RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. Name of the candidate and address Mrs. SAVITHA V

(in block letters) FIRST YEAR M Sc NURSING
NITTE USHA INSTITUTE OF
NURSING SCIENCES, PANEER ,
DERALAKATTE, MANGALORE-
574160, KARNATAKA, INDIA
2. Name of the Institution NITTE USHA INSTITUTE OF NURSING
SCIENCES, COLLEGE OF NURSING
PANEER, DERALAKATTE,
MANGALORE-574160,
KARNATAKA, INDIA

3. Course of the study and subject FIRST YEAR M Sc NURSING

OBSTETRICS AND GYNAECOLOGY
NURSING

4. Date of admission 14th JUNE 2008

5. Title of the topic:

EFFECT OF AMBULATION DURING FIRST STAGE OF LABOR ON LABOR PAIN
AND OUTCOME OF LABOR AMONG THE PRIMIGRAVIDA MOTHERS IN A
SELECTED HOSPITAL, MANGALORE

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6. BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the study
Ambulation during labor is becoming more popular. Walking during labor reduces
patients' discomfort and improve outcomes. Although it provides the birthing woman with
the freedom to walk, move about, and assume the positions of her choice during labor and
birth (unless restriction is specifically required to correct a complication).
Freedom of movement in labor appears to facilitate the progress of labor and enhance
childbirth satisfaction through restricting women's movement may have adverse effects.
No evidence of harm found for freedom to ambulate, move about, or change position
during labor and birth when restriction is not required to correct a complication.
Ambulation, movement, and changes of position during the first stage of labor may
shorten labor. Women who ambulated during the first stage of labor were less likely to
have a surgical delivery, defined as caesarean section. When allowed the freedom to
ambulate, move, and change position during labor, most women choose to do so and find
this to be an effective form of pain relief. Women who choose to ambulate during first
stage of labor had shorter first and second stages of labor, required less pain relief
medication, and had fewer abnormal fetal heart rate patterns2.
Women who assumed to be in a nonsupine position during first stage of labor had
fewer perineal injuries, less vulvar edema, and less blood loss. If the membranes are
intact, the patient is allowed to walk about. This attitude prevents venacaval compression
and encourages descent of the head. Ambulation can reduce the duration of labor, need for
analgesia and improves maternal comfort.
The investigator through her clinical experience and observations noted that, in most
of the hospitals where mothers are admitted for labor they use to be in bed even from the
time of onset of pain. And in few hospitals they may be practicing this without knowing
its exact benefit. Through the literature review on freedom of movement in labor appears
to facilitate the progress of labor and enhance childbirth satisfaction. This awareness made
the researcher to provide the method of Ambulation during the first stage of labor on the
Intensity Of Labor Pain and the Outcome of Labor among the Intranatal mothers.
6.2 Review of literature
A faster labor, fewer instrumental and operative deliveries and better maternal and
infant outcomes are some of the allayed advantages to having parturient walking

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early and often. Ambulation during first stage of labor decreases 2 hours from the
total duration of labor, decrease requests in analgesia, lower rates for instrumental
deliveries, increased Apgar score. Patients reported greater satisfaction of entire
laboring experience when being allowed to walk, even if that ambulation is of
short duration (Ex: walking across room to toilet).1
Freedom to walk, freedom to movement in labor appears to facilitate the progress
of labor and enhance childbirth satisfaction. restricting womens movement may
have adverse effects. Lithotomy position raises levels of maternal stress hormones,
thereby reduces uterine contractility and labor progress.
Ambulation, movement and changes of position during the first stage of labor
shortens the labor. Women who are ambulated during the first stage of labor were
less likely to have a surgical delivery, defined as caesarean section, forceps or
vaccum extraction. Women who assumed a non-spupine position for birth had
shorter second stage of labor, required less pain relief medication, had less perineal
injuries, less vulvar edema and less blood loss and few abnormal fetal heart rate
patterns.2
Actively promoting and encouraging women to mobilize during childbirth is a
safe, effective way of providing optimum care to healthy women, it is a cost-
effective way of reducing complications. Evidences for mobilization improves
frequency, strength and length of contractions, a reduction in the use of oxytocin to
augment labor with an average, shorter labours, improves oxygen supply to the
baby/few abnormal heart patterns. It improves alignment of pelvic bones and the
shape and capacity of pelvis, and optimizes a chance for the good fit between baby
and pelvis.3
Studies carried out on ambulation, mobility and position during labor agrees that
mobility during labor improves both the womens experience and the outcome of
labor (Deakin 2001, Downe et al 2001, Flynn et al 1978, Read et al 1981). In their
studies, Flynn et al (1978) and Read et al found the following advantages on
ambulation:- There is a more effective uterine action, shorter labor, less oxytocin
augmentation, reduced need for pharmacological analgesia. It is also documented
that recumbent positions results in supine hypotension, diminished uterine activity
and a reduction in the dimensions of the pelvic outlet (Walsh 2000); De Jong et
al(1997) states that women who take up an erect position during labor experience
less pain, have significantly less perinial injuiry and have fewer episiotomies.4
Ambulation (walking) about during labor reflexly intensifies the uterine

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 contractions. It has been shown that in ambulant patients the duration is shorter,
the need for analgesia is less, and the incidence of abnormalities of the fetal heart
lower than in recumbent women. The patient should be free to walk about and rest
in any position that is comfortable to her. She is encouraged not to lie straight on
her back as it may cause venacaval compression.5
If the membranes are intact, the patient is allowed to walk about. This attitude
prevents venacaval compression and encourages descent of the head. Ambulation
can reduce the duration of labor, need of analgesia and improves maternal comfort.
If however, labor is monitored electronically or analgesic drug (epidural analgesia)
given, she should be in bed. 6

6.3 PROBLEM STATEMENT

EFFECT OF AMBULATION DURING FIRST STAGE OF LABOR ON LABOR
PAIN AND OUTCOME OF LABOR AMONG THE PRIMIGRAVIDA MOTHERS IN A
SELECTED HOSPITAL, MANGALORE

6.4 Objectives of the study

To compare the effectiveness of Ambulation on the Intensity Of Pain among the
control and experimental group
To compare the effectiveness of Ambulation on the Outcome Of Labor among
the control and experimental group in terms of:
i. Maternal outcome and
ii. Neonatal outcome
To assess the usefulness of Ambulation by Opinionnaire
To find an association on the effectiveness of Ambulation on the Intensity of
Pain and Outcome of Labor with selected demographic variables
6.5 Operational definitions
Effect: In this study, the effect refers to the extent to which the Ambulation has its impact
on the ability of Labor Pain tolerance, Shortening the Duration of Labor and on the
Outcome of labor among the primigravida mothers in first stage of labor as measured by
Visual analogue Scale, Opinionnaire and Observational Checklist.
Ambulation: In this study, Ambulation refers to walking about or the act of travelling by
foot. Mother will be ambulated when there will be no powerful uterine contractions
during the first stage of labor and till the rupture of membrane
First stage of labor: First stage of labor is considered to last from regular uterine

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contractions to full dilatation of cervix. In this study, First stage of labor refers to active
phase where the cervix is 3cms to 7cms dilated or till the rupture of membranes
Labor pain: In this study, Labor pain means a discomfort arising from labor process and
which is interpreted as 0-3 mild pain, 4-6 moderate pain and 7-10 severe pain. Pain
intensity will be measured by using Visual Analogue Scale
Outcome of labor: In this study, Outcome of Labor refers to maternal and neonatal
outcome in terms of Duration of Labor, Mode of Delivery, Neonatal Apgars score.
Primigravid women: Primigravid women refers to women who are pregnant for the first
time and who are in 36weeks to 40weeks of gestation with no complications of labor such
as high risk pregnancy, high risk intranatal mothers, mothers with elective caesarean
section.
Opinionnaire: In this study, Opinionnaire refers to the opinions of Primigravid women
regarding the benefits of Ambulation on Labor pain and Outcome of Labor
6.6 Assumptions
This study assumes that,
a. The Intensity of Labor Pain, Outcome of Labor experiences varies from
women to women
b. Ambulation helps the expectant mother to cope with Labor Pain and
Shortening the duration of labor
c. Mother develops a positive attitude towards Ambulation
6.7 Delimitation
The study is limited to Primigravida mothers,
Who are in 36weeks to 40weeks of gestation in First stage of labor
Who are willing to participate in Ambulation
Primigravida mothers
Mothers with oxytocin infusion
Who are not with risk of pregnancy

6.8 Projected outcome (Hypothesis)

To achieve the stated objective following hypothesis has been developed will be
tested at 5% level of significance
H1: There will be a significant difference in the Intensity of Labor pain between the
control group and experimental group
H2: There will be a significant difference in the Outcome labor between control

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 group and experimental group
H3: There will be a positive significant association between Ambulation and
Opinionnaire in the experimental group

MATERIAL AND METHOD

7.1 SOURCE OF DATA
Primigravida mothers who are in the first stage (active phase ) of labor
7. 7.1.1 Research design
2 group experimental design which consists of control and experimental group
7.1.2 Setting
This study will be conducted in a selected hospital, Mangalore
7.1.3 Population
The study population consists of Primigravida mothers between 36-40weeks of
gestational age in the active First stage of labor

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling procedure
For this study systemic randomization sampling is considered as appropriate
7.2.2 Sampling size
Study sample consists of 40 Primigravida mothers between 36-40weeks of gestational
age in which 20 in each control and experimental group in the First stage (active phase) of
labor
7.2.3 Inclusive Criteria
The inclusion criteria for sampling are:
i. Normal Primigravida mothers in the active First stage of labor
ii. Mothers who are willing to participate and expecting normal labor
iii. Primi mothers admitted in the hospital without rupture of membrane.
iv. Primi mothers between 36-40weeks of gestational age with live fetus
v. Mothers with oxytocin infusion
7.2.5 Exclusive criteria
i. Mothers who are not willing to participate
ii. High risk intranatal mothers
iii. Multigravida mothers
iv. Mothers with elective caesarean section
v. Mothers with premature rupture of membrane
7.2.5 Instrument used

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 i. Demographic proforma
ii. Structured Observational Checklist for measuring individual experiences on
the outcome of labor
iii. Structured Observational Checklist for measuring the intensity of labor pain
by using Visual Analogue Scale
iv. Structured Opinionnaire on the usefulness of ambulation
7.2.6 Data collection method
To conduct the study a formal written permission need to be obtained from the
concerned authority. Individual informed consent will be taken from the subject after
explaining objectives, purpose and method of data collection prior to the study.
Purposive sampling method will be used to select 40 Primigravida mothers for the
study. Systematic random sampling will be used to select 20 subjects in both experimental
and control group.
The structured interview schedule for demographic data, for measuring the individual
differences is used. The mothers will be Ambulated when there will be no powerful
uterine contractions during the First stage of labor before the rupture of membrane among
the experimental group. The time and the distance of ambulation will be taken. The
structured Visual Analogue Scale is used to measure the Intensity of Pain. The structured
Observational Checklist is used to measure the Outcome of Labor to compare between the
control and experimental group. The structured Opinionnaire is used to measure the
usefulness of Ambulation among the experimental group. At the end data collection
respondent will be thanked for co-operation.

7.2.7 Data analysis plan

The data will be analysed in terms of objectives using both descriptive and
inferential statistics which will be as follows
i. To compare the effectiveness of Ambulation on the Intensity of Labor Pain
among experimental and control group Independent Sample t tset is used
ii. To compare the effectiveness of Ambulation on the Outcome of Labor
among experimental and control group Independent Sample t test is used
iii. The data of Opinionnaire on usefulness of Ambulation is analysed by
descriptive statistics (frequency, percentage diagrams)
7.3 Does the study require any investigation or intervention to be conducted on
patients or other humans or animals? If so please describe briefly

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 Yes, this study requires the intervention of Ambulation during the First stage of Labor
on the Intensity of Labor Pain, Outcome of Labor and to assess the usefullness of
Ambulation through Opinnionaire to conform whether it can be adopted or not among the
Primigravida mothers.
7.4 Has the ethical clearance been obtained from your institution in case of 7.3
Yes, the ethical clearance has obtained.
7.5 References
Online sources
1. Avoiding common Analgesia errors. Available from :URL
http://books.google.co.in/books?id=EHmlQ6ie3ZEC&pg=P+labor&source
2. Provides the Birthing Woman With Freedom of Movement to Walk, Move,
Assume Positions of Her Choice Available from :URL
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2409125
Text books
3. Chapman Vicky, The midwifes labor and birth handbook, first published 2003,
first Indian reprint 2004, Blackwell publisher,page no: 25,27,28
4. Fraser.M.Daine, Cooper.A.Margaret, Myles textbook of midviwes. 14th edition
2003; Chirchill Livingstone publisher, page no:472
5. Daftary N Shirish, Chakravarthi sudip, Manual of Obstetrics, 2nd edition; Elsevier
publisher, published in 2003, page no: 290
6. Dutta D C, Text book of Obstetrics, 6th edition; Central publisher, page no:135

8 Signature of Candidate

9 Remarks of the guide

10 Name and Designation of PROF. SABITHA NAYAK

(in block letters) HOD OF OBSTETRICS AND
10.1 Guide GYNAECOLOGY NURSING
NUINS, PANEER,
DERALAKATTE,
MANGALORE

10.2 Signature

10.3 Co-Guide (if any) MRS SHYNEE PAUL

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 ASSOCIATE PROFESSOR
DEPT OF OBSTETRICS AND
GYNAECOLOGY NURSING
NUINS, PANEER,
DERALAKATTE,
MANGALORE

10.4 Signature

11 11.1 Head of Department PROF. SABITHA NAYAK

HOD OF OBSTETRICS AND
GYNAECOLOGY NURSING
NUINS, PANEER,
DERALAKATTE,
MANGALORE
11.2 Signature

12 12.1 Remarks of the Chairman and Principal

12.1 Signature