A COMPARATIVE STUDY ON EFFECT OF AMBULATION AND BIRTHING BALL ON MATERNAL AND NEWBORN OUTCOME AMONG PRIMIGRAVIDA MOTHERS IN SELECTED HOSPITALS IN MANGALORE

Abstract

The study was conducted to assess the effect of ambulation and birthing ball on the maternal and newborn outcome from 01.08.2011 to 31.10.2011. This randomized control study was conducted on 60 primigravida mothers. Purposive sampling technique was used for the selection of samples followed by random allocation of 20 samples each to the three groups namely, ambulation, birthing ball and control group respectively using lottery method. Ambulation and birthing ball therapy were given to the respective samples between cervical dilatation of 1-3cm during first stage of labour, whereas the control group was not given any intervention. Here maternal outcome includes1st stage duration (Area1), 2nd stage duration (Area2), cervical dilatation rate (Area3), and type of delivery(Area4) and newborn outcome includes heart rate, respiratory rate, colour, reflex and muscle tone. Since the t calculated value in Area 1 (5.257), Area 2 (2.781), Area 3(5.438) is greater than t table value (2.042) and in Area 4, 75% of ambulation group underwent normal vaginal delivery, it shows that there is significant improvement in maternal outcome after the use of ambulation. The t calculated value in Area 1(7.223), Area 2 (5.556), Area 3(6.178) is greater than t table value (2.030) and in Area 4, 95% of birthing ball group underwent normal vaginal delivery. It shows that there is significant improvement in maternal outcome after the use of birthing ball therapy. Comparison of ambulation and birthing ball therapy on maternal outcome showed that, there is significant difference in second stage duration (t tab 2.031(df=36)< t cal 2.231= S) and type of delivery. In this study ambulation and birthing ball were found to be effective to improve maternal outcome and there was no harm to the baby. Both the experimental group mothers expressed that they were satisfied and comfortable.

Full text

A COMPARATIVE STUDY ON EFFECT OF AMBULATION AND
BIRTHING BALL ON MATERNAL AND NEWBORN OUTCOME
AMONG PRIMIGRAVIDA MOTHERS IN SELECTED HOSPITALS IN
MANGALORE
1 2
Albin Mathew , Sabitha Nayak
1 2 3 Statitician,
Nitte University, Mangalore - 575 018, India
Correspondence :
Sabitha Nayak,
Nitte Usha Institute of Nursing Sciences, Nitte University, Mangalore - 575 018, India
Abstract :
The study was conducted to assess the effect of ambulation and birthing ball on the maternal and newborn outcome from 01.08.2011 to
31.10.2011. This randomized control study was conducted on 60 primigravida mothers. Purposive sampling technique was used for the
selection of samples followed by random allocation of 20 samples each to the three groups namely, ambulation, birthing ball and control
group respectively using lottery method. Ambulation and birthing ball therapy were given to the respective samples between cervical
dilatation of 1-3cm during first stage of labour, whereas the control group was not given any intervention. Here maternal outcome
st nd
includes1 stage duration (Area1), 2 stage duration (Area2), cervical dilatation rate (Area3), and type of delivery(Area4) and newborn
outcome includes heart rate, respiratory rate, colour, reflex and muscle tone. Since the t calculated value in Area 1 (5.257), Area 2
(2.781), Area 3(5.438) is greater than t table value (2.042) and in Area 4, 75% of ambulation group underwent normal vaginal delivery, it
shows that there is significant improvement in maternal outcome after the use of ambulation. The t calculated value in Area 1(7.223),
Area 2 (5.556), Area 3(6.178) is greater than t table value (2.030) and in Area 4, 95% of birthing ball group underwent normal vaginal
delivery. It shows that there is significant improvement in maternal outcome after the use of birthing ball therapy. Comparison of
ambulation and birthing ball therapy on maternal outcome showed that, there is significant difference in second stage duration (t tab
2.031(df=36)< t cal 2.231= S) and type of delivery. In this study ambulation and birthing ball were found to be effective to improve
maternal outcome and there was no harm to the baby. Both the experimental group mothers expressed that they were satisfied and
comfortable.
Keywords : Ambulation, Birthing ball, Maternal outcome, Newborn outcome.
3
& Vandana K.
nd.
2 year M.Sc. Nursing student, Vice-Principal, Nitte Usha Institute of Nursing Sciences,
Original Article
Introduction :
Pregnancy is a unique, exciting and often joyous time in a
woman's life, as it highlights the amazing creative and
nurturing powers while providing a bridge to the future.
Pregnancy and birth are tremendously powerful stages of
development that bring a woman to motherhood, a
couple, to family and a beautiful child into the world.
Labour process may be viewed as a test of womanhood, a
test of personal competence, a peak of experience, and the
first act of motherhood. Labour process starts with the
onset of regular uterine activity associated with
effacement and dilatation of the cervix and descent of the
(1).
presenting part through the cervix
Discomfort is one of the biggest obstacles of labour and
delivery. Pregnant women don't want to experience the
fierce labour that has been in store for them. So they
demand for healthier labour, with less discomfort. Women
in the developing countries with meagre health facilities
usually lie in bed during the first stage of labour. Lying on
the back (supine) puts the weight of the pregnant uterus on
abdominal blood vessels and contractions may be less
strong than when upright. Effective contractions help
(1).
cervical dilatation and the descent of the baby
Being upright will make contractions stronger and more
efficient. It will allow gravity to keep the baby's head
pressed down, which will help the cervix to dilate faster so
(2)
that labour is speeded up. Birthing ball helps the mother
to be in an upright position and also it opens pelvis,
encouraging baby to move down. Changing positions
during labour can change the shape and size of the pelvis,
2
Nitte University Journal of Health Science
NUJHS Vol. 2, No.2, June 2012 ISSN 2249-7110 ,
A COMPARATIVE STUDY - Albin Mathew
Published online: 2020-03-02

which can help the baby's head move to the optimal
position during first stage labour, and helps the baby with
rotation and descent during the second stage. Swaying
motions such as walking, climbing stairs, and swaying back
(3)
and forth are especially helpful with this.
In the first stage of labour, the cervix will dilate to 10 cms in
diameter. In mothers having their first child, this stage
usually lasts 12 to 16 hours. Discomfort can often be helped
by body positions that allow gravity to speed dilation, such
as walking, squatting, kneeling forward on a chair or sitting
on the birthing ball. This will help the baby move down in
(4)
the pelvis faster and less painfully.
A pilot study conducted at two Canadian hospitals where
women in labour were randomly assigned to a regular
labour room or to an “ambient room.” In the ambient
room, the standard hospital labour bed was removed, and
additional equipment was added to promote relaxation,
mobility, and a calm atmosphere. The evaluations from
women assigned to the ambient room were positive; they
spent 50% or less time labouring in bed and reduced the
(5)
need for artificial oxytocic infusions.
Birthing ball helps to shorten the first stage of labour. As
one sits on the ball, they should move the hips in a circular
motion. This allows the baby's head to press against the
(6)
cervix, which promotes dilation.
A randomised and quasi-randomised trial review was
conducted to determine the effect of encouraging women
to assume different upright positions (including walking,
sitting, standing and kneeling) versus recumbent positions
(supine, semi-recumbent and lateral) in the first stage of
labour on 3706 women. Result of this review revealed that
the first stage of labour was approximately one hour
shorter for women randomised to upright as opposed to
recumbent positions (MD -0.99, 95% CI -1.60 to -0.39).
Women randomised to upright positions were less likely to
have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).
Walking and upright positions in the first stage of labour
reduce the length of labour and do not have any negative
(7)
effects on mothers and babies wellbeing.
Research evidences have shown that ambulation and
birthing ball tend to reduce the duration of first stage of
labour. Thus the investigator felt the need to utilise this
finding in her setting so as to reduce discomfort and
duration during the first stage of labour.
Methods :
The study design adopted was a randomized control trial
approach with post test control group design. Population
comprised of primigravida mothers in the first stage of
labour in selected hospitals at Mangalore. Purposive
sampling technique was used for selection of samples 60
samples, and random allocation of the samples using
lottery method, was done to assign 20 samples to the
ambulation, birthing ball and control groups.
Ambulation and birthing ball therapy were given to the
respective samples in ambulation and birthing ball group in
between cervical dilatation 1-3 cms, whereas the control
group was not given any intervention. Then maternal and
newborn outcome was analysed by cervicograph, and
Apgar score respectively. Here maternal outcome
st nd
includes1 stage duration (Area1), 2 stage duration
(Area2), cervical dilatation rate (Area3), and type of
delivery (Area4) and newborn outcome includes heart rate,
respiratory rate, colour, reflex and muscle tone. Data
obtained in these areas were analysed by independent t-
test expect in Area 4 which was analysed by frequency
percentage.
Results :
Main findings are discussed under the following headings
1. EFFECT OF AMBULATION ON MATERNAL OUTCOME
Since the t calculated value in Area 1( 5.257), Area 2
(2.781), Area 3(5.438) is greater than t table value
(2.042)at 0.05 level of significance (p<0.05) (Table 1) and
in Area 4, 75% of ambulation group underwent normal
vaginal delivery(Table 2), it shows that there is
significant improvement in maternal outcome after the
use of ambulation.
3
Nitte University Journal of Health Science
NUJHS Vol. 2, No.2, June 2012 ISSN 2249-7110 ,
A COMPARATIVE STUDY - Albin Mathew

Groups n mean t-value SD df LOS
st
(Area 1: 1 stage duration)
Ambulation 18 531 5.257 108.10950 32 0.000
group P<0.05
Control group 16 763 148.18591 HS
nd
(Area 2: 2 stage duration)
Ambulation 18 32.7222 2.781 15.32321 32 0.009
group P<0.05
Control group 16 49.9375 16.58300 HS
Area 3: cervical dilation rate)
Ambulation 18 0.0196 5.438 0.003712 32 0.000
group P<0.05
Control group 16 0.0135 0.002683 HS
t (32)=2.042 HS= Highly significant
tab
Groups n mean t-value SD df LOS
st
(Area 1: 1 stage duration)
Birthing ball group 20 471 92.97849 0.000
7.223 34 P<0.05
Control group 16 763 148.18591 HS
nd
(Area 2: 2 stage duration)
Birthing ball group 20 23.9000 8.40363 0.000
5.556 34 P<0.05
Control group 16 49.8125 18.67697 HS
Area 3: cervical dilation rate)
Birthing ball group 20 0.02230 6.178 0.005048 34 0.000
Control group P<0.05
HS
16 0.01363 0.002729
t (34)=2.030 HS= Highly significant
tab
Table1:
Table2: (Area 4: type of delivery)
Ambulation group Control group
Type of delivery Frequency Percentage Frequency
Normal vaginal delivery 15 75% 13
LSCS
Instrumental delivery 2 10% 4
3 15% 3
2. EFFECT OF BIRTHING BALL ON MATERNAL OUTCOME
The t calculated value in Area 1(7.223), Area 2 (5.556),
Area 3(6.178) is greater than t table value (2.030) at 0.05
level of significance (p<0.05)(Table 3) and in Area4, 95%
of birthing ball group underwent normal vaginal
delivery(Table 4). It shows that there is significant
improvement in maternal outcome after the use of
birthing ball therapy.
Table 3:
Table 4: (Area 4: type of delivery)
Ambulation group Control group
Type of delivery Frequency Percentage Frequency
Normal vaginal delivery 19 95% 13
LSCS
Instrumental delivery 0 0 4
1 5% 3
Ambulation group Control group
Type of delivery Frequency Percentage Frequency
Normal vaginal delivery 19 75% 19
LSCS 2 10% 0
Instrumental delivery 3 15% 1
3. COMPARING THE SIGNIFICANT DIFFERENCE OF
AMBULATION AND BIRTHING BALL ON MATERNAL
OUTCOME
Comparison of ambulation and birthing ball therapy on
maternal outcome showed that, there is significant
difference in second stage duration (t tab(36)< t cal = S) ,
(Table 5) and type of delivery(Table 6) whereas no
significant difference in first stage duration (t tab(32)> t
cal = NS) and cervical dilatation rate (t tab(36)> t cal =
NS).
There were no significant improvement found on newborn
outcome after the use of ambulation and birthing ball
therapy and also no significant association was found
between maternal and newborn outcome and the selected
demographic variables.
nd
v Table5: (Area 2: 2 stage duration)
Groups n mean t-value SD df LOS
Ambulation 18 32.7222 2.231 15.32321 36 .032
group P<0.05
Birthing ball group 20 23.9000 8.40363 S
v t (36)=2.030 S= Significant
tab
Table1:
Table 6: (Area 4: type of delivery)
Ambulation group
4. DESCRIPTION OF THE PARTICIPANTS OPINION ON THE
USEFULNESS OF AMBULATION AND BIRTHING BALL
THERAPY
ãIn ambulation group, 100% mothers were
comfortable while walking whereas in birthing ball
group only 95% were comfortable.
ã95% mothers were satisfied with ambulation and
birthing ball respectively.
4
Nitte University Journal of Health Science
NUJHS Vol. 2, No.2, June 2012 ISSN 2249-7110 ,
A COMPARATIVE STUDY - Albin Mathew

ã
mothers from birthing ball group, would like to
recommend its use to others.
ãWith regard to family support 65% from ambulation
group & 55% from birthing ball group felt the need of
family members.
Discussion :
The effect of ambulation was supported by the findings in a
similar study which was conducted in which two hundred
mothers were randomly assigned to one of two groups:
first group (100 parturients) authorized to ambulate and
second group (100 parturients) confined to bed in dorsal or
lateral recumbence. The results of the study showed that
ambulation reduces (for about 34%) the duration of the
(7)
first stage of labour significantly (P<0.0001).
In another study conducted in two hundred and twenty-
one women with uncomplicated pregnancies, were
randomly divided into two groups, ambulatory and non-
ambulatory. The result of the study showed that there was
significant difference in labour duration (2.89+/-1.83hr vs.
3.94+/-2.17hr ; P=0.001).This study concluded that walking
(9)
shortens the labour duration.
The effect of birthing ball was supported by the findings in a
study which was conducted on effects of birth ball exercise
85% of mothers from ambulation group and 95% of on pain and self-efficacy during childbirth. Results revealed
that birth ball exercises provided statistically significant
improvements in childbirth self-efficacy and pain. And also
mothers in the experimental group had shorter first-stage
labour duration, less epidural analgesia, and fewer
(10)
caesarean deliveries than the control group.
In another study conducted on effect of birthing ball in
reduction of labour pain among primigravida mothers it
was noticed that birthing ball had an effect on reducing the
duration of labour even though it was not statistically
proved. No adverse effect on maternal or fetal wellbeing
was observed as evidenced by normal FHR and maternal
physiological responses like increased rate of cervical
(11)
dilatation and reduction in the duration of labour.
Conclusion :
Labour being the end of the long expectation of pregnancy,
marks the beginning of the extrauterine life of the new
born. To mark a good beginning, the process and
experience of labour should not be a misery for the mother.
reduces the duration of labour.
There are a variety of discomforts that a woman will
experience during labour. Reducing these discomforts is an
important part of good nursing care. Non- pharmacologic
methods like walking and birthing ball helps to decrease
these discomforts as it
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Nitte University Journal of Health Science
NUJHS Vol. 2, No.2, June 2012 ISSN 2249-7110 ,
A COMPARATIVE STUDY - Albin Mathew