Effectiveness of shiatsu massage upon labour pain and coping among parturient mothers

An Experimental Study to Assess the Effectiveness of Shiatsu Massage on Labour Pain and Coping among Parturient Mothers in First Stage of Labour admitted at Selected Hospital, Chennai. OBJECTIVES: 1. To assess the level of Labour pain, coping and feto maternal parameters before and after shiatsu massage among Control and Experimental group of parturient mothers in active phase of first stage of Labour. 2. To compare the level of Labour pain, coping and feto maternal parameters among Control and Experimental group of parturient mothers after Shiatsu Massage. 3. To determine the level of satisfaction upon Shiatsu Massage among Experimental group of parturient mothers. 4. To find out the association between the selected demographic variables and the level of Labour pain, coping and feto maternal parameters of parturient mothers before and after Shiatsu Massage in Control and Experimental group. 5. To find out the association between the selected Obstetric variables and the level of Labour pain, coping and feto maternal parameters of parturient mothers before and after Shiatsu Massage in Control and Experimental group. The conceptual framework setup for the study was Swanson’s Caring theory. The variables of the study were Shiatsu Massage, Labour pain and Coping. Null hypotheses were formulated. An extensive review of literature was made based on the opinions of the experts. An experimental study of pre-test and post-test design was used. The study included 60 parturient mothers who were selected by Simple random sampling. The study was conducted at Andhra Mahila Sabha Hospitals, Chennai. Demographic variable Proforma, Obstetric variable proforma, Visual Pain Analogue scale, Pain Coping Scale, Rating Scale on Satisfaction of Shiatsu Massage and Modified WHO Partograph were the various tools used by the researcher. The validity was obtained from various experts and reliability was established. The main study was conducted after the pilot study. The level of Labour pain, Coping and Feto-maternal parameters were assessed for the Control and Experimental group of parturient mothers. The Shiatsu Massage was provided on UB30 of the Sacro – meridian region for ten minutes for every two hours in the Experimental group. Then the level of labour pain, coping and feto-maternal parameters were assessed 3 times with 2 hours of interval for both the groups. The level of satisfaction on Shiatsu Massage was assessed among the experimental group of parturient mothers after the labour. The data obtained were analyzed using Descriptive and Inferential statistics. Descriptive Statistics such as Mean, Median and Standard deviation. Inferential statistics such as Chi- Square and Independent “t” test. MAJOR FINDINGS: 1. Majority of the parturient mothers in both the control and experimental group were in the age group of 21 -25 years (53.33%, 60%), resided in sub urban areas (53.33%, 53.33%), they belong to nuclear family (73.3%, 86.66%) and none of them received information regarding Shiatsu massage previously. 2. Majority of the mothers were between 39 – 40 weeks of gestation (43.33%, 63.33%) during delivery. All of them attended more than four antenatal visits and APGAR score of newborn at birth were between 7-10. 3. Majority of the women were able to do 3 R’s (Rhythm, Ritual and Relaxation) (90%, 86.7%) before therapy and significant percentage of them were able to do 3 R’s (6.66%, 40%) after therapy in control and experimental group respectively. 4. The mean pain level was high after therapy (M=5.8, SD=0.88) compared to before therapy (M=4, S.D=1.17) in control group whereas the mean pain level was low (M=3.8, SD=0.60) after therapy compared to before therapy (M=3.8, SD=0.60) in experimental group. Hence null hypothesis H01 was rejected. 5. The mean coping level was low after therapy (M=2.00, SD=0.87) in comparison with before therapy (M=4.2, SD=0.94) in control group and the mean coping level was high after therapy (M=4.3, SD=0.69) in comparison with before therapy (M=3.3, SD=0.60) in experimental group. Hence null hypothesis Ho1 was rejected. 6. The cervical dilatation and uterine contraction were increased after therapy in comparison with before therapy were (M=4, SD=0; M=6, SD=0), (M=2.5,SD=0.50; M=3.9, SD=0.11) and (M=4,SD=0; M=6, SD=0), (M=3, SD=0; M=4, SD=0) in Experimental and Control and group of parturient mothers which shows that Shiatsu massage was not having any adverse effects over uterine contractions and cervical dilatation. 7. The majority of the participants in Experimental group were highly satisfied (86.66%) with the Shiatsu Massage and none of them reported dissatisfaction towards the intervention. In both the Control and Experimental group of parturient mothers, no significant association was found between Demographic variables and the level of labour pain perception which proves that Demographic variables has no influence over the pain perception. Hence some type of pain relief methods are essential for the women to reduce the pain. 8. Similarly no association was found between Demographic variables and the level of coping in both the Control and Experimental group of parturient mothers which means that Demographic variables may not influence the coping level of the women and hence it is the responsibility of the nurse midwife to help the mother in coping with the labour pain. 9. There was no significant association between Obstetric variables such as gravida, parity, gestational age in weeks, number of antenatal visits, cervical dilatation, duration of first, second, third stage of labour and APGAR score of newborn at birth with the level of labour pain after Shiatsu Massage in the control and experimental group. Hence null hypothesis Ho3 was retained. 10. There was no significant association between Obstetric variables such as gravida, parity, gestational age in weeks, number of antenatal visits, cervical dilatation, duration of first, second, third stage of labour and APGAR score of newborn at birth with the level of coping after Shiatsu Massage in the control and experimental group. Hence null hypothesis Ho3 was retained. The above study findings reveled that Shiatsu Massage used by the researcher to reduce the level of pain perception in parturient mothers was found to be effective. RECOMMENDATIONS: 1. The same study can be conducted with large number of samples. 2. A comparison can be made between primi and multigravid women. 3. A comparison can be made with different stages of labour. 4. The same study can be conducted at different setting. 5. A comparison can be made between different types of alternative and complementary therapies. CONCLUSION: This study shows that Shiatsu Massage was effective in reducing the Labour pain perception and improving the coping level of parturient mothers. The Experimental group of parturient mothers who received Shiatsu Massage had decreased pain perception, increased level of coping and was highly satisfied with the therapy. Shiatsu Massage is a non – invasive procedure and has no adverse effects on the mother and the fetus and hence the midwives could be encouraged to use this as a pain relief method during Labour

Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh

IntroductionTime-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh.MethodsTerm infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts.ResultsA total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges.ConclusionDespite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation.</jats:sec

Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh

Introduction Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh.Methods Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts.Results A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges.Conclusion Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation