maternity blue final thesis
Post on 04-Jun-2018
225 Views
Preview:
TRANSCRIPT
-
8/13/2019 Maternity Blue Final Thesis
1/70
CHAPTER-1
INTRODUCTION
INTRODUCTION
1
-
8/13/2019 Maternity Blue Final Thesis
2/70
The postnatal period is well established as an increased time of risk for the
development of serious mood disorders. There are three common forms of
postpartum affective illness: the blues (baby blues, maternity blues), postpartum
(or postnatal) depression and puerperal (postpartum or postnatal) psychosis each of
which differs in its prevalence, clinical presentation, and management.1
Maternity Blues The maternity ,baby or third day blues occur in the first two to
three weeks after delivery. The depression often follows a latent period of three or
four day ,is usually mild and transitory but can be more intense .Ma!imum
tearfulness and depression occur on fifth postpartum day. This condition is often
aggravated by a sore perineum ,breast, fatigue from broken nights and endless
visitor. " woman#s sense of success or failure about her labour, delivery and baby,
as well as thoughts comments from staff can be triggering factors too. The
mother#s response to her baby may not have been what she had e!pected perhaps
the automatic surge of love did not materli$e, the fact that friends, relations and
hospital staff seem more interested in the baby than in her life. "ny or all of these
can play a part in the blues, which are e!perienced by as many as %&'of newly
delivered mother. esearch suggests that about *'of mother e!periencing severe
postnatal blues will go on to develop post natal depression2.
The postpartum blues, maternity blues, or baby blues is a transient condition with a
comple! mi!ture of physical, emotional, and behavioral changes that mothers
could e!perience shortly after childbirth with a wide variety of symptoms which
generally involve mood liability, tearfulness, and some mild an!iety and
depressive symptoms. Baby blues is not postpartum depression, unless it is
abnormally severe.1
2
-
8/13/2019 Maternity Blue Final Thesis
3/70
+ostpartum blues is the most common observed puerperal mood disturbance, with
estimates of prevalence ranging from &-*' 3.The symptoms begin within a few
days of delivery, usually on day or , and persist for hours up to several days.
The symptoms include mood labiality, irritability, tearfulness, generali$ed an!iety,
and sleep and appetite disturbance. +ostnatal blues are by definition timelimited
and mild and do not re/uire treatment other than reassurance, the symptoms remit
within days 4.The propensity to develop blues is unrelated to psychiatric history,
environmental stressors, cultural conte!t, breastfeeding, or parity, however, those
factors may influence whether the blues lead to ma0or depression . 1p to &' of
women with blues will go on to develop ma0or depression in the first year
postpartum.3
" wide variety of complementary therapies claim to improve health by producing
rela!ation. 2ome use the rela!ed state as a means of promoting psychological
change. 3thers incorporate movement, stretches, and breathing e!ercises.
ela!ation and 4stress management5 are found to a certain e!tent within
conventional medicine.
5
3ne wellknown e!ample of a rela!ation techni/ue is known variously as
progressive muscle rela!ation, systematic muscle rela!ation, and 6acobson
rela!ation and Mitchell#s rela!ation. The patient sits comfortably in a /uiet room.
7e or she then tenses a group of muscles, such as those in the right arm, holds the
contraction for 8* seconds, then releases it while breathing out. "fter a short rest,
this se/uence is repeated with another set of muscles. 9n a systematic fashion,ma0or muscle groups are contracted, then allowed to rela!. radually, different
sets of muscle are combined. +atients are encouraged to notice the differences
between tension and rela!ation. ;hile postpartum depression is a ma0or health
issue for many women from diverse cultures, this condition often remains
3
-
8/13/2019 Maternity Blue Final Thesis
4/70
undiagnosed. "lthough several measures have been created to detect depressive
symptomatology in women who have recently given birth, the development of a
postpartum depression screening program re/uires careful consideration.1
ela!ation can help to relieve the symptoms of stress. "lthough the cause of the
an!iety will not disappear, you will probably feel more able to deal with it once
you have released the tension in your body and cleared your thoughts.
6acobson#s progressive rela!ation techni/ue involves contracting and rela!ing the
muscles to make you feel calmer.
-
8/13/2019 Maternity Blue Final Thesis
5/70
rela!ation of muscles would lead to rela!ation of the mind, ??because an emotional
state fails to e!ist in the presence of complete rela!ation of the peripheral parts
involved#’7. 9n other words, rela!ation inhibits the generation of thoughts and
emotions, and undoes the effects of neuromuscular hypertension on the body.
Briefly, in +M clients sit in a comfortable chair and the therapist instructs them in
contracting and releasing different muscle groups. "n individual ??learns to
recogni$e contraction in the various parts in a certain order. The large muscle
groups are attended to first, because the sensation from them is most conspicuous.
;hen an individual rela! a given part, they simultaneously rela! all parts that have
previously received practice5. "fter they master rela!ation while lying down, they
are taught how to rela! muscles in reallife situations, which re/uires ??differential
rela!ation,## minimi$ing tension in the muscles needed for some activity while
completely rela!ing muscles not being used. @lassical +M was timeconsuming.
9nitially suggested & to A& min treatments several times a week for up to more
than a year .8
+rogressive muscle rela!ation is especially helpful for people whose an!iety is
strongly associated with muscle tension. 3ther symptoms that respond well to
progressive muscle rela!ation include tension headaches, backaches, tightness in
the 0aw, tightness around the eyes, muscle spasms, high blood pressure, and
insomnia. 2ystematically rela!ing your muscles tends to help slow down your
mind.
The immediate effects of progressive muscle rela!ation include all the benefits of
the rela!ation response described above. ongterm effects of regular practice of
progressive muscle rela!ation include:8
• " decrease in depression.
• " decrease in anticipatory an!iety related to phobias.
5
-
8/13/2019 Maternity Blue Final Thesis
6/70
• eduction in the fre/uency and duration of panic attacks.
• 9mproved ability to face phobic situations through graded e!posure.
• 9mproved concentration.
• "n increased sense of control over moods.
• 9ncreased selfesteem.
• 9ncreased spontaneity and creativity.
Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is
the name given to a techni/ue of rela!ing the whole, or part, of your body,
thus relieving the muscle tendons produced by stress. 9t can be applied
rapidly, either as full rela!ation of your whole body or rela!ation of selected
parts of body not in use at any given moment. 9n this way rest can be
obtained in one part of body, while activity may be going on in another .2
This method utili$es knowledge of the typical stressCtension posture and
reciprocal rela!ation of muscle whereby one muscle group rela!es as
opposing group contract. 2tress induced tension in the muscle that work to
create the typical posture may be released by voluntary contraction of the
opposing muscle groups. +ropioreceptive receptor in 0oints and muscle
tendons record the resulting position of ease and this is relayed to and
registered in the cerebrum.2
Mitchell#s method involves adopting body positions that are opposite to
those associated with an!iety (fingers spread rather than hands clenched, for
e!ample). 9n autogenic training, patients concentrate on e!periencing
6
-
8/13/2019 Maternity Blue Final Thesis
7/70
physical sensations, such as warmth and heaviness, in different parts of their
bodies in a learned se/uence.9
CHAPTER-2
NEED OF STUDY
NEED OF STUDY
7
-
8/13/2019 Maternity Blue Final Thesis
8/70
-
8/13/2019 Maternity Blue Final Thesis
9/70
CHAPTER-3
OBJECTIVES
OBJECTIVES
9
-
8/13/2019 Maternity Blue Final Thesis
10/70
• To study the effects of Mitchell#s rela!ation techni/ue in maternity blues.
• To study the effects of progressive rela!ation techni/ue in maternity blues.
•
To compare the effects of +rogressive rela!ation techni/ue and Mitchellrela!ation techni/ue on maternity blues.
10
-
8/13/2019 Maternity Blue Final Thesis
11/70
CHAPTER-4
HYPOTHESIS
HYPOTHESIS
• A!"#$%&"'(# )*+,")#': The progressive rela!ation techni/ue would be more
effective than Mitchell#s rela!ation techni/ue in the management of maternity
11
-
8/13/2019 Maternity Blue Final Thesis
12/70
blue.
• N!! )*+,")#' The progressive rela!ation techni/ue would not be more
effective than Mitchell#s rela!ation techni/ue in the management of maternity
blue.
12
-
8/13/2019 Maternity Blue Final Thesis
13/70
CHAPTER-5
OPERATIONA/ DEFINITIONS
OPERATIONA/ DEFINITIONS:
M"T>D9TE B1>
Maternity blues, or baby blues is a transient condition with a comple!
mi!ture of physical, emotional, and behavioral changes that mothers could
13
-
8/13/2019 Maternity Blue Final Thesis
14/70
e!perience shortly after childbirth with a wide variety of symptoms which
generally involve mood liability, tearfulness, and some mild an!iety and
depressive symptoms. Baby blues is not postpartum depression, unless it is
abnormally severe 2 .The maternity, baby or third day blues occur in the first
two to three weeks after delivery. The depression often follows a latent
period of three or four day.
+3>229F> >"G"T93D T>@7D9H1>
+rogressive muscle rela!ation was described by dmund 6acobson .9t is a
systematic techni/ue for achieving a deep state of rela!ation. Tensing and
releasing various muscle groups throughout the body.6
M9T@7> >"G"T93D T>@7D9H1>
Mitchell#s rela!ation techni/ue is a method physiological rela!ation. 9t is the name given to a
techni/ue of rela!ing the whole, or part, of your body, thus relieving the muscle tendons
produced by stress. 9t can be applied rapidly, either as full rela!ation of your whole body or
rela!ation of selected parts of body.IJ
>2293D 2@">
>
-
8/13/2019 Maternity Blue Final Thesis
15/70
CHAPTER-6
REVIE0 OF /ITERATURE
REVIE0 OF /ITERATURE
• #%&!! #" &!:The maternity ,baby or third day blues occur in the first two to
three weeks after delivery. The depression often follows a latent period of
three or four day ,is usually mild and transitory but can be more intense
.Ma!imum tearfulness and depression occur on fifth postpartum day. This
condition is often aggravated by a sore perineum, breast, fatigue from
15
-
8/13/2019 Maternity Blue Final Thesis
16/70
broken nights and endless visitor ." women#s sense of success or failure
about her labour, delivery and baby, as well as thoughts comments from
staff can be triggering factors too.2
• O’ H&$& #" &! : +ostpartum blues is the most common observed puerperal
mood disturbance, with estimates of prevalence ranging from &-*' 3.The
symptoms begin within a few days of delivery, usually on day or , and
persist for hours up to several days. The symptoms include mood lability
irritability, tearfulness, generali$ed an!iety, and sleep and appetite
disturbance. +ostnatal blues are be definition timelimited and mild and do
not re/uire treatment other than reassurance, the symptoms remit within
days.4 The propensity to develop blues is unrelated to psychiatric history,
environmental stressors, cultural conte!t, breastfeeding, or parity (7apgoodet al.,8K%%) ,8, however, those factors may influence whether the blues lead
to ma0or depression (Miller, &&). 1p to &' of women with blues will go
on to develop ma0or depression in the first year postpartum.31
• S"#'% 198 :Lound that postnatal blues peaked on days *.
-
8/13/2019 Maternity Blue Final Thesis
17/70
stressors, () discussion of postpartum stressors, and () a control discussion
about their awareness of postpartum stress. They found that the groups
receiving rela!ation training were significantly less distressed than the non
rela!ation training groups during the first K weeks postpartum. They also
found that the groups that discussed possible postpartum stressors were lesselated after delivery than the groups not e!posed. The authors recommended
the use of e!tended, nonspecific rela!ation training both before and after
delivery as a way of reducing postpartum emotional distress.24
• ')! 0.O H&$& 2tudies of the prevalence of the blues have reported a
wide range (A' to %*'). 2tudies reporting relatively high prevalence rates
have used criteria such as the presence of crying at some time during thefirst week after delivery. ower prevalence rates have been obtained in
studies using more stringent criteria for the blues, such as high scores on
standard depression or mood scales.11
• E% J&,:,% trained his patients to voluntarily rela! the muscles in
their body whenever they are not being used to perform a particular task. 7e
found that the rela!ation procedure is effective against a number of ailments
including ulcers, insomnia, and hypertension.6
• P$,;$#'(# $#!&dmund
6acobson in the early 8K&s.12 6acobson did not ever fully understand how by
shutting down ones responses to e!ternal and internal stimulants one could
not only reduce an!iety, but actually reduce such problems as skin allergies
and rashes. 9t is not at all clear how shutting down our physical responses
can be so effective in curing various disorders.12
•O’H&$& = S>&'% 1996): 9n a meta analysis of *K studies from Dorth"merica, >urope, "ustralasia and 6apan (nN8,%8& sub0ects), found an
overall prevalence rate of postpartum depression of 8'. This was based on
studies that assessed symptoms after at least two weeks postpartum. (to
avoid confounding of postpartum blues) and used a validated or standardi$ed
measure to assess depression.1
17
http://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Insomniahttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Peptic_ulcerhttp://en.wikipedia.org/wiki/Insomniahttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Edmund_Jacobsonhttp://en.wikipedia.org/wiki/Edmund_Jacobson
-
8/13/2019 Maternity Blue Final Thesis
18/70
• B""%#$ O?H&$& 0 0&",% D. 212 The structure of women=s
mood in the early postpartum. 2tates that Opostpartum bluesO is a mild,
predictable mood disturbance occurring within the first several days
following childbirth. +revious analyses of the ObluesO symptom structure
yielded inconclusive findings, making reliable assessment a significant
methodological limitation. The current study aimed to e!plicate the
symptom structure of women=s mood following childbirth, and to e!amine
psychometric properties of the !periences Huestionnaire (H), an
adapted version of the ennerly Blues Huestionnaire that included
additional items from the +ositive and Degative "ffect 2chedule. Mothers
who recently delivered (D N 8A) were recruited from a university hospital
and asked to complete mood ratings on si! consecutive days using the H.
>!ploratory factor analysis yielded an interpretable twofactor solution
identified as Degative "ffect and +ositive "ffect. 2cale reliability indices
were e!cellent, with a high level of agreement in factor structure over time.This twofactor model provides reliable assessment of women=s mood in the
early postpartum, informing the study of reproductiverelated mood
disorders.13
• N&$&')&'&) @ &%%&") @'$'*&++& V#%&"#) R&&%%& 211:
+ostpartum blue is common in socially and economically insecure mothers ,
"mong the 8& women screened, 8 mothers fulfilled the inclusion criteria
and were recruited in this study. 3f the 8 women screened, - werediagnosed to have ++B, accounting for *%.*' prevalence rate. Most of the
mothers were literate (K8') and housewives (--'). "bout K' of the
mothers had previous history of miscarriage and %' had a history of
psychiatric illness. Two mothers had marked suicidal tendency (by >+stimated the prevalence and
track the risk factors associated with, Maternity blues (MB). " transversal
study was performed with 88 women, on the tenth day of puerperium. +itt2cale (8KA%), 2tein (8K%&), and a /uestionnaire with socio demographic and
obstetric data were used for assessment. esults of study showed the
prevalence of Maternity Blue was .-' according to the 2tein scale221. 9n
the univariated analysis, civil status and tobacco use were associated with
MB. egally married women and nonsmokers showed a risk appro!imately
times lower of e!periencing the problem.15
18
http://www.ncbi.nlm.nih.gov/pubmed?term=Buttner%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=O%27Hara%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Watson%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Menezes%20PR%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Tedesco%20JJ%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Kahalle%20S%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Zugaib%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Buttner%20MM%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=O%27Hara%20MW%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Watson%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22156719http://www.ncbi.nlm.nih.gov/pubmed?term=Menezes%20PR%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Tedesco%20JJ%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Kahalle%20S%5BAuthor%5D&cauthor=true&cauthor_uid=18988444http://www.ncbi.nlm.nih.gov/pubmed?term=Zugaib%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18988444
-
8/13/2019 Maternity Blue Final Thesis
19/70
•
1
• P#"$,' A @&;!'&$' /.213 "n!ious and depressive components of
>dinburgh +ostnatal dinburgh +ostnatal ++
-
8/13/2019 Maternity Blue Final Thesis
20/70
7eart rate was measured using a pulse o!imeter , at baseline, and before and
after intervention .The supine position showed reduction in heart rate
significantly in all groups.
-
8/13/2019 Maternity Blue Final Thesis
21/70
a firstline treatment in a stepped care approach to managing depression,
especially in younger populations and populations with sub threshold or
first episodes of depression.2
• V'",$'& / S&!" &")!##% #$$ 1997 : Mitchell=s 2imple +hysiological
ela!ation and 6acobson=s +rogressive ela!ation Techni/ues: "
comparison. This study was aimed to compare the shortterm physiological
effects of Mitchell=s simple physiological rela!ation and 6acobson=s
progressive rela!ation. Twentyfour nor motensive sub0ects, 8 men and ten
women, participated in the si!week study. 2ystolic blood pressure (2B+)
and diastolic blood pressure (
-
8/13/2019 Maternity Blue Final Thesis
22/70
forgetfulness Cmuddled thinking. +rimary blues emerged as a separate
cluster from depression and was more fre/uent (A' versus 8A',
respectively). The final /uestionnaire was validated on a further sample of
%- newly delivered women, comparing prenatal scores to the mean of
scores obtained on days 8to 8& postpartum. The scores for the primary blues
cluster significantly increased postpartum, while scores for depression did
not change. These findings may indicate that changes in depression are not
characteristic in the early puerperium. " second study by ennerly and ath
(ennerly 8K%K) on88 women compared maternal blue /uestionnaire
scores with the women# s social environment and personality type (>ysenck
+ersonality 9nventory).+ostnatal blues was significantly associated with
neuroticism, poor social ad0ustment with the role as a house worker, and a
poor relationship in either the family unit, e!tended family or marriage.4131
• H&+;,, #" &!.1988 The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural conte!t, breastfeeding,
or parity . 7owever, those factors may influence whether the blues lead to
ma0or depression (Miller, &&). 1p to &' of women with blues will go on
to develop ma0or depression in the first year postpartum (@ampbell et al.,
8KKP 3=7ara et al., 8KK8b).31
"mong the 8& women screened, 8 mothers fulfilled the inclusion criteria
and were recruited in this study. 3f the 8 women screened, - were
diagnosed to have ++B, accounting for *%.*' prevalence rate. Two mothers
had marked with suicidal tendency (by >+
-
8/13/2019 Maternity Blue Final Thesis
23/70
CHAPTER-7
ATERIA/S AND ETHOD
ETHODS
• NUBER OF SUBJECTSA& 21B6>@T2
• SOURCE OF SUBJECTS
23
-
8/13/2019 Maternity Blue Final Thesis
24/70
8.
-
8/13/2019 Maternity Blue Final Thesis
25/70
SAP/IN@
•SAP/E SIE The sample si$e consists of A& sub0ects in maternity blues.
• SAP/E CRITERIA: 2ystematic random sampling method is used to
divide the patient in to two groups.
roup " M9T@7>#2 >"G"T93D T>@7D9H1> (nN&)
25
-
8/13/2019 Maternity Blue Final Thesis
26/70
roup B 6"@3B23D#2 >"G"T93D T>@7D9H1> (nN&)
• VARIAB/E OF THE STUDY
I%#+#%#%" (&$'&:!#
+rogressive rela!ation techni/ue
Mitchell#s rela!ation techni/ue
D#+#%#%" (&$'&:!#dinburgh +ostnatal 2cale (>
-
8/13/2019 Maternity Blue Final Thesis
27/70
-
8/13/2019 Maternity Blue Final Thesis
28/70
nsure the legs are not straight. 3pen (A& degree) angle behind knee
A. +oint the toes, then release. ;iggle toes to and fro to ensure no cramping
occurs.
-. +ush yourself into the support. elease.
%. +ush your head into the head rest (or cupped hands).
K. Breath using the diaphragm. +ush tummy out as you breathe in. Lour
seconds in and hold for four seconds then breathe out for four seconds.
-
8/13/2019 Maternity Blue Final Thesis
29/70
8.;ith eyes still closed imagine a calm place and put yourself in a deck chair
in the scene. Meditate on that scene.
emember that you should never drive away in a car after work without doing this
sort of e!ercise first to ensure that neckC0aw tension is not creating tunnel vision for
you.
@ROUP B-PRO@RESSIVE RE/AGATION TECHNIUE %3
The system comprises8*& basic e!ercises, which have been found to be
effective, if practiced regularly.8
There are no contraindications for progressive muscle rela!ation unless the musclegroups to be tensed and rela!ed have been in0ured. 9f you take tran/uili$ers, you
may find that regular practice of progressive muscle rela!ation will enable you to
lower your dosage.
@'#!'%# ,$ P$&"''%; P$,;$#'(# !# R#!&
-
8/13/2019 Maternity Blue Final Thesis
30/70
ways of supporting your body most completely. (;hen lying down, you may want
to place a pillow beneath your knees for further support.) 2itting up is preferable to
lying down if you are feeling tired and sleepy. 9t=s advantageous to e!perience the
full depth of the rela!ation response consciously without going to sleep.
A. oosen any tight clothing and take off shoes, watch, glasses, contact lenses,
0ewelry, and so on.
-. Make a decision not to worry about anything. ive yourself permission to put a
side the concerns of the day. "llow taking care of yourself and having peace of
mind to take precedence over any of your worries.
%. "ssume a passive, detached attitude. This is probably the most important
element. Eou want to adopt a Olet it happenO attitude and be free of any worry
about how well you are performing the techni/ue.
-
8/13/2019 Maternity Blue Final Thesis
31/70
. @lench your fists. 7old for -8& seconds and then release for 8*&
seconds. 1se these same time intervals for all other muscle groups .(fig no.)
. Tighten your biceps by drawing your forearms up toward your shoulders and
Omaking a muscleO with both arms. 7old... and then rela!.
. Tighten your tricepsthe muscles on the undersides of your upper armsby
e!tending your arms out straight and locking your elbows. 7old ... and then rela!.
*. Tense the muscles in your forehead by raising your eyebrows as far as you can.
7old ... and then rela!. 9magine your forehead muscles becoming smooth and
limp as they rela!.
A. Tense the muscles around your eyes by clenching your eyelids tightly shut.7old... and then rela!. 9magine sensations of deep rela!ation spreading all
around them.
-. Tighten your 0aws by opening your mouth so widely that you stretch the muscles
around the hinges of your 0aw. 7old ... and then rela!. et your lips part and allow
your 0aw to hang loose.
%. Tighten the muscles in the back of your neck by pulling your head way back, as
if you were going to touch your head to your back (be gentle with this muscle
group to avoid in0ury). Locus only on tensing the muscles in your neck. 7old ...
and then rela!. 2ince this area is often especially tight, it=s good to do the tense
rela! cycle twice.
K. Take a few deep breaths and tune in to the weight of your head sinking into
whatever surface it is resting on.
8&. Tighten your shoulders by raising them up as if you were going to touch your
ears. 7old ... and then rela!.
88. Tighten the muscles around your shoulder blades by pushing your shoulder
blades back as if you were going to touch them together. 7old the tension in your
shoulder blades ... and then rela!. 2ince this area is often especially tense, you
might repeat the tenserela! se/uence twice.
8. Tighten the muscles of your chest by taking in a deep breath. 7old for up to 8&
31
-
8/13/2019 Maternity Blue Final Thesis
32/70
seconds ... and then release slowly. 9magine any e!cess tension in your chest
flowing away with the e!halation.
8. Tighten your stomach muscles by sucking your stomach in. 7old ... and then
release. 9magine a wave of rela!ation spreading through your abdomen.
8. Tighten your lower back by arching it up. (Eou should omit this e!ercise if you
have lower back pain.) 7old ... and then rela!.
8*. Tighten your buttocks by pulling them together. 7old ... and then rela!.
9magine the muscles in your hips going loose and limp.
8A. 2/uee$e the muscles in your thighs all the way down to your knees. Eou will probably have to tighten your hips along with your thighs, since the thigh muscles
attach at the pelvis. 7old ... and then rela!. Leel your thigh muscles smoothing
out and rela!ing completely.
8-. Tighten your calf muscles bypulling your toes toward you (fle! carefully to
avoid cramps). 7old ... and then rela!. (fig no.)
8%. Tighten your feet by curling your toes downward. 7old ... and then rela!.
8K. Mentally scan your body for any residual tension. 9f a particular area remains
tense, repeat one or two tenserela! cycles for that group of muscles.
&. Dow imagine a wave of rela!ation slowly spreading throughout your body,
starting at your head and gradually penetrating every muscle group all the way
down to your toes.
E% , $#!&
-
8/13/2019 Maternity Blue Final Thesis
33/70
first day of the commencement of the treatment. Then they were given respective
treatment as decided per group. The sub0ects were reassessed on the last day of the
treatment.
Lig no8 M9T@7>#s >"G"T93D T>@7D9H1> 9D 21+9D> E9D
33
-
8/13/2019 Maternity Blue Final Thesis
34/70
Lig no M9T@7>#s >"G"T93D T>@7D9H1> 9D 29 E9D
34
-
8/13/2019 Maternity Blue Final Thesis
35/70
Lig. no 6"@3B23D#2 >"G"T93D T>@7D9H1>-
35
-
8/13/2019 Maternity Blue Final Thesis
36/70
"sk the patient to clenched your fist and hold for-8& seconds than rela!.
Lig no. 6"@3B23D#2 >"G"T93D T>@7D9H1>
36
-
8/13/2019 Maternity Blue Final Thesis
37/70
"sk the patient . Tighten your calf muscles bypulling your toes toward you (fle!
carefully to avoid cramps). 7old ... and then rela!.
O",# #&$#
EASUREENT OF DEPRESSION
37
-
8/13/2019 Maternity Blue Final Thesis
38/70
-
8/13/2019 Maternity Blue Final Thesis
39/70
CHAPTER-8
DATA ANA/YSIS
STASTICA/ ANA/YSIS
39
-
8/13/2019 Maternity Blue Final Thesis
40/70
I%"$& ;$,+ ,+&$',%
RT-+$# " "#" , @ROUP A
JRT-+$#-+," "-"#" , @ROUP B
40
"ssessment>
-
8/13/2019 Maternity Blue Final Thesis
41/70
I%"#$ ;$,+ ,+&$',% :* EDPS
41
A##%" S)#!#
,&##%"
N:#$
,:#"
#&% S"&%&$
#('&"',%
"-
(&!#
+-
(&!#
P$# T#"
,+&$',%
RT 3 15.33 3.325 .374 .71
JRT 3 15.66 3.575
P," "#"
,+&$',%
RT 3 8.2 2.28 1.95 .55
JRT 3 7.1 2.73
-
8/13/2019 Maternity Blue Final Thesis
42/70
CHAPTER-9
RESU/T
RESU/T
This chapter deals with the most important and crucial aspect of investigating the
data to answer the research /uestion through suitable statistical treatment.
42
-
8/13/2019 Maternity Blue Final Thesis
43/70
" sample of A& patients were selected and allotted randomly into two groups of
e/ual si$e of & sub0ects using systematic random sampling method .roup "
received Mitchell#s rela!ation techni/ue and roup B received 6acobson rela!ation
techni/ue. The assessment was done by >dinburgh postnatal depression scale. The
collected data was statistically analy$ed.
The score were following:
8.MT 2cores:roup"
• +re test mean 8*. and standard deviation .*
• +ost test mean %.& and standard deviation .%&
.6T 2cores:roupB
• +re test mean 8*.AA and standard deviation was .*-*
• +ost test mean -.8&& and standard deviation was .&-
• .@omparison within the groups before and after treatment : BE >
-
8/13/2019 Maternity Blue Final Thesis
44/70
• +ost test comparison: tN 8.K*P pN&.&**
44
-
8/13/2019 Maternity Blue Final Thesis
45/70
@RAPH
INTER @ROUP COPARISON BET0EEN @ROUP A AND @ROUP-B
BY EDINBUR@H POSTNATA/ DEPRESSION SCA/E
45
-
8/13/2019 Maternity Blue Final Thesis
46/70
CHAPTER -1
DISCUSSION
DISCUSSION
46
-
8/13/2019 Maternity Blue Final Thesis
47/70
9n this study the effectiveness of progressive rela!ation techni/ue Fs Mitchell
rela!ation techni/ue on maternity blues was assessed.
A& sub0ects of the age group between 8%Kyears were taken for the study .The
sub0ect who met the inclusion criteria were included in the study .+ermission for
the study was taken from the above hospitals and ethical committee of career
institute of medical sciences . "n informed and written consent form was also
taken from the females , where the patient agreed to participate in the study and
the data was collected from females by using evaluation tools. The participant
were divided into two groups. roup " (&) and roup B (&) using the systematic
random sampling.
dinburgh +ostnatal +dinburgh +ostnatal +
-
8/13/2019 Maternity Blue Final Thesis
48/70
-
8/13/2019 Maternity Blue Final Thesis
49/70
were taking part in +M treatment from 8&CK% to KC&&, were /uestioned
about their e!periences.7
• J&'# A!&% B#!! J,#""#B#""&%* S&!"',( 2 Mitchell=2 ela!ation
Techni/ue: 9s 9t >ffectiveQ 2howed effectiveness of Mitchell=s rela!ation
techni/ues including diaphragmatic breathing, compared with diaphragmatic
breathing alone and supine lying.1.
• "s maternity blues is postpartum depressive condition. Maternal blues is a
common condition in most of the +ostpartum women and left untreated.27.
• "mong the rela!ation techni/ues, we emphasi$e that of +rogressive Muscle
ela!ation, which is used in this study. 9t is mainly based on the premise
that an!iety and rela!ation are e!cluding situations. The procedures used are
simple: the individual retracts a specific set of muscles as much as possible
and e!periences as tension sensation. The muscles are then rela!ed as much
as possible and the individual focuses on the rela!ation sensations. 9t is,
therefore, a participant e!ercise in which the individual herself seeks a state
of rela!ation and physical wellbeing.;hen +rogressive Muscle ela!ation
is practiced and incorporated to the mother#s life style, it can help to
neutrali$e some of the effects of stress reaction.24
The distinction in the current study is that both techni/ues either 6acobson
progressive rela!ation techni/ue or Mitchell#s rela!ation techni/ue were used to
produce rela!ation in maternal blues rather than physiological effects on cardiac
components. "lthough the current study does not provide information about the
49
-
8/13/2019 Maternity Blue Final Thesis
50/70
mechanism of action or change, however it suggests that both methods were found
effective significantly.
50
-
8/13/2019 Maternity Blue Final Thesis
51/70
CHAPTER-11
CONC/USION
51
-
8/13/2019 Maternity Blue Final Thesis
52/70
CONC/USION
9n this study we found that both the techni/ue Mitchell#s rela!ation and 6acobson#s
rela!ation techni/ue are effective in the management of maternity blues but
6acobson#s rela!ation was found to be more effective than Mitchell#s rela!ation
techni/ue. esult of this study suggest that a gradual improvement was seen
throughout the session. The pre and post treatment score of >dinburgh +ostnatal
+
-
8/13/2019 Maternity Blue Final Thesis
53/70
CHAPTER-12
/IITATIONS
/IITATIONS
53
-
8/13/2019 Maternity Blue Final Thesis
54/70
• This study was conducted on a small sample si$e of A& patients.
+opulation of the both groups was smallP only & patients in each group
might not represent the ma0ority of the maternal blues population.
• The study was not consent and concluded with appropriate interval
follow ups. 2ome follow ups should be conducted to strengthen the
conclusion.
• 3nly one scale was used to assess the maternal blues. The >
-
8/13/2019 Maternity Blue Final Thesis
55/70
CHAPTER -13
BIB/IO@RAPHY
55
-
8/13/2019 Maternity Blue Final Thesis
56/70
BIB/IO@RAPHY
1. obertson, >., @elasun, D., and 2tewart, . (&&). isk factors for
postpartumdepression. 9n 2tewart, ., obertson, >., 6: +rospective study of
postpartum blues: Biologic and psychosocial factors. "rch en +sychiatry %: %&8,
8KK8 .
4. ennerly 7, ath
-
8/13/2019 Maternity Blue Final Thesis
57/70
13. +ost partum depression literature review of risk factor and interventions
:Buttner MM, 3=7ara M;, ;atson
-
8/13/2019 Maternity Blue Final Thesis
58/70
21.Fictoria 2alt, athleen M err Mitchell=s 2imple +hysiological ela!ation
and 6acobson=s +rogressive ela!ation Techni/ues: " comparison +hysiotherapy
Folume %, 9ssue , "pril 8KK-, +ages &&U&-http:CCd!.doi.orgC8&.8&8AC2&&8
K&A(&*)AA&%8A.
22. +itt B: 4Maternity blues.5 Br 6 +sychiatry 8: 8, 8K-.
23. 2tein : The pattern of mental change and body weight change in the first post
partum week. 6 +sychosom es : 8A*, 8K%& 8. 7andley 2, nfermagem && setembrooutubroP 8&(*):A*K.
25. B9@> +9TTV @onsultant +sychiatrist, .8
26. 2tefanie aers8 , Melanie ;aschke8 and 1lrike >hlert8 81niversity of Wrich, 2wit$erland
X@orrespondence: 1lrike >hlert, .,
-
8/13/2019 Maternity Blue Final Thesis
59/70
CHAPTER-14
ANNEGURE
59
-
8/13/2019 Maternity Blue Final Thesis
60/70
ANNEGURE- I
INFORED CONSENT FOR
T'"!# , ")# "*
4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue
on maternity blues5
I%(#"';&",$ "nkita upta
9, ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ, freely and voluntarily agree to participate
in her research pro0ect.
P$+,# , "*
9 have been informed that this study is going to help me in maternity blues .
ela!ation techni/ue is an acceptable management to treat maternity blues and will
help the healthcare professionals to predict better treatment in future.
P$,#$#
9 understand that i will be treated with either 6acobson rela!ation techni/ue or
Mitchell#s rela!ation techni/ue. 9 also understand that this would be done under
the physiotherapist#s supervision. 9 am aware that 9 will have to follow therapist#s
instructions.
B#%#'"
This treatment will help to improve /uality of life, and will reduce depression. 9twould also help in detecting better choice of treatment for maternity blues.
60
-
8/13/2019 Maternity Blue Final Thesis
61/70
C,%'#%"'&!*
9 understand that the medical information produced by this study will be
confidential. 9f the data are used for publication in the medical literature or
teaching purpose, no names will be used and other literature such as photographs
or audio or visual tapes will be used only with permission.
R##" ,$ ,$# '%,$&"',%
9 understand that 9 am free to ask /uestions about the study at any time. The
therapist will be available to answer my /uestion. @opy of this consent form will
be given to me to keep for my careful reading.
R#&! ,$ >'")$&>&! , +&$"''+&"',%
9 understand that my participation is voluntary and 9 may refuse to withdraw
consent and discontinue participation at any time. 9 also understand that she may
terminate my participation in the study at any time after she has e!plained the
reason to doing so.
2ign of 9nvestigator 2ign. 3f +articipant
61
-
8/13/2019 Maternity Blue Final Thesis
62/70
ANNEGURE- II
CASE PRO-FORA=ASSESSENT CHART
T'"!#
4The effect of progressive rela!ation techni/ue Fs Mitchell#s rela!ation techni/ue
on maternity blues5
N&# , ")# ),!&$ : "nkita upta
@'# :
-
8/13/2019 Maternity Blue Final Thesis
63/70
T$#&"#%" )'",$*
F&'!* )'",$*
#%"$&! )'",$*
O:"#"$' )'",$*' &%*
P#$,%&! )'",$*
"ppetite: oodC+oorC9mpaired
Bowel: DormalC@onstipated
Micturition:
2leep: oodC
-
8/13/2019 Maternity Blue Final Thesis
64/70
S*"#' #
-
8/13/2019 Maternity Blue Final Thesis
65/70
ANNEGURE- III
H'%' "$&%!&"# E'%:$;) P,"%&"&! D#+$#',% S&!# EPDS)
ननन : ननन:
नननन नननन नननन :
ननननन नन नननन नननन : ननन ननननन :
नन नननन ननननन ननन नन ननननन न ननननन ननन नन नननन
ननननन नननन नन ?
1. नननन नन नननन नन ननननन नननन ननननन नन ननननन नननन
नननन नन ?
□ नननन नननन ननननन नननननन नन ननन
□ ननन नननन नननननन नननन
□ नननन नननननन नननन
□ नननननन नननन
2. नननन नन ननननन / ननननन ननन ननननन ननननन नननन ननन ?
□ ननननन नननन नननन नन
□ ननन ननन नननन नन नन
□ ननन, नननन नन नन
□ नननननन नन
3. नननन ननन ननन ननननन नन नननन नन ननननन ननन नननन नन
नन नननन नननन ननन ? *
□ ननन , नननन
□ ननन , ननन ननन
□ नननन नननननन नननन
□ नननन नननननन नननन
4. नननन नन नननन नननन नननननननन नननन नन ननननननन नननन नन
?
65
-
8/13/2019 Maternity Blue Final Thesis
66/70
□ नननन नननननन नननन
□ नननन नन ननन
□ ननन ननन ननन
□ ननन नननन नननननन
5. नननन नन नननन नननन नननननननन नननन नन नन नन नन ननननन
नननन नन ? *
□ ननन, नननन नननननन
□ ननन ननन ननन
□ नननन नननननन नननन
□ नननन नननननन नननन
6. नननन नननन ननननन नन नननन ननन न ननननन नन *
□ ननन, नननननननन ननन ननन ननन ननन नननननन ननन ननननन
नननन नन नननन
□ ननन, ननन ननन ननन ननन ननन नननननन ननन ननननन नननन
नन नननन
□ नननननननन ननन ननन ननन ननन नननननन ननन ननननन नननन
ननन
□ नननन नननन ननन ननन ननन नननननन ननन ननननन ननन
7. नननन नन नन ननन नन नननन ननन नन नननन नननन ननन
ननननननन नन ? *
□ ननन, नननन नननननन
□ ननन ननन ननन
□ नननन नननननन नननन
□ नननन नननननन नननन
8. नननन नन नननन नन नननन ननननन नननन ननन ? *
□ ननन, नननन नननननन
□ ननन ननन ननन
□
नननन नननननन नननन□ नननन नननननन नननन
9. नननन नन नननन नननन ननन नन नन नननन नननन ननन ? *
□ ननन, नननन नननननन
□ ननन ननन ननन
□ नननन नननननन नननन
66
-
8/13/2019 Maternity Blue Final Thesis
67/70
□ नननन नननननन नननन
10.नननन नननन नन ननन नननन नन नन ननन नननननननन नन
ननननन ननन नन ? *
□ ननन, नननन नननननन
□ ननन ननन ननन
□ नननन नननननन नननन
□ नननन नननननन नननन
SCORING
• QUESTIONS 1, 2, & 4 (without an *) are scored 0, 1, 2 or 3 with top boxscored as 0 and the bottom box scored as 3.
• QUESTIONS 3, 5-1 (!a"#$% with an *) are reverse scored, with the top boxscored as a 3 and the bottom box scored as 0.
• Maximum score: 30
• Possible Depression: 10 or greater
• lwa!s loo" at item 10 #suicidal thoughts$
ANNEGURE-IV
FEEDBAC FOR
67
-
8/13/2019 Maternity Blue Final Thesis
68/70
Sl.no Students Name Class Contact No Feedback & Remark Signature
68
-
8/13/2019 Maternity Blue Final Thesis
69/70
CHAPTER-15
ASTER CHART
ASTER CHART
Sl. No GROUP-A GROUP-B
69
-
8/13/2019 Maternity Blue Final Thesis
70/70
MRT-PRE
TREATMENT
MRT-POST
TREATMENT
JRT-PRE
TREATMENT
JRT-POST
TREATMENT
1 15 9 11 9
2 14 11 20 5
3 16 12 15 6
4 12 6 21 7
5 15 10 16 8
6 18 7 17 5
7 16 9 20 4
8 12 6 12 5
9 11 7 15 10
10 19 11 10 4
11 13 10 12 6
12 17 8 20 12
13 16 7 12 5
14 15 9 15 6
15 21 9 17 10
16 11 6 12 517 20 10 17 6
18 17 6 16 7
19 15 7 10 5
20 23 15 20 8
21 18 8 13 7
22 13 9 15 8
23 15 7 15 9
24 15 6 12 5
25 22 10 14 9
26 14 8 13 9
27 13 6 20 7
28 12 7 23 10
29 11 5 19 7
30 11 5 18 9
Total
Mea 15.33 8.20 15.66 7.100
S! 3.325 2.280 3.575 2.073
top related