teaching programme on water birth among adolescent girls

Teaching Programme on Water Birth among Adolescent Girls

Research Article

A study to assess the effectiveness of plannedteaching programme on water birth amongadolescent girls in a selected college at Mangalore

Darling Bibiana*, Jomy Cherian

Principal, Shree Devi College of Nursing, Maina Towers, Ballalbagh, Mangalore 575003, India

a r t i c l e i n f o

Article history:

Received 28 August 2012

Accepted 30 October 2013

Available online xxx

Keywords:

Effectiveness

Water birth

Planned teaching programme

Adolescent girls

a b s t r a c t

The experience of pain during labour is a complex, individual and multifaceted response to

sensory stimuli generated during childbirth. Despite the fact that labour is painful for most

women, a powerful myth of painless childbirth still prevails. Many alternative methods of

pain relief are available that are safe and inexpensive. One of them is water birth. Water

birth is the process of giving birth in a tub of warm water. The theory behind water birth is

that the baby has been in the amniotic sac for nine months and birthing into a similar

environment is gentler for the baby and less stressful for the mother. Adolescence is the

time to prepare for understanding great responsibilities, a time for exploration and

widening horizons, and a time to ensure healthy all round development. Puberty is also a

time of behavioural changes when the reproductive capacities get established. Midwives

are ‘with woman’, providing the family with supportive and helpful relationships as they

share the deep and profound experiences of childbirth. To become skilled helpers nursing

students need to develop reflective skills and valid midwifery knowledge grounded in their

personal experiences and practice.

Aim: The aim of the study was to assess the effectiveness of planned teaching programme

on water birth among adolescent girls in a selected college at Mangalore.

Method: An evaluative approach with quasi experimental, pre-test post-test design without

control group was used for the study. The data was collected from 60 adolescent girls using

simple random sampling technique. The study was conducted in selected college at

Mangalore.

Results: There was significant difference between per-test and post-test knowledge score

(t ¼ 44.23, p < 0.05). There was no association between the pre-test knowledge score and

selected variables.

Conclusion: All the subjects in the study group gained knowledge on water birth indicating

that planned teaching programme was an effective method for increasing knowledge.

Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.

* Corresponding author. Tel.: þ91 9886932378 (mobile); fax: þ91 0824 2451108.E-mail addresses: [email protected], [email protected] (D. Bibiana).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier .com/locate/apme

a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1e4

Please cite this article in press as: Bibiana D, Cherian J, A study to assess the effectiveness of planned teaching programme onwater birth among adolescent girls in a selected college at Mangalore, Apollo Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.10.011

0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2013.10.011

1. Introduction

Childbirth is a biological process which gives joy to the mother

and the family, and it is the culmination of a human pregnancy

or gestation period with the birth of one or more child from a

woman’s uterus. It is a crucial moment in a woman’s life. It

changes entire life of a woman. She becomes a mother e a

nurturer. Though theend result is rewardinge seeing the face of

her child, her flesh e the process is very exacting. Due to the

original sin,womankindwascursed togo through thispain.This

was the redemption for women. Today childbirth need not be a

painful process, where a woman has to undergo unendurable

pain.1

Birth is a normal, healthy part of a woman’s life. The

amount of pain a woman experiences during her labour is

influenced by many individual, physical, emotional, and

environmental factors. Some of these factors can be antici-

pated and actively controlled by the woman and/or her sup-

port teamwith preparation and information. Relaxation skills

and accurate knowledge about the birth process give awoman

confidence in her ability to work with her body.1,2

Alternative approaches to childbirth aremore popular than

ever. Water, acupuncture and acupressure, and hypnosis are

some of the ways expectant mothers are coping with labour

pain. Underwater delivery or simply ‘water birth’ is becoming

increasingly popular worldwide. Water birth is a safe method

for painless delivery, which takes place in a pool or a tub filled

with warm water. Water being a cooling agent helps the

mother to relax physically and mentally. Water birth is a safe

method for painless delivery, which takes place in a pool or a

tub filled with warm water. Water being a cooling agent helps

the mother to relax physically and mentally.3

“Water birth has psychological benefits for the foetus. It

reduces ‘birth trauma’ in the child”. When a child enters the

world, it finds itself in a completely different environment and

setting. The change from a protective fluid-filled sac to a dry,

airy environment can trigger shock or trauma in the child.

And as in an underwater delivery the shift is from fluid to

fluid, the baby does not experience any trauma. Rather, a

water baby adapts to the environment better.4

A descriptive study was conducted in Tanzania among 135

adolescent girls to assess knowledge of pregnancy and child-

birth. The study finding revealed that only 33% of girls could

correctly identify the age at which a woman can conceive.

Regarding the duration of pregnancy, 77.3% could answer the

correct nine months. None of them have known about alter-

native birthing method. Knowledge about childbirth and other

related aspects were unknown to the adolescent girls. The

researcher concluded that poor knowledge of childbirth among

adolescence is related to lack of effective and coordinate in-

terventions to address reproductive health and motherhood

and theymust provide with appropriate information regarding

childbirth through innovative school based programme.5

A comparative study was conducted in Switzerland among

5953 to assess the safety of alternative birthmethods in general

and of water births. The results shows that 2014 spontaneous

births were water births, 1108 were Maia-birthing stool births

and 2362 were bed births. Results revealed that an episiotomy

wasperformed inonly12.8%of thebirths inwater. Themothers’

blood loss is the lowest in water births. Fewer painkillers are

used in water births and the experience of birth itself is more

satisfying after a birth inwater. The average arterial blood pHof

the umbilical cord as well as the Apgar scoring at 5 and 10 min

were significantly higher after water births. The researchers

concluded that water births and other alternative forms of

birthing such as Maia-birthing stool do not demonstrate higher

birth risks for themother or the child than bed births.6

An evaluative study was conducted in London among 189

mothers about the responses to water birth who had experi-

enced water birth. The results showed that water birth is a

consumer-led trend,mainly pursued by educatedmiddle class

women. The researcher concluded that better antenatal

preparation is needed to reduce the need for other forms of

analgesia when women are in water. Women’s responses to

the survey suggested that mothers perceived water birth as

therapeutic. Mothers demonstrated a strong desire for water

in labour. There were no significant behaviour differences

between water-born babies and non-water-born babies.7

Study findings revealed that the most commonly used

complimentary therapy was water birth and the decision

making regarding this was made with the help of midwives.8

Episiotomy needed for the water birth is very low.9 Water

birth is to beconsidereda safemethod for ahealthymother and

a healthy full-term foetus with cephalic presentation.10 Water

birth in India is alsogainingpopularity. In India it is emergingas

a promising alternative to painful traditional delivery.11

Midwives are ‘with woman’, providing the family with

supportive and helpful relationships as they share the deep

and profound experiences of childbirth. To become skilled

helpers nursing students need to develop reflective skills and

valid midwifery knowledge grounded in their personal expe-

riences and practice. Midwife educators and practitioners can

assist nursing students and enhance their learning by

expanding the scope of practice, encouraging self-assessment

and the development of reflective and professional skills.

Nursing students have high expectations for gaining skills

and knowledge to prepare them to enter professional practice.

Through the experiences of learning and applying doula skills

to their professional nursing practice, new graduates will be

better prepared to enter the real world of nursing practice.

Objectives of the study were to:

� Determine the existing knowledge score of adolescents

regarding water birth using a structured knowledge

questionnaire.

� Find the effectiveness of planned teaching programme on

water birth among adolescents.

� Find the association between pre-test knowledge score and

selected demographic variables

The conceptual frame work adopted for this study was

based on general system theory by Ludwig Von Bertalanffy.

2. Materials and methods

An evaluative approach with quasi experimental, pre-test

post-test design without control group was adopted for the



study. Sixty adolescent girls from Shree Devi College of

Nursing, Mangalore were selected using simple random

sampling technique. Sample size was determined based on

the pilot study finding. The instrument used was a self-

administered knowledge questionnaire prepared by the

investigator. It consists of total 26 items related to knowledge

regarding water birth. There were two sections. Section A

consists of three items assessing the knowledge related to

female reproductive system. Section B consists of twenty

three items assessing the knowledge related to basic concepts

of water birth.

The knowledge score were classified based on the score

obtained as poor (�40%), moderate (41e60%), good (61e80%)

and very good (81e100%). The prepared tool was validated by

seven experts. Reliability of structured knowledge question-

naire was assessed by split half method and the ‘r’ value was

r ¼ 0.89 and the tool was found reliable.

A systematically developed planned teaching programme

was designed to provide information on water birth with a

view to improve their knowledge on water birth, which in-

cludes criteria, preparation, benefits, risks, and labour care.

Pilot study was conducted among six subjects by using

random sampling technique. The subjects for pilot study

possessed the same characters that of the samples for final

study. It was found that the study was feasible, the ques-

tionnaire and PTP were relevant and time and cost of the

study was within the limit. Prior permission was obtained

from the concerned authority of the college. Data was

collected after informed consent of the sample. Pre-test was

conducted followed by the teaching programme. After seven

days a post-test was conducted using the same questionnaire

to evaluate the effectiveness of planned teaching programme.

3. Results

Descriptive and inferential statistics were used to analyse the

data. For the present study the significant findings were most

of them (61.1%) were in the age group of 20 years, about 88.3%

adolescent girls belonged to nuclear family. The highest per-

centage (46.6%) of the girls belonged to family income group of

Rs. 8001e10,001 and above and 48.3% of the girls received

health information from mass media (Table 1).

The total mean percentage of pre-test knowledge score

was 44.6% with mean � SD of 13.4 � 4.01 and the mean post-

test knowledge score was 89.3% with mean � SD was

23.22 � 1.20 showing an effectiveness of 44.5% with

mean � SD 11.57 � 1.73. Significance of difference between

pre-test and post-test was statistically tested by using paired

‘t’ test. The significance difference suggesting that the PTPwas

effective in increasing the knowledge of the adolescent girls

t(59) ¼ 44.23, p < 0.05. There was no association between pre-

test knowledge score and demographic variables.

4. Discussion

In pre-test it has been found that majority (70%) of the

adolescent girls had average knowledge. The mean post-

test knowledge score (23.22 � 1.20) was higher than the

pre-test knowledge score (11.57 � 1.73) which revealed that

gain in knowledge on water birth, by reducing the poor

knowledge category and increasing the excellent category.

The significance difference suggesting that the PTP was

effective in increasing the knowledge of the adolescent girls

t(59) ¼ 44.23, p < 0.05. It is evident that PTP was effective in

improving the knowledge of adolescent girls regarding

water birth. The finding of this study is consistent with the

study conducted among 50 adolescent girls in the age group

of 16e18 years on effectiveness of PTP on normal vaginal

delivery in a selected rural area, Udupi. Findings revealed

that the mean differences between the post-test and pre-

test knowledge score of adolescent girls on normal vaginal

delivery found to be significant t ¼ 16.20, (p < 0.05). This

suggested that the PTP was effective in improving knowl-

edge of adolescent girls.12

5. Implications

Planned teaching programme also helps the future nurses

to practice the alternative birth method and to guide their

patients to the appropriate treatment centres. Nursing stu-

dents as future nurses and midwives have a role in pre-

paring their clients for childbirth through proper guidance

and education. Planned teaching programme also helps the

future nurses to practice the alternative birth method and to

guide their patients to the appropriate treatment centres.

Nursing students as future nurses and midwives have a role

in preparing their clients for childbirth through proper

guidance and education.

Nurse administrator plays a vital role in the supervision

and management of nursing profession. The nursing admin-

istrator can plan and conduct education programmes which

are beneficial to nursing faculty, staff nurses and students.

There are only very few studies conducted on water birth.

More innovative teaching methods like reproductive health

issues package can be implemented and its effectiveness can

be evaluated.

Limitations of the study were that the sample size was

small so the generalization of the finding is limited.

Table 1 e Frequency and percentage distribution ofsamples according to their demographic variables.

Demographic variables Frequency Percentage

Age

a) 19 yrs 18 30

b) 20 yrs 37 61.67

c) 21 yrs 5 8.33

Type of family

a) Nuclear 53 88.3

b) Joint 7 11.7

Family monthly income

a) Rs. 5001e8000/- 15 25.0

b) Rs. 8001e10,000/- 28 46.7

c) More than 10,001/- 17 28.3

Source of information

a) Mass media 29 48.3

b) Parents/relatives/friends 8 13.3

c) No information 23 38.3

a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1e4 3


6. Conclusion

The study supports the concept that planned teaching pro-

gramme for adolescent girls are an effective strategy to

improve knowledge on water birth. Water birth is an option

chosen by some women for pain relief during labour and

childbirth, and studies have reported that water birth in an

uncomplicated delivery helps to reduce the need for anal-

gesia, without evidence of increased risk to mother or

newborn. Hot water tubs are available in many hospitals and

birthing centres. It is the belief of midwives, birthing centres

and a growing number of obstetricians, that reducing the

stress during labour and delivery also reduces foetal

complications.

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Negi N. Water birth for safe, less painful child delivery. [online].Available from URL: http://www.lifestyle.merinews.com.

2. What the research says about water birth. [online]. Availablefrom: http://www.babycentre.co.u.k/midwives/.com.

3. Alternative methods of birth. [online]. Available from URL:http://www.first_time_pregnancy.com.

4. Nath T. Water birth in India gaining popularity one world southAsia. [online]. Available from URL: http://southasia.oneworld.net/OWSAinfo/functionalarea.com.

5. Mushil Declare L. Knowledge about safe motherhood amongschool pupils in a rural area in Tanzania. BMC PregnancyChildbirth. 2007;7:5.

6. Geissbuehler V, Stein S, Eberhard J. Water births comparedwith land births. J Perinatal Med. 2004;32(4):308e314.

7. Richmond H. Women’s experience of water birth. PractMidwife. 2003 Mar;6(3):26e31.

8. Munstedta K, Sehrtotera C, Bruggmanna, Tinniberg RH,Georgib VR. Use of alternative therapies and birthing methodsin departments of obstetrics in Germany. Available from URL:http://www.ncbi.nlm.nih.gov/pubme; 2009 April 16.

9. Meyer SL, Weible CM, Woeber K. Perceptions and practice ofwater birth: a survey of Georgia midwives. J Midwifery WomensHealth. 2010;55(1):55e59. JaneFeb.

10. Water Birth. American Pregnancy Association. Available fromURL: http:/www.americanpregnancy.org/labornbirth/waterbirth.html.

11. Da Silva FM, de Oliveira SM, Nobre MR. A randomisedcontrolled trial evaluating the effect of immersion bath onlabour pain.Midwifery. 2009 Jun;25(3):286e294. Pub 2007 Jul 25.

12. Thomas Sara. Effectiveness of PTP on Normal Vaginal Delivery ina Selected Rural Area in Udupi. unpublished MSc thesis.Bangalore: RGUHS; 2008.



Apollo hospitals: http://www.apollohospitals.com/Twitter: https://twitter.com/HospitalsApolloYoutube: http://www.youtube.com/apollohospitalsindiaFacebook: http://www.facebook.com/TheApolloHospitalsSlideshare: http://www.slideshare.net/Apollo_HospitalsLinkedin: http://www.linkedin.com/company/apollo-hospitalsBlog:Blog: http://www.letstalkhealth.in/

teaching programme on water birth among adolescent girls

Health & Medicine

water birth iskeywords

birth process

tub of warm water

mother e

selected college

e d i c i n e x x x

labour pain

woman experiences