and fear3.
The attitudes of women who perceive their experience of giving birth by
caesarean section (CS) differ significantly from those of women who deliver
2
vaginally. Labour, as a life event, is characterized by tremendous psychological
changes that require major behavioural adjustment in a short period of time.
Consequently, the labour process constitutes a unique set of “Stressors” that
challenges a woman’s ability to cope.
The former are often less satisfied with their experience, and with themselves.
The magnitude of the impact of caesarean delivery on the woman varies tremendously
according to the interplay of a number of variables, such as the integration of the
individual skills of the doctor, and ego strength. Most women who undergo caesarean
birth experience a feeling of resentment towards the physicians, profound
disappointment at treatment expectation, and the loss of the happy moment of natural
birth. This has been known to lead to depression postpartum in such women, and the
rejection of their babies. So there is need to investigate the effect self esteem of primi
mothers undergone caesarean and vaginal delivery.4
But in the post partum period after caesarean section the mother experience lot
of discomforts than mother undergone vaginal delivery. Sleep disturbances and
fatigue is more in mother undergone caesarean section. Most women who had a
caesarean did not breastfeed, quite different from today’s picture; however, “the
initiation of lactation cannot be the same as after a birth in physiological conditions.
After a caesarean, for obvious reasons, mother and baby need help.” Non-labour
caesareans seem to be associated with more breastfeeding problems as there has been
no opportunity for the release of hormones involved in childbirth and lactation. The
current study is related to compare the self esteem and parenting behaviour of primi
mothers who underwent caesarean section and normal vaginal delivery.
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6.1 NEED FOR THE STUDY
A caesarean section, is a surgical procedure in which one or more incisions are
made through a mother's abdomen and uterus to deliver one or more babies, or, rarely,
to remove a dead fetus. A Caesarean section is usually performed when a vaginal
delivery would put the baby's or mother's life or health at risk, although in recent
times it has been also performed upon request for childbirths that could otherwise
have been natural. In recent years the rate has risen to a record level of 46 percent in
China and to levels of 25 percent and above in many Asian and European countries,
Latin America, and the United States.
It was predicted that if age-specific caesarean rates continued at the steady
pattern of increase observed since 1970, 40 percent of births would be by caesarean in
the year 2000.Those predictions fell short, but not by much. The National Centre for
Health Statistics reported that the percentage of caesarean births in the United States
increased from 20.7 percent in 1996 to 32 percent in 2007. Caesarean rates increased
for women of all ages, races/ethnic groups, and gestational ages and in all states5.
Due to increase in the prevalence of caesarean section there is a study
conducted to assess the level of self-esteem of newly delivered mothers who had
caesarean section (CS) and evaluate the socio demographic and obstetrics correlates
of low self-esteem in them. Newly delivered mothers who had CS (n = 109) and who
had spontaneous vaginal delivery (SVD) (n = 97) completed questionnaires on socio
demographic and obstetrics variables within 1 week of delivery. They also completed
the Rosenberg self-esteem scale. Women with CS had statistically significant lower
scores on the self-esteem scale than women with SVD (p = 0.006). Thirty
(27.5percent) of the CS group were classified as having low self-esteem compared
4
with 11 (11.3 percent) of the SVD group (p = 004). The correlates of low self-esteem
in the CS group included polygamy (odd ratio (OR) 4.99, 95percent confidence
interval (95 percent CI) 1.62-15.33) and emergency CS (OR 4.66, 95 percent CI 1.55-
16.75).CS in South-Western Nigerian women is associated with lowered self-esteem
in the mothers6.
A study conducted on subsequent obstetric performance related to primary
mode of delivery, in San Francisco, reported that the Women who gave birth by
Caesarean were more disappointed. Even after 5 years of birth, the mothers expressed
dominant feelings of fear and anxiety about their experiences and were more reluctant
to become pregnant again. Thus it reveals that the Caesarean section is a terrifying
experience for most of the women. Some women were expressed their feelings about
Caesarean section was bad impression7.
Women who deliver vaginally may be more responsive to their newborns in
the early postpartum period than those who deliver via caesarean section, new
research suggests. Using functional magnetic resonance imaging (FMRI) to measure
brain activity of women, found a significant difference in activity in certain cortical
and sub cortical areas of the brain in this group of mothers who delivered vaginally
compared with those who delivered by caesarean section. Broadly speaking, the
cortical brain regions are believed to be important for regulating emotions and
empathy8.
Nurses are often in ideal position to assess the health and its problems and to
offer education and support. Nurse need to be knowledgeable about signs and
symptoms of post partum period. When the nurse develops an effective plan for
nursing management, she should be considering appropriate referral resource. The
5
above studies show that the caesarean delivery leads to some adjustment problem in
primi mothers during post partum period. So the investigator felt the importance of
comparison of primi mothers underwent caesarean section and normal vaginal
delivery. This study was not conducted till now in this area. Based on the above
considerations the investigator felt that there is a need to conduct a study regarding
comparison of self esteem and parenting behaviour between primimothers underwent
caesarean section and normal vaginal delivery.
6.2 REVIEW OF LITERATURE
The present study aimed to assess the self-esteem of newly delivered
primiparious mothers who had caesarean section (CS) in relation to their parenting
self-efficacy. A total of 115 primiparious women who delivered by CS were
compared with 97 matched controls who had vaginal delivery during the same period.
The mean score on the Rosenberg self-esteem scale was significantly lower for the
Caesarean group, both prior to discharge (p = 0.006) and at six weeks (p < 0.001),
than the vaginal delivery group. The mean score on the parent-child relationship
questionnaire was also lower in those who had CS compared with those who had
vaginal delivery (p < 0.001, OR 4.71, 95 percent CI 1.75-14.71).Caesarean in
Nigerian women is associated with lowered self-esteem and predicts poor parenting
self-efficacy in the postnatal period9.
The present study was designed to investigate possible differences in
psychological adjustment and satisfaction between women delivering vaginally and
those delivering by emergency caesarean section. 22 women who delivered vaginally
and 22 women who delivered by emergency caesarean section were selected
according to stringent criteria, to control for factors known to be associated with
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positive caesarean outcomes. Significant differences were found in level of
satisfaction, with caesarean mothers reporting less satisfaction with the delivery than
vaginal mothers10.
A comparative field study was done to collect both quantitative and qualitative
data to determine if women perceived their childbirth experience less positively when
they had caesarean deliveries and in what ways. The hypothesis, primiparas having an
emergency caesarean birth will have a less positive perception of their birth
experience than those who deliver vaginally, were supported at the .01 level of
significance (t test). Perceptions of 20 primiparas having an emergency caesarean
birth and 30 primiparas having a vaginal birth were measured by a 29 item
questionnaire within 48 hours postpartally. More caesarean delivered women had not
named their infants; this difference was significant at the 0.005 level. Caesarean
delivered mothers suffered a loss in self-esteem, possibly due to unfulfilled
expectations for a vaginal delivery and the physical trauma and corresponding loss of
control due to the surgery11.
The purpose of this study was to examine differences in psychosocial
outcomes between primiparas experiencing vaginal deliveries and primiparas
experiencing caesarean deliveries. One hundred and ninety-four vaginal delivery
primiparas and 81 caesarean delivery primiparas from the Kaohsiung city area in
Taiwan were recruited at 6 weeks postpartum to participate in this study. Using two-
sample tests, we found no significant differences in perceived stress, self-esteem, or
depression between vaginal and caesarean delivery primiparas. However, the
caesarean delivery primiparas showed a significantly higher level of perceived social
support than vaginal delivery primiparas. The lack of substantial differences between
7
the groups may be a result of the normalizing effect of the high caesarean birth-rate
and greater social support given to this method of childbirth`12
The present study conducted to examine changes in personality from late
pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries.
A prospective, group-comparative cohort study including 314 healthy primiparas
having either ‘caesarean section on maternal request’ (n = 74) or ‘spontaneous vaginal
delivery group’ (n = 240). The self-report inventory Karolinska Personality Scales
was mailed to participants at 37–39 gestational weeks in pregnancy and 9 months
after delivery. There was a statistically significant increase in Impulsivity (P = 0·046)
and decrease in Socialization (P = 0·004). The scores developed differently depending
on mode of delivery. Thus, women in the vaginal delivery group increased their
scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery
group decreased their scores.13
To investigate contact between mothers and their newborn child and study if
there are differences between those who requested an elective caesarean section
compared to women who had a vaginal birth. The psychometric properties of a scale
that measure the contact between mother and child were also investigated. It was a
prospective cohort study. Setting was Danderyd Hospital, Stockholm, Sweden.510
primiparas from three groups: women undergoing caesarean section on maternal
request (n = 96), women undergoing caesarean section on obstetrical indication (n =
116) and women planning a vaginal delivery (n = 198). The later were further divided
into subgroups; women who underwent assisted vaginal delivery (n = 35) and women
who had an emergency caesarean section (n = 65).The instrument used was the
Alliance Scale. Mothers with a vaginal delivery experienced breastfeeding less
stressful than the mothers with a caesarean delivery. 14
8
The present study is to test the hypothesis that caesarean section delivery
mothers would be less responsive to own baby-cry stimuli than vaginal delivery
mothers in the immediate postpartum period, conducted functional magnetic
resonance imaging, 2–4 weeks after delivery, of the brains of six mothers who
delivered vaginally and six who had an elective caesarean section delivery.
Correlations between own baby-cry responses in the left and right reticular nuclei and
parental preoccupations (r = .64, p < .05 and .67, p < .05 respectively), as well as in
the superior frontal cortex and Beck depression inventory (r = .78, p < .01). This
suggests that vaginal delivery mothers are more sensitive to own baby-cry than
caesarean section delivery mothers in the early postpartum in sensory processing,
empathy, arousal, and motivation, reward and habit-regulation circuits15.
6.3 STATEMENT OF THE PROBLEM
A comparative study to assess the self esteem and parenting behaviour between primi
mothers who underwent caesarean section and normal vaginal delivery in selected
hospitals Bangalore
OBJECTIVES OF THE STUDY
1. To assess the self esteem and parenting behaviour of primi mothers who
underwent caesarean section
2. To assess the self esteem and parenting behaviour of primi mothers who
underwent normal vaginal delivery.
3. To compare the self esteem and parenting behaviour of primi mothers who
underwent caesarean section and normal vaginal delivery
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4. To find out the association between self esteem and parenting behaviour and
selected demographic variables among primi mothers who underwent caesarean
section and normal vaginal delivery.
OPERATIONAL DEFINITON
Assess
In this study, it refers to an organized and systematic way of finding out the self
esteem and parenting behaviour of primi mothers who underwent caesarean section
and normal vaginal delivery.
Self esteem
In this study it refers to evaluation of the emotional, intellectual, and behavioural
aspects of the self-concept which will be assessed by using Rosenberg's self-esteem
scale.
Parenting behaviour
In this study it refers making strong emotional bond between mother and new born by
care and love of mother which will be assessed by using self structured questionnaire.
Primi mothers
In this study it refers to women those who are becoming a mother for the first time
either by caesarean section or vaginal delivery, within 48-72 hours of child birth.
Caesarean section
In this study it refers to the extraction of the fetus through an opening made in
abdominal and uterine wall
Normal vaginal delivery
In this study it refers to birth of fetus through vagina and delivery and no
complications to mother and baby
10
6.4 ASSUMPTIONS
1. Primi mothers who underwent caesarean section may experiences low level self
esteem and parenting behaviour than normal vaginal delivery.
2. There may be a difference in level of self esteem and parenting behaviour
among primi mothers who underwent caesarean section and normal vaginal
delivery.
VARIABLES UNDER THE STUDY
Research variable
Self esteem
Parenting behaviour
Demographic variable
Age
Education
Religion `
Occupation
Socio economic status
DELIMITATIONS
The target population is limited to mothers who delivered by caesarean section and
normal vaginal delivery at selected hospitals, Bangalore
11
7. MATERIAL AND METHODS:
7.1 SOURCE OF DATA
The data will be collected from primi mothers in post natal ward and post operative
ward in selected hospitals Bangalore.
RESEARCH APPROACH:
The investigator will use explorative research approach to conduct the study.
RESEARCH DESIGN:
The investigator will use descriptive research design to conduct the study
RESEARCH SETTINGS:
Study will be done in post operative and post natal ward of selected maternity
hospitals Bangalore
POPULATION
The target population of the study will be primi mothers underwent normal vaginal
delivery and caesarean section in selected hospitals, Bangalore
SAMPLING TECHNIQUE:
Primi mothers admitted in post natal and post operative ward will be selected by
purposive sampling technique
SAMPLE SIZE:
The sample size will be 100 post natal mothers (50 primi mothers undergone vaginal
delivery and 50 primi mothers underwent caesarean section.)
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SAMPLING CRITERIA
INCLUSION CRITERIA
Post natal mothers who delivered after 37 weeks of gestation.
Post natal mothers who are admitted in post natal ward and post operative ward
after caesarean section and vaginal delivery, within 48-72 hours of child birth.
Women who can speak and understand kannada and English
EXCLUSION CRITERIA:
Women who are suffering with psychiatric illness
Women who are suffering with medical problems like diabetes, heart disease
and hypertensive disorders.
METHODS OF DATA COLLECTION
Data will be collected after obtaining written permission from the hospital
administrator, and OBG ward in charge. In this study Rosenberg's self-esteem scale
for self esteem and self structured questionnaire for parenting behaviour will be used
to collect the data.
7.2 DESCRIPTION OF TOOL
It consist of three parts
Part 1: It consist of demographic variables like age, gender, religion, family type,
education, occupation and socio economic status
Part 2: Rosenberg's self-esteem scale will be used to assess the self esteem of primi
mothers underwent caesarean section and normal vaginal delivery.
13
Part 3: Self structured questionnaire will be used to assess the parenting behaviour of
primi mothers who underwent caesarean section and normal vaginal delivery.
DATA ANALYSIS METHOD
Descriptive
Mean, standard deviation, frequency distribution, percentage will be used to
describe demographic variables and self esteem and parenting behaviour.
Inferential
T test will be used to compare the self esteem and parenting behaviour of primi
mothers underwent caesarean section and vaginal delivery.
Chi square test is used to find out the association between self esteem and
parenting behaviour with selected demographic variables.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN
OR ANIMAL? IF SO PLEASE DESCRIBE BRIEFLY.
No, this is a descriptive study; it does not require any investigation to be conducted
on patient or human or animal.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Yes, the ethical clearance certificate has been enclosed.
14
8. REFERENCE
1. Maureen H. Motivational quotes for pregnant women. Available from: URL:
http://prettydarkhorse.hubpages.com/hub/
2. Susan C, William F, Family cantered maternity and new born care. Care during
labour and birth. 20I0 July 28; Available from: URL: http://www.phac-
aspc.gc.ca/hp-ps/dca-dea/publications/fcm-smp/fcmc-smpf-05-eng.php
3. Nystrom K. Parenthood experiences during the child’s first year. Literature
review. 2003 April 29. Available from: URL:
http://pure.ltu.se/portal/files/32603150/Parenthood experiences during the child
first year literature review.pdf
4. Lulu A, Nuaim A. Views of women regarding caesarean section. 2004 January; 25
(6): P. 707-710. Available from: URL:
http://ipac.kacst.edu.sa/edoc/2004/143877.1-20040300870.pdf
5. Joy S. Caesarean birth & how to support women pre- and post surgery. 2011 July
1; Available from: URL:
http://wellmother.org/projects/docs/pregnancyessaycaesarean.pdf
6. Loto O M, Adewuya A O, Ajenifuja O K, Orji E O, Owolabi A T, Ogunniyi SO.
Maternal fetal neonatal med. The effect of caesarean section on self-esteem
amongst primiparious women in South-Western Nigeria: a case-control study.
2009Sep; 22(9): P. 765-9.Availableat: URL:
http://www.ncbi.nlm.nih.gov/pubmed/19544153
7. Jolly J, Walker J, Bhabra K. An international journal of obstetrics & gynaecology.
Subsequent obstetric performance related to primary mode of delivery.2005
august 19; 106(3): P. 227-232. Available from: URL:
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1999.tb08235.x/full
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8. Cassels C. Journal of child psychology and psychiatry. Vaginal delivery may
increase maternal responsiveness to newborns.2008 September 23; Available
from: URL: http://www.medscape.com/viewarticle/581065
9. Adewuya A O, Ajenifuja O K, Orji E O. Ayandiran E O, Owolabi A T.Cesarean
section in relation to self-esteem and parenting among new mothers in
southwestern Nigeria. Acta obstet gynecol Scand. 2010; 89(1): P. 35. Available
from: URL: http://www.ncbi.nlm.nih.gov/pubmed/19824868
10. Padawer J A , Fragan C, Bulman R J,Chorowski M. Women's psychological
adjustment following emergency caesarean versus vaginal delivery. Psychology of
women quarterly. 1987 August 14 .Available from: URL:
http://pwq.sagepub.com/content/12/1/25.abstract
11. Marut J S, Mercer R T. Birth Defects. The caesarean birth experience.
Implications for nursing. 1981;17(6): P. 129-52.Available from: URL:
http://www.ncbi.nlm.nih.gov/pubmed/7326369
12. Chen C H, Wang S W. Research in Nursing & Health. Psychosocial outcomes of
vaginal and caesarean births in Taiwanese primiparas. 2002 November 7; 25(6):
P.452. Available from: URL:
http://onlinelibrary.wiley.com/doi/10.1002/nur.10056/abstrat
13. Wicklund I, Edman G, Larsson C, Andolf E. Journal of advanced nursing. First-
time mothers and changes in personality in relation to mode of delivery. Journal
of advanced nursing. 2009 July 3; 65(8): P. 1636. Available at: URL:
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2009.05018.x/abstract
14. Carlander A K K , Edman G, Christonson K, Andolf E, Wicklund I. Sexual &
Reproductive Healthcare. Contact between mother, child and partner and attitudes
towards breastfeeding in relation to mode of delivery. 2010 February; 1 I( 1): P.
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27-34. Available from: URL:
http://www.sciencedirect.com/science/article/pii/S1877575609000044
15. Swain J E, Asgin E T ,Mayes L C, Feldman R, Constable R T, Leckman J F.
Journal of child psychology and psychiatry. Maternal brain response to own baby-
cry is affected by caesarean section delivery.2008 October; 49(10): P. 1042-52.
Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-
7610.2008.01963.x/full
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9 SIGNATURE OF THE
CANDIDATE
10 REMARKS OF THE
GUIDE
This study is aimed to examine the relationship
between self esteem and parenting behaviour of
Primi mothers. The study may be approved.
11 NAME AND
DESIGNATION OF
a. GUIDE
b. CO-GUIDE (if any )
c. SIGNATURE
d. HEAD OF THE
DEPARTMENT
e. SIGNATURE
Asst. Prof. MRS. PRATHIMA. P
Asst. Prof .MRS.PRATHIMA. P
12 a. REMARKS OF THE
PRINCIPAL
b. SIGNATURE
Relevant study may be approved
18