Post on 30-May-2018
transcript
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
(AS PER RGUHS- BANGALORE)
SUBMITTED BY:-Mrs.PACKIA ANNA PRISCILLA .PIst YEAR NURSINGObstetrics and Gynecological Nursing(2009-2011)ORIENTAL COLLEGE OFNURSING, BANGALORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKAPERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NAME OF THE CANDIDATE AND ADDRESS MS.P.PACKIA ANNA PRISCILLA,1st Year MSc nursing,(Obstetrics and Gynaecological Nursing),Oriental College of Nursing,43/52, 2 nd Main , Industrial town,West of Chord road, Rajajinagar,Bangalore-44.
NAME OF THE INSTITUTION Oriental College of Nursing,Bangalore-44.
COURSE OF STUDY AND SUBJECT 1st Year M.Sc. nursing,Obstetrics and Gynaecological Nursing
DATE OF ADMISSION TO THE COURSE 16-06-2009
TITLE OF THE TOPIC “ A STUDY TO ASSESS THE EFFECTIVENESS OFINTERVENTION PACKAGE ON KNOWLEDGEREGARDING LAMAZE TECHNIQUE AMONGMIDWIVES IN SELECTED HOSPITALS,BANGALORE.”
BRIEF RESUME OF THE INTENDED WORK6.0 Introduction6.1 Need for the study6.1.1 Statement of the problem6.2 Review of literature6.3 Objectives6.3.1 Operational definitions6.3.2 Assumptions6.3.3 Hypothesis6.3.4 Sampling criteria (inclusion & exclusion criteria)
Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed EnclosedEnclosed
MATERIALS AND METHODS7.1 Source of data: Enclosed
7.2 Method of data collection: Enclosed
7.3 Does the study require and investigation or interventions to be conducted on the patients or other human being or animals ?
NO
7.4 Has ethical clearance been obtained from your institutions?
YES, ethical committee's report is here with enclosed.
8.0 List of References: Enclosed
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE KARNATAKA.
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NAME OF THE CANDIDATE AND ADDRESS MS.P.PACKIA ANNA PRISCILLA1st Year MSc nursing,(Obstetrics and Gynaecologic Nursing),Oriental College of Nursing,43/52, 2 nd Main , Industrial town,West of Chord road, Rajajinagar,Bangalore-44.
COURSE OF STUDY AND SUBJECT 1st YEAR M.SC.NURSING,OBSTETRICS&GYNAECOLOGIC NURSING.
DATE OF ADMISSION TO THE COURSE 16-06-2009
TITLE OF THE TOPIC “A Study To Assess The effectiveness Of Intervention Package On Knowledge Regarding Lamaze Technique Among Midwives In Selected Hospitals, Bangalore.
6. Brief Resume Of The Intended Work
6.0 INTRODUCTION:
Child birth is a sweet memory that a mother should always cherish it.
Labour is an experience of delivering the baby and placenta from the uterus
through the vagina to the outside world1.
Labor is often thought of as one of the more painful events in human
experience it ranges widely from woman to woman and even from pregnancy
to pregnancy. Pain depends on many factors, such as parity, size and shape
of the pelvis, presentation &position of the fetus and the strength of
contraction2.
In New Delhi, Jan 15: Due to the complications during the child birth
around 78,000 women die each year in India. This means that on an average
every seven minutes, one woman dies during birth or giving birth to a child.
There are many ways to handle pain during labor. It includes Breathing
technique, Hypnosis, Yoga, Meditation ,Walking, Massage or counter
pressure, Changing position, Taking a bath or shower, Medication such as
Analgesics, Tranquilizers, regional anesthesia. Medications have been used
for labor and delivery pain relief since the mid-19 th century. Today, there are
several drugs available to help mothers endure the pain of childbirth. Most can
be classified as analgesics or anesthetics. Analgesics relieve but do not
completely stop pain. Any medication a woman takes can affect her baby. In
most of cases, women report the sensation of breathing difficulties, and some
of the medication’s effect on the chest muscles, although it produces no real
danger, it can provoke anxiety.Breathing during labor is not meant to be a
distractive technique such as visualization or massage. Instead you will learn
to be more in tune with and in control of your body. Breathing patterns can
benefit during a different phase of contractions3.
An Indian Council of Medical research study conducted in 2008
submitted a report that 25% of babies in India are born through cessarian
sections in that 18% of the surgeries are elective. There has been atleast a
25% rise in the number of woman opting for cesareans in the last few year in
Delhi, as don’t want to go through pain like all expectant mothers opt for a
caesarian section in hospitals6.
Many women make the decision before going to the labor to have
natural child birth and later change their mind, others plan to get pain
medication and then arrive at the hospital as the baby is about to be born and
birth happens before they have a chance to get medicine. It is always best to
know mothers options before they enter into labour. Weighing the options
about pain relief during labour and delivery women need to be educated on all
the different type of pain management by talking to the health care providers 9.
Dr Lamaze introduced natural child birth in France in 1951. Lamaze was a
sympathizer ran a maternity clinic, during a trip to Russia in 1951 he
discovered a new method to relieve pain in labor through a Lamaze technique.
The Lamaze method is a technique designed to help expectant
mothers focus attention away from the pain of delivery, because the relaxation
and breathing techniques will help a woman in labor stay focused, comfortable,
and in control of the delivery process. It also helps women to overcome the
fears that are often associated with childbirth. Many women who practice
Lamaze breathing during their deliveries are able to avoid pain medication –
and the side effects that come with it – altogether. Both the mother-to-be and
her support partner use these methods to help decrease the mother's
perception of pain.
According to Linda Harmon, Executive Director of Lamaze
International, Lamaze technique promotes a natural, healthy and safe
approach to pregnancy, childbirth and early parenting practices. Knowing that
pregnancy and childbirth can be demanding on a woman’s body and mind,
Lamaze
serves as a resource for information about what to expect and what
choices are available during the childbearing years. This helps to simplify and
clarify the childbirth process, alleviate a woman’s fears and, most importantly,
helps a woman feel more informed and repared so they can achieve a safe
and healthy pregnancy and birth18.
Lamaze education and practices are based on the best, most
current medical evidence available, and can help reduce the overuse of
unnecessary interventions while improving overall outcomes for mothers and
babies. Working closely with families, health care providers and Lamaze
educators, millions of pregnant women have achieved their desired childbirth
outcomes using Lamaze practices. Word of mouth spread in the United States
during the late 1950s, after Marjorie Karmel gave birth assisted by Dr. Lamaze
and she wrote of her childbirth experience in Thank You, Dr. Lamaze. The
book inspired many women to approach childbirth as a shared event for both
mother and father21.
The Lamaze breathing exercises includes, Baseline breathing,
Slow breathing, Blowing breathing, Patterned breathing , Cleansing breathing
exercise. The baseline breathing exercise consists of monitoring normal
breathing pattern for one minute to determine how many breaths normally
breathe per minute. The slow breathing exercise consists of inhaling as count
to 3, 4 or 5 and exhaling as count to the same. The blowing breathing exercise
in done by inhaling through nose and then exhaling by blowing out of mouth.
The patterned breathing exercise is the familiar "he, he, hoo" technique that is
often associated with Lamaze. This is done by exhaling with two short breaths
followed by blowing out the rest of the air through mouth. The cleaning breath
exercise that consists of taking a deep, slow breath in through nose then
exhaling with a deep, slow breath out of mouth. Many mind–body interventions
are applied to chronic illness, but this technique also appears to be applicable
to the acute situation of delivery. The Lamaze method encouraged expectant
mothers to use the breathing training to learn how to cope with the labor pains
without drugs and to give birth at home or in birthing centers with a birthing
partner and/or midwife9.
6.1) NEED FOR THE STUDY
The intensity of the labour pain isn’t always the determining
factors that drives woman to seek pain management of a repetitive nature and
length of time the pain persists with each contraction. It should not be turned it
a thing that she should fight to forget. Child birth preparation, enhance their
self awareness, trusting their body9.
A survey of several investigations, which included both
primiparas and multiparas; revealed that the incidence of intolerable pain
ranged from 35% to 58% during labour.Another found that 77% of primiparas
reported that their pain during child birth was severe or intolerable5.
A recent survey of American women who gave birth between
2000 and 2002 found that 61% of the respondents used breathing techniques,
and of those, 69% rated them as "very helpful".20
The Lamaze technique offers parents wishing to have a
natural birthing experience the knowledge and skills to fulfill that dream.
It gives them more confidence and control over the birth process.
Methods used in Lamaze have been proven to lead to faster and easier
deliveries with fewer complications. Parents using Lamaze generally
have a more positive and relaxed attitude toward the birth of their baby.
Lamaze classes educate the midwife to prepare the women about the
way they can decrease their perception of pain such as through
relaxation techniques and breathing exercises, Lamaze approach takes
a neutral position wards pain medication encouraging women to make
an informed decision about its right for them.9
The quasi-experimental study was conducted to explore the
effectiveness of the video-based Lamaze method on pre-natal mothers'
knowledge and attitudes, compared with that of traditional nursing guidelines
two experimental groups E (1): issued with traditional nursing guidelines and
instructed in video-based Lamaze method; and E (2): instructed in video-based
Lamaze method), and two control groups C (1): issued with traditional nursing
guidelines and C (2): issued with no guidelines). Before the intervention, E (1)
had the highest score for knowledge. Scores for attitude showed no significant
difference between the four groups. This study showed that the video-based
Lamaze method is likely to promote more effectively than traditional guidelines
the knowledge, attitudes, and practice of prenatal mothers in relation to giving
birth. The use of this method in conjunction with traditional nursing guidelines
may be even more effective in relation to maternal attitude23.
According to Lamaze International, the goal of Lamaze classes is
to "increase women's confidence in their ability to give birth." Toward that end,
women learn a variety of simple coping strategies, of which breathing is only
one. The classes aim to help women "learn how to respond to pain in ways
that both facilitate labor and increase comfort. The study was conducted to
explore in belief about personal control through Lamaze child birth training by
using modes (Lamaze classes, red cross classes, no classes)the findings are
discussed and suggested Lamaze training helps to improve and better meet
the immediate needs of expectant and new parents.
This study was conducted in a public general hospital in Mexico
City to evaluate efficacy of the support during labor to reduce cesarean rate.
From March 1997 to February 1998, a group of 100 pregnant women were
studied. These women were at term, engaged in an active phase of labor,
exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous
uterine incision, and possessed adequate pelvises. The group was randomly
divided into two subgroups comprising 50 women, each:Results confirmed that
support during labor was associated with a significant reduction in cesarean
birth and pitocin administration.22
The results of this study showed support during labor is
associated with positive outcomes that have physical, emotional, and
economic implications.As per the college of literature,science and arts
university of Michigan,USA. There are multiple models of child birth education
for both with in health care settings, including centering pregnancy,and
external programs,such as Lamaze. As a component of child birth
preparation , a birth plan can be a medium to improve patient provider
communication regarding a desired labor and birth experience and improve
satisfaction with care.A wide variety of childbirth preparation classes is
currently available to expectant parents in most communities14.
The Lamaze approach to prenatal education has had dramatic
gains in popularity resulting mainly from the satisfaction of those using the
training and their encouragement of friends to do likewise.As with every
service, it is the consumer who determines what is or is not effective with the
increasing numbers of Lamaze-trained couples in labor units, it is important
that the nurse understand the differences between Lamaze and other
approaches, especially that of "natural" childbirth.Analgesics and narcotics
sometimes cause sleepiness and lower the mother’s attention and strength to
push. The drugs can also decrease a woman’s memory of her birth
experience. In addition, they may temporarily depress respiration in the mother
and baby. Child birth preparation usually Lamaze technique enhance women
self awareness trust in their body. It will make the body to produce it own
endorphins, natural relaxant and pain killers to help ease labour pain13.
6.1.1) STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of intervention package on knowledge
regarding lamaze technique among midwives in selected hospitals,Bangalore”
6.2) REVIEW OF LITERATURE
Review of literature is the selection of available documents on
the topic, which contain information, ideas, data, and evidence return from a
particular stand point to fulfill certain aims or express certain views on the
nature of the topics and how it is to be investigated, and effective evaluation of
this document in relation to the research being proposed.
1) Studies related to negative experience on labor pain:
A descriptive study was conducted to assess the negative
experience of labour pain among 53 postnatal mothers by in depth interview
technique.The finding of the study were all woman who expressed labour pain
were severe and intolerable , unable to cope with the pain during contraction ,
some of them said that they were panicked and felt they might died in pain ,
Most of the woman told that they did not want any more children.The study
review the increased perception of pain might be due to lack of knowledge of
the process of child birth an education regarding the birth process and coping
with pain10.
This project was conducted to improve perinatal care effectiveness. The
data analysis were to identify the lasck of completeness of perinatal care
process , a dearth of education tools in the Vietnamese language and poor
communication , which resulted in poor nursing education outcomes. After
providing communication cards , nursing education pamphlets, video-
CDs,proper practice of Lamaze during labor rose from 43% to80.6%. These
improvement acheieved project aims. This project not only improved the
effectiveness of perinatal care for Vietnamese women , but also improved their
satisfaction with nursing services21.
A discussion regarding child birth education and birth plans was
considered a key component to perinatal care, although many women did not
receive any formalized preparation. There are multiple models of child birth for
both with in health care settings, including child birth preparation like Lamaze
technique. As a component of child birth preparation a desired labor and
satisfied birth experience were held21.
A longitudinal Cohorts study conducted for woman on negative birth
experience due to unexpected medical problem operative delivery, induction of
argumentation of labour pain, lack of control during delivery and administration
of analgesia. The above said studies indicates, the need for some intervention
to avoid or reduce the negative experience of the child birth and labour.
A study conducted to determine whether women's attitudes and
concerns, confidence in ability to control pain, and practice of pain-control
techniques would predict pain and coping or distress-related thought during
labor. During the third trimester of their pregnancies, 115 women completed
the prenatal self-evaluation inventory and measures of confidence and practice
of pain-control techniques, interviews were conducted to assess levels of pain
and the content of women's cognitive activity on a continuum that ranged from
coping-related thought to distress-related thought. The results suggest that,
with the shift from latent to active labor, women's fundamental concerns and
anxieties become manifest, and may take precedence over the skills acquired
through childbirth education in moderating experienced pain and distress16.
2) Study related to pharmacological intervention in reduction of negative
experience of labor:
A study conducted to evaluate the effectiveness and
acceptability of a lidocaine spray in reducing perineal pain during spontaneous
vaginal delivery among 185 woman with out epidural analgesia using
randomized controlled trial were 93 woman received topically applied
Lidocaine anesthetic spray and 92 woman received placebo spray8.
The severity of perineal pain was assessedby using McGill pain
questionnaire. Which is an (0-100) scale? The statistical analysis reveals that
the means pain score among experimental group (Lidocaine group) was 76.9
the mean pain score among control group (placebo group) was 72.1 the main
difference is 4.8 at P-value 0.14. This indicates there is increase in pain for
Lidocaine spray compared with placebo spray. Accompanied by 30% of
neonatal resuscitation among experimental (Lidocaine) group and 23% of
neonatal resuscitation in a control placebo group8.
This study significantly explores that the pharmacological intervention is
in effective in reducing the negative experience of the mother related to child
birth & labour as well as having ill effect on the neonates too, which stress the
use of non-pharmacological intervention to over come the untoward
incidence8.
3) Studies related to effectiveness of non pharmacological intervention
to reduce negative experience of pregnancy and labor:
A quasi-experimental study done to evaluate the effectiveness of non-
pharmacological strategies on pain relief during labor among 30 parturient at
Humanizew labor unit of a School maternity hospital in Nafal in Brazil by
assessing pain by using analogous visual scale. The collected data were
subjected to analysis using Mann-Whitney’s U test which reveals there is
statistical significance level of P=<0.05 with acceptance of respiratory exercise
up to 80%. There fore through application of these strategies the labor process
may be less painful, less tense. Since they need attention, counseling &
communication skills aimed at better onducting child birth. In this context, this
research support, the need to select non-pharmacological strategies for
parturient relief pf pain & anxiety in the labor process11.
4) Studies related to effectiveness of Lamaze technique:
A method of child birth in which, the expectant mother is prepared
psychologically and physically to give birth without the use of pain relieving
drugs. The advantages of the method include the need for little or no analgesia
for relief of pain and participation in the labour by the mother giving her a
guess about sense of self satisfaction at delivery. The father of the baby also
benefits by participating in the birth of his child. A study was conducted to
discuss the effect of Lamaze practice on the outcome of pregnancy and labour
among 70 primipara women by controlled semi-experimental clinical trial.The
subjects were divided into control and study group.Study group receieved
Lamaze technique included a training programme for the study group
cointaining 6 session.The study group was more satisfied with their labour.
The finding shows Lamaze practices can increase satisfaction of labour
process and it can decrease the length of second stage of delivery. Inclusion
of Lamaze technique in maternal care program is highly suggested12.
This study was conducted to explore the effectiveness of the video-
based Lamaze method on Pre-natal mothers' knowledge and attitudes,
compared with that of traditional nursing guidelines. Using a quasi-
experimental design, women in labor with gestations of 32 weeks or more
were divided into four study groups, including two experimental groups (E(1):
issued with traditional nursing guidelines and instructed in video-based
Lamaze method; and E(2): instructed in video-based Lamaze method), and
two control groups (C(1): issued with traditional nursing guidelines and C(2):
issued with no guidelines). Before the intervention, E (1) had the highest score
for knowledge.17
Scores for attitude showed no significant difference between the four groups.
The experimental groups had higher scores than the control groups in the
posttest. This study showed that the video-based Lamaze method is likely to
promote more effectively than traditional guidelines the knowledge, attitudes,
and practice of prenatal mothers in relation to giving birth. The use of this
method in conjunction with traditional nursing guidelines may be even more
effective in relation to maternal attitude23.
The study was conducted plasma concentration of beta-endorphin and
adrenocorticotropic hormone in women with and without child birth
preparation.25 women had received child birth preparation with the Lamaze
method, and 22 women had received no preparation. Mean concentration of
beta-EP from the beginning of labor until puerperium were higher in women
who had received preparation. The researcher discussed the role of childbirth
preparation was a way to enhance beta-EP secretion. Levels of
adrenocorticotropic hormonal closely related with behaviors during labor22.
6.3 OBJECTIVES
1. To assess the knowledge regarding Lamaze technique among midwives before
intervention package
2. To assess the knowledge regarding Lamaze technique among midwives after
intervention package.
3. To evaluate the effectiveness of intervention package on Lamaze technique
4. To find out the association between knowledge on Lamaze technique and
selected variables
.
6.3.1 OPERATIONAL DEFINITIONS
Effectiveness : Refers to the significant improvement in the Knowledge of
midwives on Lamaze technique as assessed by response to the structured
questionnaire.
Intervention package : Includes teaching programme
through lecture and demonstration regarding Lamaze technique.
.
Lamaze technique : A method that mother adopts for easy and pain free
child birth which includes on the types of breathing exercises like Baseline
breathing, Slow breathing, Blowing breathing Patterned breathing, cleansing
breathing exercise as per the Stages of labor with out the use of any pain
relieving drug.
Midwives : A nurse who is trained and
certified to assist women during labor.
6.3.2) ASSUMPTION
Midwives may have some knowledge regarding breathing techniques in
labor.
6.3.3) Hypothesis
There is a significant increase in knowledge on Lamaze technique
among midwives after the Intervention package than before.
6.3.4) SAMPLING CRITERIA
1. Inclusion criteria
a) Midwives who have under gone GNM & Bsc
course
b) Those who are available at the time of study
c) Midwives who are interest to participate in the
study
2. Exclusion criteria
a) The nurse who have already undergone formal
training in Lamaze technique and Obtained
certification.
7. MATERIALS AND METHODS
7.1 Source of the data :
Data will be collected from midwives working in maternity unit of the selected
hospitals Bangalore.
7.2 Method of data collection:
a) Research approach : Evaluative
b) Research design : Quasi experimental. One group pre test & post test design.
c) Research setting : Maternity unit in Selected hospitals, Bangalore
d) Population : All the midwives working in maternity unit of selected hospitals.
e) Samples : Midwives fulfilling the inclusion criteria.
f) Sample size : 50
g) Sampling technique: The sampling technique adopted for the study is simple random sampling.
h) Method of data collection: Self administered questionnaire.
i) Tool for data collection: Structured Questionnaire.
j) Method of data analysis and interpretation: The researcher will use appropriate
statistical technique for data analysis and present in the form of tables and
diagrams. The data will be analyzed by using descriptive and inferential
statistical.
1) Demographical variable will be assessed by frequency distribution and
percentage.
2) Level of knowledge will be assessed by mean, standard deviation,
3) Effectiveness of Intervention package will be assessed by paired‘t’ test.
4) Association between level of knowledge and selected variables will be
determined by ‘chi’square test
k) Variables under study:
Independent variable - Intervention package on Lamaze technique
Dependent variable - Knowledge on Lamaze technique.
Attribute variable - Age, education, income, experience ,source of
information.
l) Projected outcomes:
This study will enable midwives to gain knowledge regarding Lamaze
technique. There by midwives can adequately support the mothers during the
labor process.
7.3) Does the study require any investigation or intervention to be conducted
on patient or other humans or animals? If so please describe briefly?
No
7.4) Has ethical clearance been obtained from your institution?
Yes ethical committees report is here with enclosed.
Bibliography
1) Myles text .book for midwives.14th
edition .DianM.Fraser:Margaret A .Cooper 2003 pp 435-43.
2) Caron – leulliez M.Can bull med hist .child birth with out
pain .politics in france during the cold war 2006;
3) Larissa Hirsch,MD,serdar H ,ural,MDKids
health.org/parents/pregnancy…./childbirth-pain.html.Dealing
with pain during child birth.2008feb. Available from:
URL:http://kidshealth.org/parents/pregnancyne
wborn//pregnancy/chidbirth-pain.html#
4) Gayle L.Riedmann,CNM,MS education for childbirth
Riedmann,G,Glob.libr.women’s med, [ISSN;175-2228]
October 2008;DOI 10.3843/GLOWN.10109, Available
from
:URL:ttp://www.glown.com/Index.html//P=glown.cml/section-
view&articled=109
5) John David Loeser, John .j. bonica Bonica’s management 3rd
edition.Steph
6) Preetha nair Intoday deliver us from pain August 10 ,2009
Available from URL: www.intoday.in/index.php?
option=com...............task
7) Chang MY,chen CH ,Huang KF A comparison of massage
effects on labour pain using the McGill pain questionnaire in
National Tainan Institue of nursing ,ROC 2006sep;14(3) 190-
197 Available from : URL:
http://www.ncbi.nlm.nih.gov/pubmed.
8) Julia sanders , Tim J Peters , Rona Campbell, To assess the
effectiveness and acceptability of Lidocain spray in reducing
perineal pain during spontaneous vaginal delivery20032004
Available from : URL:
http://www.ncbi.nlm.nih.gov/articles/pmc.
9) Prism’s. Nursing practice, child birth methods- Lamaze
method. Journal of clinical nursing education, training and
career development October – December 2008 volume 3
no: 4. pp 152-153.
10) waldenstrom U Hildingsson I , Rubertson C, Radestad I .
A negative birth experience prevalence and risk factors in a
national sample birth .2004 mar; 31 (1):17-27
11) Rejane marie barbosa davim I ; Gilson de vascocelos
Torres II ;Eva Saldanha de Melo III Riberrao preto Non
pharmacological strategies on pain relief during labour.
Rev.Latino-AM.Enfermagem vol.15 no.6 November
/December 2007. Available from : URL: http://
www.scielo.br/pdf/recus/v43n2/en.pdf.
12) F. Fahami , S .Masoudfar , Sh. Davazdahemami. The
effect of Lamaze practices on the out come of pregnancy and
labour in primpara women “Iranian journal of nursing and
midwifery research summer 2007 vol 12 , no 3.111.
13) K Hesson Variability in breathing patterns during latent
labor
linkinghub.elsevier.com/retrieve/pii/S0091218296001395 -
Similar - 1997 - Cited by 5 - Related articles.
14) Trueba, Guadalupe; Contreras, Carlos, Velazco,
Maria Teresa, Lara, Enrique García, Martínez, Hugo B.
Journal of Perinatal Education Alternative Strategy to
Decrease Cesarean Section: Support by Doulas During
Labor , Lamaze International , Volume 9, Number 2, 1
April 2000 , pp. 8-13(6).
15) Normal Labor and Childbirth
www.maqweb.org/maqslides/powerpoint/Maternal/nlc/nlc.ppt
- Similar
16) Michael Wuitchik, Ph.D. 1 , Kathlyn Hesson, M.Sc. Donald
A. Bakal, Ph.D. 1 Michael Wuitchik , Dr. Michael Wuitchik,
Perinatal Predictors of Pain and Distress During labor.
Volume 17 Issue 4, Pages 186 – 191 Published Online:
31 Mar 2007 Journal compilation © 2009, Wiley Periodicals,
Inc
17) A basic text family centered maternity or new born care
3rd edition celste.R Phillips pp 168-169
18) J Obstet Gynecol Neonatal Nurs. 1986 Sep-
Oct;15(5):412-8. The role of the nurse in labor and delivery as
perceived by nurses and patients. Collins BA.
19)Journal of Obstetric, Gynecologic, & Neonatal Nursing
Volume 6 Issue 2, Pages 53 – 54 Published Online: 28 Jul 2006 © 2009 AWHONN A Clarification of the Lamaze
Method JUDITH ANDERSEN, RN, MS
20)Tsai MN Kao LR ,Kang CM, Hu Li Za Zhi project to improve
perinatal care effectiveness in Vietnamese women.
Department of Nursing, Cathay General Hospital Sijhih
Branch, ROC.2008 Dec
21)Bailey JM, Crane P, Nugent CE. College of literature,
science and the arts, university of Michigan , F4835 Mott
hospital SPC 5264 , Ann arbor , mi 48109- 5264, USA Child
birth education and birth plans. 2008 September.
22)Florido J, Oltras CM, Fajardo MC , Gonzalez- Escanuela E,
Villaverde C, Gonzalez-Gomez F. Department of Obstetrics
and Gynecology , University of Granada , Spain Eur J Obstet
Gynecol Reprod Biol. Plasma concentration of beta –
endorphin and adrenocorticitropic hormone in women with or
with out child birth preparation. 1997 June
9. Signature of the candidate :
10. Remarks of the guide :
11. Name and designation (in block letters) :
11.1 Guide :
11.2 Signature :
11.3 Head of the department :
11.4 Signature :
12. Remarks of chairman / principal :
12.1 Signatures