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Effectiveness of Ambulation during First Stage of Labour, on the Outcome of Labour among Primigravid Women in Selected Hospitals of Palakkad District, Kerala
Abstract
Many women desire mobility during labour, which helps to enhance their physiological and psychological wellbeing. The purpose of the study was to determine the effectiveness of ambulation during first stage of labour, on the outcome of labour. Quasi experimental, post test only control group design was used in 60 samples. Statistical analysis of data revealed that ambulation during first stage of labour was effective in reducing duration of labour (t value = -2.27 and p value <0.05) also in bringing positive behavioural response (Mann-Whitney U test, p value< 0.05).
... Na sua maioria os estudos incluíram parturientes nulíparas17,18,19,20,21,22,23,24,25,27 , de baixo risco17,18,20,21,22,24,25,27 , com gravidez de termo18,20,21,22,23,24 e com feto único18,20,21,22,23,24,25 .Nos artigos analisados, as posições reclinadas/deitadas consideradas foram a posição supina17,23,24,25 , semi-reclinada na cama 17, 23, 25 e posição de decúbito lateral23,25 . No que respeita às posições verticais/mobilidade consideraram-se a posição de pé20,23,24,25,27 , sentada19,20,21,23,24,25,27 (cama, cadeira, bola de parto), ajoelhada20, 23, 24 , agachada 20, 23, 24, 25 , em quatro apoios 25 , a deambulação 17, 18, 19, 27 e o movimento de balanço pélvico 20, 21, 22 . ...
... Na sua maioria os estudos incluíram parturientes nulíparas17,18,19,20,21,22,23,24,25,27 , de baixo risco17,18,20,21,22,24,25,27 , com gravidez de termo18,20,21,22,23,24 e com feto único18,20,21,22,23,24,25 .Nos artigos analisados, as posições reclinadas/deitadas consideradas foram a posição supina17,23,24,25 , semi-reclinada na cama 17, 23, 25 e posição de decúbito lateral23,25 . No que respeita às posições verticais/mobilidade consideraram-se a posição de pé20,23,24,25,27 , sentada19,20,21,23,24,25,27 (cama, cadeira, bola de parto), ajoelhada20, 23, 24 , agachada 20, 23, 24, 25 , em quatro apoios 25 , a deambulação 17, 18, 19, 27 e o movimento de balanço pélvico 20, 21, 22 . ...
... Na sua maioria os estudos incluíram parturientes nulíparas17,18,19,20,21,22,23,24,25,27 , de baixo risco17,18,20,21,22,24,25,27 , com gravidez de termo18,20,21,22,23,24 e com feto único18,20,21,22,23,24,25 .Nos artigos analisados, as posições reclinadas/deitadas consideradas foram a posição supina17,23,24,25 , semi-reclinada na cama 17, 23, 25 e posição de decúbito lateral23,25 . No que respeita às posições verticais/mobilidade consideraram-se a posição de pé20,23,24,25,27 , sentada19,20,21,23,24,25,27 (cama, cadeira, bola de parto), ajoelhada20, 23, 24 , agachada 20, 23, 24, 25 , em quatro apoios 25 , a deambulação 17, 18, 19, 27 e o movimento de balanço pélvico 20, 21, 22 . ...
Enquadramento: O trabalho de parto é um processo inimitável, único e emocionante para a mulher que o experiencia. Vários organismos nacionais e internacionais recomendam a mobilidade e adoção de posturas verticais, como práticas benéficas na dinâmica do primeiro estádio do trabalho de parto. Objetivo: Identificar a evidencia científica sobre a influência da mobilidade e adoção de posturas verticais na duração do 1º estádio do trabalho de parto. Método: Realizou-se uma revisão integrativa da literatura, através da pesquisa em bases de dados bibliográficas online. Dois revisores independentes avaliaram a relevância dos artigos, a extração e síntese dos dados. Resultados: Da pesquisa (337 artigos) obtiveram-se doze artigos para análise, a qual demonstrou quase com unanimidade que a mobilidade materna e a adoção de posturas verticais durante o primeiro estádio do trabalho de parto encurtam a duração desse estádio. Conclusão: Apesar do consenso encontrado, a heterogeneidade dos estudos analisados quanto ao número de participantes e tipo de intervenções, requer atenção na interpretação dos resultados e aponta para a necessidade de mais estudos sobre a temática.
... More upright postures for labor and delivery have been documented than any other positions. 14 ...
... They should also repeat these five positions at 5-cm, 7-cm, and 10-cm of cervical dilatation. Based on a previous study, the participants in the intervention group will be recommended to walk for an hour several times a day on average depending on their tolerance and duration of labor (32). Eventually, the amount of mobility and type of positioning will be at the mother's discretion 8. ...
CITATION Abdolalipour S, Abbasalizadeh S, Mohammad-Alizadeh-Charandabi S, Abbasalizadeh F, Jahanfar S and Mirghafourvand M (2024) Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol. Background: According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO. Methods: This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination. Discussion: The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections. Clinical Trial Registration: https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).
... The mobility guideline was based on a former study [22] and advised each woman in the intervention group to walk for an average of one hour during labor, divided into smaller but frequent occasions, by her endurance. If the mother was uncomfortable with this protocol, she decided on her mobility and position during labor by herself. ...
Background
In 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes).
Methods
This study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' ‘intrapartum care model, or the control group, which received the’ ‘hospital’s routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear.
Results
The average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05).
Conclusion
The intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures.
... respectively; p = 0.002), maternal and neonatal outcome data not available in this study. 8 8) Prabakar et al 2015 Effectiveness of ambulation during the rst stage of labor-on-labor outcome. Quasi experimental posttest only 60 samples, duration of labor was effective (t value -2.27 and p value <0.05) brought positive behavioral response (Man -Whitney U test p value <0.05) nding are supported by systematic review which include 21 studies total 3706 women on mobility duration on rst stage. ...
This systematic review is the product of 10 top published journals. The search engines adopted in this study were PubMed, Medline, Cochrane Library, Google Scholar, and Research gate. The inclusion criteria were:1. Papers published between 2004-2020, 2. Top tier journal articles (High quality), 3. Term Mobility and rst stage of labor, duration of labor, Maternal and neonatal outcome. The present highlight is that the active phase of labor enhances the effect of gravity that helps the fetus to descend comfortably as there is adequate space to move downwards as the diameter of the pelvis expands to its maximum. The pressure on the nerve in the spine during labor is reduced and thus reducing and relieving pain. If the membranes are intact, the woman is allowed to walk about. This attitude prevents vena cava compression and encourages descent of the head. Ambulation can reduce the duration of labor, need for analgesia and improve maternal comfort. Mobilization improves frequency, strength and length of contractions, decreases the use of oxytocin to augment labor and improves oxygen supply to the fetus. It improves alignment of pelvic bones and the shape and capacity of pelvis, and optimizes the good t between fetus and pelvis. This paper shows the research gaps from different studies in the review of the literature. In this present study of systematic review, 10 recent multiple interventions based on RCTs and Non RCTs studies between 2004 to 2020 were systematically reviewed using the keywords search method. The ndings are discussed and research gaps are listed accordingly Systematic review on Mobility/Ambulation during the First Stage of Labor:
... If the membranes are intact and the women is allowed to walk about, this attitude prevents compression and encourages descend of head 4. Duration of the first stage is shortened in 25% and cephalic moulding is not increased, the incidence of forceps delivery diminished in the ambulant group. 5 When allowed the freedom to ambulate and change position during labor and birth, many women up to choose this as it has become a more effective form of pain relief. 6 A prospective study was conducted among antenatal mothers in France on ambulatory epidural anesthesia and duration of labor. ...
Introduction: The birthing women experiences, many demanding sensation and discomfort during labour and child birth. The childbearing women commonly tensed about childbirth and delivery. Ambulation during first stage of labour eases the process and it became a popular measure during this phase. Ambulation has also been found to increase foeto-maternal circulation which in turn increases the well-being of the new-born as well. Through the literature review, movement in labour to facilitates the progress of labour and enhance child birth satisfaction. This consciousness made the researcher to supply or issue the method of ambulation during the first stage of labour. With this aim, the study was conducted to assess the effectiveness of ambulation on maternal parameters in first stage of labor among the primi mother. Materials and Methods: A quasi experimental posttest only control group design was adopted to evaluate the efficacy of ambulation during first stage of labor on maternal parameters among primi mothers. Non probability purposive sampling technique was used to recruit 40 primi mothers who are in first stage of labor and were assigned into experimental group and control group. A structured questionnaire was used to collect the demographic variable; Numerical pain rating scale was used to assess the intensity of pain, Tool to assess the frequency and duration of uterine contraction, Stethoscope to assess the foetal heart rate and opinionnaire on ambulation was used to assess the maternal parameters. Tool was administered for 20 minutes at different time interval for experimental group only. Mothers in the control group underwent routine treatment. The data obtained was analyzed and interpreted using descriptive and inferential statistics. Results: The study findings showed that there is significant difference in the pain level in both groups. The mean and standard deviation in 2nd post intervention in experimental group is 3.35+0.48 and in control group 2.95+ 0.22. There was significant difference and comparison of cervical dilatation among both the groups. The mean and standard deviation in 2nd post intervention in experimental group is 2.20 +0.41 and in control group 2.10 + 0.30. The comparison of frequency of contraction among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 2.20 + 0.41 and in control group 2.10 + 0.00. The comparison of duration of contraction among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 2.05 + 0.68 and in control group 2.00 + 0.00 was statistically significant. The comparison of FHR among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 3.80 + 0.41 and in control group 3.75 + 0.63. There is no significant difference in control group. There was no significant association between the selected demographic variables with maternal parameters such as pain, cervical dilatation, frequency of contraction, duration of contraction in experimental and control group. There is a significant association between age and fetal heart rate in experimental group. Conclusion: The study concluded that the ambulation technique is effective to reduce the duration of labor in first stage among primi mothers. The mothers in the experimental group who were administered ambulation technique experienced reduction in the duration of labor.
Maternal positioning during labor affects many aspects of the anatomy
and physiology adaptations needed to influence all aspects of labor
including powers, passage, passenger and psyche. upright and mobile
positions , use gravity to aid descent of the fetal head into the pelvis, as
the head is applied directly and evenly on the cervix, uterine contractions
are intensied in strength, regularity and frequency, as effective
contractions are vital to aid cervical dilatation and fetal descent, they have
an important role in helping to reduce dystocia (slow progress in labor).
Background: Labor is a physiologic process and consideration of labor pain and relief that is among the major components of maternal care. Application of some labor positions can lay the fetus better in the pelvic canal direction. Aim of the study: to evaluate the pain intensity in the sitting position versus the walking position during the first stage of labor and investigate their effects on labor outcomes among primiparous women. Research design Quasi-experimental research design was utilized to fulfill the aim of this study. Setting: The study was carried out in the labor unit in the obstetric department at Mansoura University Hospital. Sample: Included 100 primiparous women in 1 st stage of labor were recruited in the study, they were divided into two equal groups; a sitting group (50) and a walking group (50) randomly selected through convenient sampling from those who were hospitalized in the previously selected setting with a gestational age of 37–42 weeks, singleton pregnancy, and with cephalic presentation. Tools: Structured Interviewing questionnaire sheet, Structured Observational Checklist including (Partograph and Apgar score), and Visual analogue pain intensity scale (VAS) were used.
EFFECTIVENESS OF AMBULATION DURING THE FIRST STAGE OF LABOR ON INTENSITY OF LABOUR PAIN AND DURATION OF FIRST STAGE OF LABOUR AMONG THE PRIMIGRAVIDA MOTHERS
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