Effect of video on Breathing Exercises during labour on Pain

Perception and Duration of Labour Among Primigravida Mothers

Kirandeep Kaur, Avinash Kaur Rana, Shalini Gainder
Abstract : Childbirth is a painful process. Various complementary methods are used to relieve pain. Quasi
experimental study was conducted to assess the effect of video on breathing exercises during labour on pain
perception and duration of labour among the primigravida mothers admitted in tertiary care hospital, India.
Forty mothers, purposely selected, were randomly allocated 20 each into experimental and control group. The
experimental group participants were shown a video on 'breathing exercises during labour', before onset of
labour and performance of exercises during labour was assessed through the checklist. The pain score during
first stage of labour was recorded as per numeric pain rating scale. Duration of first and second stage of labour
was measured by developed tool. The assessment of pain perception at the latent, early and late active phases
of first stage of labour showed statistical significant difference among experimental and control group (p<0.01).
Statistical significant difference(p<0.01) was also observed in the duration of first stage of labour with mean
duration(8 hours 48 minutes) in experimental group as compared to control group (9 hours 48 minutes). The
mean duration of second stage of labour was also significantly less (p<0.01) i.e. 24 minutes in experimental
group as compared to 32 minutes in control group. The study concluded that the practice of breathing
exercises during labour help to reduce pain perception & duration of first and second stage of labour.

Key words:
Pain perception, Duration of labour, Video

Correspondance at
Dr. Kirandeep Kaur
Add. Professor, Depar tment of Obstetrics
and Gynecology, PGIMER, Chandigarh.
Email address: deepkirangill@gmail.com

Introduction
Labour pain is a complex, personal,
subjective, multi-factorial phenomenon which
is influenced by psychological, biological,
socio-cultural and economic factors. Although
labour is often thought of as one of the most
painful events in human experience, it ranges
widely from woman to woman and even from
pregnancy to pregnancy. First-time mothers
are more likely to give their pain a higher rating
than woman whove had babies before.1,2
The unique aspect of childbirth is the
association of this physiologic process with

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

pain and discomfort. However, the experience

of pain during laboiur is not a simple reflection
of the physiologic processes of parturition.
Instead, labour pain is the result of a complex
and subjective interaction of multiple
physiologic and psychological factors on a
womans individual interpretation of labour
stimuli. An understanding of labour pain in a
multidimensional framework provides the
basis for a woman-centered approach to
labour pain management that includes a broad
range of pharmacologic and nonpharmacologic intervention strategies.3
Mother can soothe herself with
attention-focusing devices such as relaxation,
slowed breathing and music; and can supply
herself with calming sights to look at and
special companions to comfort her. Perhaps
mother choose to concentrate on so-called
left-brain (rational) activities-counting to
herself, pacing or patterning her breathing,
focusing on a particular picture, or listening
to her par tner count time on a watch.
Practicing lots of strategies and being flexible
about changing strategies midstream can help
her get through the painful contractions and
prevent her from tensing up in anticipation
of future pain.4,5
Nonpharmacologic
pain-relief
techniques were used on laboring women to
assess which was most effective technique.
Of the ten nonpharmacological strategies
rated by the forty six mothers, breathing
techniques were repor ted as the most
effective pain relieving technique used during
labor, followed by relaxation, acupressure, and
massage. The results provide directions for

childbir th educators in designing and

implementing an effective childbirth education
curriculum that assists women to have
empowered birth experiences.6,7
The antenatal women require education
in preparation for childbirth and pain reduction
strategies. The first time mothers out of
unawareness, fear, anxiety results in an
uncooperative attitude and a stressful
childbirth experience. So need was felt to
teach mothers an alternative therapy to cope
with labour. Among various methods of
teaching like still pictures, booklets, flip books,
models, posters, motion picture had an
advantage above all. Learning through video
have a long lasting impression as it compels
and holds the attention of the viewer. The
individual watching the video imitates the
behaviour and try to be competent in
performing it. This is based on principle of
learning by doing which is congruent with the
Chinese proverb 'what I hear I forget, what I
see I remember, what I do I know'.
Films are inevitable as practically the
best teaching method. They show settings and
situations that no amount of discussion can
convey. Video, as an educational intervention,
is useful because the technology provides
multi-media multi-sensory information about
complex behavior. A computer search of the
electronic databases of Medline and CINHAL
between 1990 and 1999 by Krouse in 2008
reviewed 18 research studies involving video
modelling which identified three major uses
i.e. assisting decision making regarding
treatment options, reducing pre-procedural
anxiety and improving coping skills and

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

teaching self-care practices.7 So the concept

assessing the impact of video, on 'breathing
exercises during labour', on pain perception
and duration of labour among primigravida
mothers an alternative therapy to cope with
labour was channelized.
Objective
To assess the effect of video on
breathing exercises during labour on pain
perception and duration of labour among
primigravida mothers.
Materials and Methods
The study was carried out in labour
room of Nehru hospital, PGIMER, Chandigarh.
The study protocol was a video film of Hindi
version (duration- 10 minutes) which was
developed with the storyline on breathing
exercises during first stage of labour (slow
breathing, fast breathing, pant-pant blow) and
for second stage of labour (breathing
exercises during childbirth). The video was
developed in two phases. First phase was
preliminary preparation which included review
of literature, generation of pool of data,
preparation of preliminary video. In the second
phase content and face validity of the video
was assessed by showing the video among
the panelist and then feasibility of using the
video was checked through pilot study and
the necessary modifications were introduced
into the video. The video was again shown to
the panelist for validation and the video was
finalized.
The other tools included in the study
were sociodemographic per forma,
observation checklist for assessing the

practice of breathing exercises by the mothers

in experimental group, modified 1-10 numeric
pain rating scale, assessment proforma for
duration of labour. The tools in the study were
prepared based on extensive review of
literature and researcher's clinical experience.
Validation was obtained by the experts in the
field of nursing, public health, community
medicine, obstetrics and gynecology. Forty
primigravida mothers who were admitted in
labour room in the month of October and
November were selected by purposive
sampling technique. Those mothers who were
willing to participate in the study and had
minimal qualification up to matric were
enrolled in the study. Mothers with respiratory
diseases such as asthma, tuberculosis
abdominal/ uterine surgery were excluded
from the study. Randomization was done by
lottery method into experimental and control
group.
The study proposal was approved by
the Ethical Committee of PGIMER, Chandigarh
and the Head of Department of Obstetrics and
Gynecology. Socio-demographic profile of the
subjects in both the groups were filled. The
subjects in the experimental group were
shown the 'video film' prior to the onset of
labour and re-demonstrations of the breathing
exercises were obtained whereas control
group received no inter vention. The
performance of the exercises was rated on
the 'observation checklist during the labour.
Then pain perception at the latent phase, early
active phase and late active phase was
verbalized by the mothers in both the groups
on 'modified numeric pain rating scale'. The

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

duration of first and second stage of labour subjects were in the age range of 20-27 years
was noted on the assessment performa for with the mean age 23.82.1 years. Among
duration of labour. The data was analyzed with the subjects of both groups, 65 % of subjects
the help of SPSS Program. The various in the age group of 23-26 years. Taking in
consideration qualification, 50% of the subjects
statistical measures such as measures of in control group and 45 % in experimental
central tendency, measures of dispersion, group were undergraduates and equal
percentage, parametric tests i.e. unpaired t test proportion were graduate and above in former
and non-parametric tests i.e. chi square test in comparison to 55% in the latter. For
occupation more than half were not working
were used to interpret the results.
in both the groups. The maximum mothers
Results
had less than 2 years of married life in both
Socio Demographic profile of the the groups with the range in experimental
subjects in experimental and Control group was 10 months to 3 years with Mean
1.04 0.76 years, and the years of married
Groups:
life of control group ranges between 10
It is evident from table 1 that the months and 3 and half years with mean
subjects in experimental group were in the age 1.010.7 years. Both the groups were found
range of 19-28 years with the mean age to be homogeneous in nature as per chi
24.32.1 years whereas control group square test (p>0.05).
Table 1: Socio Demographic Data
Variable
Experimental
Control GROUP X 2
GROUP(n=20)n (%)

(n=20)n (%)

P value

05(25)
13(65)
02(10)

06(30)
13(65)
01(5)

2.297
2
0.317NS

9(45)

10(50)

11(55)

10(50)

0.159
2
0.924NS

Occupation
Not working
Workinng

12(60)
08(40)

11(55)
9(45)

0.688
3
0.876NS

Years of married life

<2 years
>2 years

16(80)
4(20)

17(85)
3(15)

0.035
1
0.852NS

Age in years*
19-22
23-26
27-30
Qualification
Under graduation
Graduation
and above

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Obstetrical data in experimental and control

groups
Table 2 describes the subjects with respect
to Period of Gestation and Obstetrical or
Medical problem. Mean POG of Experimental
group was 37.81.2 weeks with range of 35
weeks 3 days to 40 weeks whereas Mean
POG of Control group was 37.51.2 weeks

with range of 35 weeks 4 days-39 weeks 4

days. The table also depicts the obstetrical or
medical problem among the subjects of both
the groups. 55% of the subjects in
experimental group and 65% in control group
had no obstetrical or medical problem. Both
the groups were found to be statistically
homogeneous in nature as per chi square
test.(p >0.05).

Table 2: Obstetric Data

EXPERIMENTAL GROUP
(n=20)
n (%)

CONTROL GROUP
(n=20)n (%)

X2
df, P value

POG**
35-37+6 weeks
38-40+6 weeks

11(55)
9(45)

11(55)
9(45)

5.969
3
0.113NS

Obstetrical/
Medical problem
No obstetrical or
medical problem

11(55)

13(65)

2.700
4

Obstetrical or
medical problem

9(45)

7(35)

VARIABLE

0.609NS

*Period of Gestation
Performance of breathing exercises by
mothers in experimental group
Figure 1 reveals the performance of the
breathing exercises during labour by
experimental group subjects to whom
breathing exercises were taught using a video.
Majority of the mothers (90%) performed the
exercises rated as satisfactory and only 10 %
performed average.

Figure 1 : Performance of breathing

exercises by mothers in labour*
n = 20
average
satisfactory
10%

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

90%

Pain perception in the first stage of labour

Figure 2 illustrates the comparison of
pain perception in latent phase, early active
phase and late active phase in both groups
(experimental and control) in the first stage of
labour. The mean score of pain in latent phase
was 3.1 0.5 with range of 2 to 4 in
experimental group whereas in control group
it was 4.05 0.7 with range of 3 to 5. The
mean score of pain in early active phase for
experimental group was 5.9 0.8 with range
of 4 to 7 whereas it was 7.05 0.9 with
range of 5 to 8 in control group. The mean
score of pain in late active phase in
experimental group was 8.5 0.7 with range
of 7 to 10 whereas it was depicted 9.3 0.7
with range of 8 to 10 in control group. The
unpaired t test depicts the significant difference
in the pain scores in latent, early active and
late active phase of first stage of labour among
both groups (p value<0.01)

Pain score

Figure 2:
Pain perception in first stage of
labour
N=40
First stage of labour
Early Late
Latent
active
active
phase
phase
phase
9
7
5
3
1

Experiment
al group
Control
group

Duration of first and second stage of labour

in experimental and control groups
Table 3 compares the Duration of first
and second stage of labour in both groups
(experimental and control). More than half of
the subjects (60%) in experimental group as
compared to only 1/4 th subjects in control
group had less than equal to nine hours
duration of first stage of labour. 40% of the
subjects in experimental group had more than
nine hours duration of first stage of labour in
comparison to th of the subjects in control
group . The mean value and standard
deviation was 8.8 0.9 hours with range of
7.45 to 11.20 hours in experimental group
whereas that in control group was 9.8 1.1
hours with range of 8.25 - 12.10 hours.
Taking into consideration the Duration of
Second Stage of labour in experimental and
control group, 45% of the subjects in
experimental group had duration of 2nd stage
of labour less than 20 minutes as compared
to only 5 % in control group. More than half
(60%) of the control group subjects had 20
minutes to 35 minutes duration of second
stage of labour in comparison to 45% of
experimental group. Only 10% of subjects in
experimental group as compared to 35% in
control group had more than 35 minutes
duration of second stage of labour. The mean
value of duration of 2nd stage of labour for
experimental group was 24 6.4 minutes
with range of 15 to 40 minutes. The value of
mean duration of 2nd stage of labour for control
group was 32.1 8.5 minutes with range of
20 to 50 minutes. The unpaired t test depicts
the statistically highly significant difference in
the duration of first and second stage of labour
among both groups (p value<0.01).

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

Table 3: Comparison of Duration of First and Second stage of labour in experimental and
control groups
N=40
Duration of labour

Experimental
group n=20(n%)

Control goup
n=20(n%)

t, df,
p value

First stage of labour (hours)

<9 hours
12(60)
>9 hours
8(40)

5(25)
15(75)

-3.103
38
0.004

Second stage of labour

(minutes)
<20
20-35
>35

1(5)
12(60)
7(35)

-3.405
38
0.002

9(45)
9(45)
2(10)

Discussion
Most women experience labour pain as
severe or unbearable during childbirth. So it
is valuable to offer complementary pain relief
methods to women in childbir th. Most
childbirth education classes and most books
on childbirth present relaxation techniques,
along with a variety of rhythmic breathing
patterns intended to complement and promote
relaxation or to provide distraction from labor
pain. They are also used to enhance a
woman's sense of control. 1,8,9
Practicing the breathing techniques
becomes an automatic response to pain. A
mother more relaxed will respond in a positive
manner to pain. Breathing techniques
determine the wellbeing status and become a
measure of control. The present study
included breathing exercises as a
complementary pain relief therapy in labour.

This is also consistent with earlier research

repor ting breathing and relaxation as the
predominant techniques employed for pain
relief in labour.6,10 For teaching the breathing
exercises to the mothers before labour various
methods were taken into consideration which
can help the mothers to learn, understand and
practice the desired behaviour in labour.
Audio visual education in the modern
sense of the expression is a movement of
recent growth. The film is the most potent
medium of learning. On the same ground the
present study developed a Hindi version video
on 'breathing exercises during labour' with
duration of 10 minutes. The video developed
during the study was very helpful in teaching
the breathing exercises and was able to
motivate the mothers to practice these
exercises during labour. This was evident from
the scores of the 'observation checklist for

Nursing and Midwifery Research Journal, Vol-9, No.1, January 2013

practice of breathing exercises during labour'

as majority of the mothers performed the
exercises rated as satisfactory. The results
were consistent with the computer search of
the electronic databases by Helene J. Krouse
in 2008 which found that the use of video as
a teaching aid has potential benefits for clinical
practice in facilitating knowledge acquisition,
reducing preparatory anxiety, and improving
self-care.7
The assessment of pain perception at the
latent phase, early and late active phases of
first stage of labour showed statistically
significant difference among experimental and
control group. The pain scores reported by
the subjects of both the groups were
minimum in latent phase and maximum in late
active phase. The study results were in
agreement with those of Jaya Bharathi who
found statistical highly significant difference
in the post-assessment level of labour pain
perception of primi mothers in experimental
and control groups.11
Breathing exercises secure more
oxygen in order to have strength and energy
for mother and child and brings a purpose
for each contraction, making them more
productive. In the same context the present
study depicted the significant reduction in the
duration of first stage of labour among the
subjects of experimental group. The findings
in the current study are consistent with the
work of Ciobanu and Anca who found that
labor parameters were upgraded for the group
which practiced breathing and relaxation and
depicted significant reduction in duration of
first stage of labour.12

The study results had also shown the

significant reduction in the duration of second
stage of labour in the group which practiced
breathing exercises. The results were in
agreement with the previous research findings
in which the duration of second stage of
labour was 21 minutes in group which
practiced breathing exercises in comparison
to 39 minutes which did not. Thus reflecting
the reduction in duration of second stage of
labour.12
The present study hence concluded that
the use of video on breathing exercise during
labour was effective during childbir th to
reduce pain perception and duration of labour.
It is recommended that the obstetric nursing
personnel should focus on teaching breathing
exercises as complementary therapy with
multimedia aids and encouraging the mothers
during labour to practice them to make
childbir th a less painful and stressful
experience.
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