RAJIV GANDHI UNIVERSITY OF HEALTH SC IENCES

KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Mrs. MAYA NAIR

FIRST YEAR MSc NURSINGOBG NURSING

2011 – 2013

MANASA COLLEGE OF NURSING,MALLUR

Karnataka.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

Mrs. MAYA NAIR

2 NAME OF THE INSTITUTION MANASA COLLEGE OF NURSING,

MALLUR, KARNATAKA

3 COURSE OF THE STUDY AND

SUBJECT

I YEAR M. Sc. NURSING

OBSTETRICS AND

GYNECOLOGICAL NURSING

4 DATE OF ADMISSION TO THE

COURSE

5 TITLE OF THE STUDY

“AN EXPLORATORY STUDY TO DETERMINE THE LEVEL OF

SATISFACTION AMONG FIRST PARITY POSTNATAL MOTHER

REGARDING POSTNATAL CARE AT SELECTED MATERNITY

HOSPITALS AT BANGALORE”

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Postpartum period is the period of adjustment after child birth when anatomical and

physiological changes of consumption are reversed to an almost pre pregnancy

level. The postpartum period starts about an hour after the delivery of the placenta

and includes the following six weeks. Care during post natal period involves the

care of both the mother and her newborn after delivery. Post natal care emphasize

the importance of support for new mother in the post natal period in caring of their

infants. Thus, better post natal care influences the maternal confidence in infant care

practices especially during first 6 weeks.1

Midwifery care is strengthened through the world; even then there is a rise of

maternal morbidity mortality rate, because the mothers did not come forward to

obtain the care.7 Minor symptoms are very common in pregnancy as well as during

post partum period affecting both the mother and her newborn. The symptoms

should be properly assessed in case they represent more serious health problems in

the postnatal period.2

Postnatal care covers the core care that every healthy woman and healthy baby

should be offered during the first 6-8 weeks after the birth. Although for most

women and babies the postnatal period is uncomplicated, care during this period

needs to address any deviation from expected recovery after birth.3

An important part of maternity service provision is the care provided by midwives

in the immediate postpartum period. Evidence suggests that postpartum morbidity

and its impact on women's health after childbirth is an area of genuine concern.3

Every year, four million infants die within their first month of life, representing

nearly 40 percent of all deaths of children under age 5. Almost all newborn deaths

are in developing countries, with the highest number in South Asia and the highest

rates in sub-Saharan Africa. Most newborn deaths occur at home, regardless of

whether delivery was in the home or in a health care facility, and regardless of

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whether a skilled attendant was present at birth. More than half a million women die

each year as a result of complications from pregnancy and childbirth. Most of these

deaths occur in sub-Saharan Africa and South Asia. More than 60 million women

deliver at home each year without the benefit of skilled care. As with newborn

deaths, nearly all maternal deaths occur in developing countries. Both mothers and

their newborns are vulnerable during the postnatal period, especially during the first

24 hours following the birth.4

Several studies in both high and low income countries have identified the

importance of the postpartum period for acute short-term, long-term, and chronic

morbidity. Moreover, up to two thirds of maternal deaths occur after delivery .

Therefore, the World Health Organization suggests that health care should be

provided at 6 hours, 6 days, 6 weeks, and 6 months post delivery, in order to ensure

women's physical and mental health and well-being. Despite this recommendation,

seven out of ten women do not receive any postpartum care, based on Demographic

and Health Surveys conducted in 30 low income countries between 1999 and 2004 .

Low utilization of postnatal care has been related to women's lack of knowledge

about its importance, their lack of perceived need (especially if they are feeling

well), their low level of education, poverty, lack of access to health care facilities

that provide postnatal care, lack of appointments or recommendations from health

care providers to obtain postnatal care, poor attitudes of the health care providers, or

women's tendency to give priority to the health needs of their infants rather than

their own.5

6.1 NEED FOR THE STUDY

The postnatal period – defined here as the first six weeks after birth – is critical to

the health and survival of a mother and her newborn. The most vulnerable time for

both is during the hours and days after birth. Lack of care in this time period may

result in death or disability as well as missed opportunities to promote healthy

behaviours, affecting women, newborns, and children.6

Over the past decade a number of studies have identified women's dissatisfaction

with postnatal care. In particular, women report high levels of dissatisfaction with

hospital-based postnatal care including: lack of rest; lack of consistent advice; the 4

perception that midwives are too busy; inadequate time available to ask questions;

inappropriate or non-individualised advice; too much information provided in a

short period; and the short and fragmented nature of midwifery care. On discharge

from hospital, women have reported: that they lack confidence, particularly for

breastfeeding; are unprepared for physical or psychosocial problems they may

encounter; and have little follow-up or community support. While several studies

have investigated models of continuity of midwifery care and community-based

postnatal care, few have investigated strategies to improve the environment of the

postnatal unit and the way postnatal care is provided by midwives in hospital.7

,

Evaluation of effectiveness of health care services provided from mother’s point of

view from the her level of satisfaction with post natal care would help in improving

the quality of post natal care, nursing performances as well as improving nursing

practices and education. Hence the investigator felt to take up the study.

6.2 REVIEW OF LITERATURE

A Review of literature is a body of text that aims to review the critical points of

current knowledge and methodological approaches on a particular topic, the role of

the literature review is to formulate and clarify the research problems, to ascertain

what is already known in relation to problem of interest, for developing a broad

conceptual context, facilitate cumulating scientific knowledge for interpreting the

result of the study8.

The review of literature is classified under following subheadings:-

1) Review of Literature related to post natal care among first parity post

natal mothers.

2) Review of Literature related to level of satisfaction among first parity

post natal mothers regarding post natal care.

Review of Literature related to post natal care among first parity post natal

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mothers.

A recent study in the West Bank – Palestine found maternal mortality ratios of 29.2

and 36.5 per 100,000 live births for the years 2000 and 2001, respectively. Of the 36

maternal deaths that were recorded, 20 (55%) occurred during the postpartum

period. In Palestine (West Bank and Gaza), studies conducted between 2003 and

2005 reported that only 23 to 34% of women received postpartum care.9

Although the vast majority of women in Palestine (West Bank and Gaza) delivers in

hospitals or health institutions such as private doctor clinics or maternity homes, the

average postpartum stay in hospitals is only 24 hours. As a result, women need to

obtain postnatal care in community health clinics. Several studies have assessed the

receipt of postnatal care in Palestine , however, none of these studies have reported

factors associated with its non-use.9

Government policy has highlighted the provision of a postnatal service that responds

to women's physical, psychological, emotional and social needs. This paper presents

the results of a small in-depth qualitative study that aimed to explore the views of

first-time mothers with regard to the level of support they would have liked to

receive from health visitors during the postnatal period, focusing on the theme of

health visitor contact. Homogenous sampling was used to identify seven first-time

mothers. Data was collected from semi-structured interviews and analysed using a

thematic network approach. Four organising themes were identified--health visitor

contact, emotional adjustment to motherhood, infant feeding and other support.

Although the first-time mothers valued the postnatal support provided by the health

visitor highly, there were varying levels of satisfaction with the frequency and

pattern of health visitor contacts. The findings also raise issues about the perception

of need and the value of home visiting during the postnatal period.10

A cross-sectional survey was conducted at three clinics run by the Ministry of

Health providing Mother and Child Health Care in West Bank, Palestine. A total of

264 postpartum women attending the clinics were interviewed face-to-face, using a

structured questionnaire. Although the majority of women considered postnatal care

necessary (66.1%), only 36.6% of women obtained postnatal care. The most

frequent reason for not obtaining postnatal care was that women did not feel sick

and therefore did not need postnatal care (85%), followed by not having been told

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by their doctor to come back for postnatal care (15.5%). Based on a multivariable

analysis, use of postnatal care was higher among women who had experienced

problems during their delivery, had a cesarean section, or had an instrumental

vaginal delivery than among women who had a spontaneous vaginal delivery. Use

of postnatal care was also higher among women who delivered in a private hospital

as compared to those who delivered in a public hospital. In addition, we found

regional differences. The higher use of postnatal care among high-risk women is

appropriate, but some clinically dangerous conditions can also occur in low-risk

women. Future efforts should therefore focus on providing postnatal care to a larger

number of low-risk women.11

All women who gave birth in September/October 2007 in South Australia and

Victoria were mailed questionnaires six months following the birth. Women were

asked about whether they received a midwifery home visit in the first week and to

respond to a series of statements about what were the best and the worst things

about the care they received from the midwife who visited them. They were also

asked to rate the care they received from the midwife. Of 2446 women in public

maternity care, 80% reported receiving a midwifery visit in the first week at home.

However, there were differences between the two states, with 88% in South

Australia reporting they received a visit compared to 76% in Victoria. On average

women received 1.7 visits (range 1–14). Sixty-three percent rated the care they

received from the visiting midwife as ‘very good’. ‘Reassurance that the baby was

okay’ and ‘the midwife was friendly and helpful’ received the highest number of

responses to the question what were the best things about care. Although a majority

of women rated domiciliary highly, more post natal care than a third rated their care

as less than ‘very good’, suggesting that some aspects of care could be improved.12

Review of Literature related to level of satisfaction among first parity post

natal mothers regarding post natal care.

A cross-sectional, self report survey was used to describe the practical, emotional

and informational support provided by midwives in the initial postpartum period. A

questionnaire, specially designed for this population, was posted at 8 weeks

postpartum to every woman with a registered live birth in WA. Completed

questionnaires were received from 2699 women. Data were analysed using

descriptive statistics, t-tests and chi-squared. Results indicate that overall, women

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were happy with most aspects of midwifery care related to practical advice and

assistance in relation to baby care and their immediate physical recovery. Areas that

received a less positive rating were related to providing consistent advice,

availability of the midwife, emotional care and information on maternal health

needs, immunisation and contraception. In general, first time mothers rated both the

style and quality of care more negatively than multiparous women. There was a

trend by women accessing private hospital care to rank their care less favourably.

There were minimal differences noted between women in metropolitan and non-

metropolitan areas. Midwifery care at home was rated very positively and

significantly better than hospital care (p ≤ 0.002). Although the majority of women

in this study were satisfied with the components of physical and information care

and assistance with infant feeding and sleep and settling provided in the short-term,

there was less satisfaction with emotional care and preparation for life at home with

a new baby.13

Another exploratory study was conducted to predict women's satisfaction with

postpartum nursing centers, which have become popular in Taiwan in recent years.

After completing a consent form and demographic questionnaire, 401 women from

different centers identified by proportional stratified quota sampling completed four

questionnaires over the telephone after their fourth week postpartum. A high level of

social support and low level of postpartum stress significantly predicted their

satisfaction with the postpartum nursing centers.14

A study was conducted to assess new parents’ satisfaction with postnatal care and to

estimate the proportion of fathers who were given the option of spending the night at

the postnatal ward. A questionnaire was mailed to new parents 6 months after the

birth of their child in a Swedish hospital. The main outcome was overall satisfaction

with postnatal care. 294 new mothers and 280 new fathers completed the

questionnaire. 34% of the mothers were dissatisfied with the overall postnatal care.

The strongest associated factors for new mothers’ dissatisfaction were: unfriendly

and unhelpful staff (RR 10.3; 3.2–32), lack of support from staff (RR 6.4; 2.3–17.5),

new fathers not permitted to stay overnight (RR 5.2; 1.8–14.5), dissatisfaction with

postnatal checks of the woman herself (RR 2.6; 1.1–6.3) and dissatisfaction with

practical breast-feeding support (RR 1.6; 1.2–2.1). Sixty-three percent of the fathers

were given the option of spending the night at the postnatal ward. The fathers who

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chose not to spend the night on the ward were older, had other children and were

dissatisfied that they were not allowed to play a greater role in the care of their

newborn baby.15

Another study was undertaken To describe the level of satisfaction of women who

come to the University Hospital of Albacete (CHUA), as regards the health

carereceived upon admission for giving birth and during the immediate postnatal

period, and to evaluate if the socio-demographic variable has an influence on user

satisfaction of the delivery room service. Descriptive and cross-sectional study

carried out through an interview in order to obtain data on the socio-demographic,

obstetric and gynaecological variables, together with a satisfaction questionnaire for

women in the puerperium period at the CHUA, reference hospital of the Health Area

in Albacete, in the Obstetrics Service. The selection was made by systematic

sampling. It is found that 92.1% (164) of Spanish-born women carry out a proper

integral control of pregnancy, compared to 63.4% (109) of immigrants

(χ(2)=42.172; gl=1; P=.000). The majority (87.5%, 287) of the total number of

satisfied women thought that the midwife interest was better or much better than

they expected (χ(2)=102.466; gl=4; P=.000). The large majority of satisfied women

(95.81%, 320) would recommend the hospital, while the number of unsatisfied

women had doubts (χ(2)=93.680; gl=2; P=.000). The socio-demographic variables

did not appear to have an influence on the overall satisfaction of the women, except

for the age. In general, both the autochthonous and immigrant women were satisfied

with the attention received in the CHUA Delivery room.16

6.3 STATEMENT OF PROBLEM

“An exploratory study to determine the level of satisfaction among first

parity postnatal mother regarding postnatal care at selected maternity

hospitals at Bangalore”

6.4 OBJECTIVES OF THE STUDY

1) To assess the level of satisfaction of first parity post natal mothers with

post natal care.

2) To determine the association regarding the level of satisfaction of first

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parity post natal mothers with post natal care with their selected

demographic variables.

6.5 OPERATIONAL DEFINITIONS

Level of satisfaction : It refers to the level of appreciation by the first parity post

natal mothers admitted in selected maternity hospital to receive post natal care.

First parity post natal mothers : It refers to the mothers who has delivered for the

first time both normally and by caesarean section.

Post natal care : It refers to the systematic examination, care and appropriate

advices given to the mother during post partum period.

6.6 ASSUMPTIONS

The study assumes that.

First parity post natal mothers may have Inadequate knowledge and poor level of

satisfaction regarding the post natal care.

6.7 HYPOTHESIS

NH1 : There is no significant change in level of satisfaction among first parity

mothers regarding postnatal care.

NH2 : There is no significant association regarding level of satisfaction among first

parity mothers with their selected demographic variables.

6.8 DELIMITATIONS

This study is delimited to:

The mothers who has delivered for the first time only.

MATERIALS AND METHODS OF THE STUDY7.1 SOURCES OF DATA

Data will be collected from the first parity post natal mothers who are receiving post

natal care in selected maternity hospitals in Bangalore.7.1.1 RESEARCH DESIGN

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7.

Non experimental descriptive study design.

7.1.2 RESEARCH APPROACH

Explorative research approach.

7.1.3 STUDY SETTING

The study will be conducted at selected maternity hospitals in Bangalore.

7.1.4 VARIABLES OF THE STUDY

i. STUDY VARIABLE

Level of satisfaction of post natal care among first parity post natal mothers in

selected maternity hospitals.

ii. DEMOGRAPHIC VARIABLES

Age, educational status, dietary pattern and socio economical status. occupation,

income of primigravida mothers.

7.1.5 POPULATION

The Population will be first parity post natal mothers receiving post natal care in the

maternity hospitals.

7.2 METHOD OF DATA COLLECTION

Data will be collected by structure interview schedule.

7.2.1 SAMPLING TECHNIQUE

The sample for the study will be convenient sampling technique.7.2.2 SAMPLE SIZE

Sample size of the study is 60 first parity post natal mothers.

7.2.3 INCLUSION CRITERIA

1. Mothers who have delivered normally for the first time.

2. Mothers who are willing to participate in the study.

7.2.4 EXCLUSION CRITERIA

1. Mothers who have delivered by caesarean section.

2. Mother who are not available at the time data collection.

3. Mothers with medical and gynaecological complications.

7.2.5 INSTRUMENTS USED

Part I:

It includes demographic data of the first parity post natal mother such as Age, 11

educational status, dietary pattern and socio economical status, occupation and

family income.

Part II: Interview schedule

It includes Interview schedule for the assessment of level of satisfaction of post

natal care given to the first parity post natal mothers.

Part III:

7.2.6 DATA COLLECTION METHOD

1) Permission will be obtained by the concerned authority2) Purpose of conducting the study will be explained to the subjects.3) Informed consent will be obtained from subjects4) Data would be collected using interview method

7.2.7 METHOD OF DATA ANALYSIS AND INTERPRETATION

Data collected on level of satisfaction regarding post natal care among first parity

post natal mothers and its statistical effects will be analyzed to answer the objectives

through following statistical techniques.

i) Frequency and percentage to describe the demographic characteristics

of first parity post natal mothers being studied under research.

ii) Mean standard deviation and mean score percent will be used to assess

the knowledge and level of satisfaction for post natal care among first

farity post natal mothers.

iii) Chi-Square test will be used to find out the association between the level

of satisfaction and selected demographic variables.

7.2.8 DURATION OF THE STUDY:- 4-6 weeks

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN ANIMALS?

-NO-, Data include only verbal response, no intervention is carried out.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUION IN CASE OF 7.3?

-YES- Ethical clearance will be obtained from the ethical committee of the

institution.

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Weibrecht JM: Postpartum depression assessments at well-baby visits:

screening feasibility, prevalence, and risk factors. J Womens Health

(Larchmt ) 2005, 14:929-935

2) Fikree FF, Ali T, Durocher JM, Rahbar MH: Health service utilization for

perceived postpartum morbidity among poor women living in Karachi.

3) Soc Sci Med 2004, 59:681-694. PubMed   Abstract | Publisher   Full   Text

4) Clinical guidelines, CG37- Issued: July 2006

5) John N.K.mbilu. Essentials of obstructs and Gynecology for clinical officers

and midwifes; 1

6) Web publication date: 3 Aug 2010 (based on February 2010 search)Last

updated: Jan 16, 2009

7) http://women-300711.html

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evaluation of the risks and benefits Sept 2009 Pharmacy In81-84

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methods .5th edition.Lipping Cott Publication;2000. p:57.

10) Bailey S. Wiltshire Primary Care Trust. sarah.bailey@suht.swest.nhs.uk

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2012 Feb 23.

12) http://www.scribd.com/doc/48848043/post partal nursing care

13) Desai S, Sep 28, 2010, 03.05am IST Tags: India makes progress on reducing

maternal mortality rate.

14) Journal List > West J Med > v.173(1); Jul 2000ht

15) Hung CH, Yu CY, Liu CF, Stocker J. School of Nursing, Kaohsiung

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Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung City 80708,

Taiwan.2010 Wiley Periodicals, Inc.

16) http:// (www.clinicalevidence.com).Web publication date: 3 Aug 2010

(based on February 2010 search)Last updated: Jan 16, 2009

17) Servicio de Obstetricia, Hospital General de Almansa, Albacete, España.

BMC Pregnancy Childbirth. 2010 Oct 27;10:70.

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