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INTRODUCTION
Over the years, a lot of mothers say that their first childbirth was an extraordinary
experience. This made the researchers wonder of the things they went through. For
primigravida mothers who havent experienced childbirth but about to, they face fears
and anxiety in regards to the unknown possibilities that may happen to them or to their
baby. Because of such fears, they find ways to cope up and manage the stress.
Discovering the common fears to this phenomena and coping mechanisms they use, well
help the primigravida mothers to be prepared for childbirth.
Before delivery, many things come to mind to worrying mother. Fear of deformed
babies, surgery itself and other invasive procedure such as episiotomy and anesthesia
administration, afraid of a long labor, afraid that she might not make it. Especially if there
is a friend or relative who tell their birthing experience which gives her undesirable
impression towards labor.
Labor experiences among primigravida mothers are somehow different from
multiparous mother. To multiparous mother labor is not that painful and traumatic
because they already know the feeling and used to it. They got that strength, confidence
and perceive labor pain and discomfort as normal and natural since they already
experience labor and childbirth. In the case of primigravida mothers, everything that a
mother will feel is new. When contraction increased it gradually surges the burden of the
mother, so the apprehension is greatly increased which may lead to panic and
disorientation during delivery.
a) Pregnancy
b) Labor
c) Delivery
3.) What are the coping mechanisms employed by the respondents
a) Physical
b) Emotional
c) Psychological
d) Social
e) Spiritual
Theoretical framework
This study will be anchored on the theory of Roy Adaptation Model
which explains that human system has the capacity to adjust effectively to changes in the
environment and affects the environment. Promote survival, growth, reproduction &
mastery.
Conceptual framework
Basing in the theory of Callista Roy, the following are the concepts in the study:
A quantitative descriptive design will be conducted in Bago City Health Office,
Bago City to determine common fears related to childbirth and coping mechanisms
among primigravida mothers admitted this year of 2014.
Schematic diagram of the theory and conceptual framework
Common fears
Labor
Childbirth
Delivery
Coping mechanisms
Physical
Emotional
Psychological
Spiritual
social
The purpose of this study is to determine the common fears related to childbirth
and coping mechanisms among primigravida mothers admitted at Bago City Health
Office, Bago City of year 2014.
Definition of terms
Childbirth. It is an act or process of giving birth to a child (McGraw-Hill, 2005).
Operationally, it refers to a situation where the mother is in the process of giving birth.
Coping mechanism. Are any efforts directed to stress management (Stuart & Lardia,
2005). Operationally, it refers to how ht e mother manage stress.
Fear. It is cause by physical or psychological exposure to a threatening situation (Stuart,
2005). Operationally, it refers to the emotion the mother is experiencing during
childbirth.
Primigravida. It refers to a woman pregnant for the first time (Elsevier, 2009).
Operationally, it refers to the mother who will be sharing her experience about her first
labor.
Review of related literature discusses the foreign and local related concepts and
studies. Also a synthesis is made to summarize the related concepts and studies of the
research.
Related Concepts
Foreign
An article by Shelley Albini in (2010) on fears state that many are familiar with the
instinctual response of "fight or flight." As a basic survival instinct, when a person senses a threat,
real or perceived, their body throws out adrenalin so that they can either run for safety or stay and
fight. In fear, blood is sent away from the uterus and to the extremities. Understanding what the
body can do and trusting in the process can take one quite far in allowing a peaceful birth.
Knowledge is power. There is much written to support the fact that the body's natural pain killers
- endorphins - are available to birthing women as they let go of fear. By understanding what their
body can do given the chance, many allow the natural process to occur without suffering.
As stated by Carol Nelson in (2008) the length of labor is extremely variable, with the
average length of active labor being 12 hours. Some labors are "harder" or "easier" than others
due to things like the position and size of the baby, shape and size of the pelvis and a myriad of
other physical, emotional and psychological factors that come into play. Each woman has her own
perceptions about labor as well. It is viewed by some as a necessary evil, a means to an end that
must be endured with the least amount of discomfort possible. Others view it as a natural,
spiritual, miraculous event that they want to experience fully with minimal intervention.
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An article by Expectant Mothers Guide in (2006) states that fear of childbirth is common
among moms-to-be. Most women have concerns about coping with pain, childbirth-related
injuries and the possibility of having a cesarean section. Some moms have additional concerns
due to previous life experiences such as sexual assault, having undergone invasive fertility
treatments, previous traumatic birth experience or pregnancy loss.
Local
Related Studies
10
Foreign
A study by Warchief in (2010) of fears of mothers is anxiety / anxiety is a concern,
difficulty, uncertainty / fear of loss resulting from actual or perceived threat and can cause a
person to feel frightened, worried for no apparent reason, difficulty concentrating, tension,
tiredness, restlessness and sleep disturbance. The survey results revealed that as many (50.0%)
respondents experienced anxiety were, (36.4%) respondents experienced mild anxiety and as
many (13.6%) respondents experienced severe anxiety.
According to the study by the University of Skvde in (2012) womens experiences of
being involved in decisions and the relationship to professional and social support during their
first labor can be conceptualized as one main theme: "Most important for first time mothers
during labor is to be respected for their needs, to feel involved in the care, and support from their
partner". This theme contained three categories: "To be respected for their needs", "To be
involved in the care" and "Support from the partner". A safe and calm environment positively
influenced the womens sense of support, and the ability to have her partner physically present
positively influenced the sense of support.
A study conducted by Suddha (2009) explored and assessed the different levels of strees
and its manifestation and different stressors in women with PIH in response to stress. The
research approach for the first phase of the study were corelational and phenomenology. The
subjects were selected by convenience sampling technique. There were 65 women with PIH in
the first phase and the 6 women with PIH during the second phase.
The results found that majority (64.61%) of women had moderate stress levels. The
finding indicated that there were no correlation between levels of stress and use of effectiveness
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of coping strategies. The association between levels of stress and quality of life of women with
PIH showed that quality of life was independent of levels of stress.
The study concluded that all of the four dimensions depict the importance of holistic and
comprehensive care.
A study by Dawid in (2010) stated that interaction between the women and the nursing
staff was not that sufficient enough, yet we know that rendering quality health care will depend
on good interactions. Impaired nursing care in labor mainly includes poor pain management, lack
of psychological support and explanations, as well as poor communication. Inefficiency of the
abovementioned factors may have bad consequences to the woman like fear and anxiety, which
can adversely affect the labor process.
According to Sadawarte and Bhure in (2007) primigravida mothers who were poorly
informed about the labour pain experienced difficulties. Some may have been informed but lacks
some of the necessary details concerning labour pains such as duration of the pain, pain
expectation and possible pain analgesia. Many of them were highly motivated but due to the lack
of knowledge and preparation, they found labour very challenging.
A study conducted by Subasheni in (2007) had the objectives of assessing the anxiety
related to the onset of labour and delivery among primigravida mothers and determining the
association between the levels of anxiety with selected variables. The approaches used in the
study were descriptive survey approach and descriptive exploratory survey design with a
purposive sampling technique in selecting their respondents. 50 primigravida mothers were
selected in the clean labour ward at Vani Vilas Hospital, Bangalore. The tool consisted of 65 items
to assess the level of anxiety.
The overall findings of the study showed that higher the age of the mothers, higher was
the anxiety level. The anxiety among primigravida mothers obtained were approximately 80%
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low to moderate level of anxiety basis of different variables of social aspects. It revealed that
mothers with anxiety are higher in number than the mothers without anxiety. Providing
psychological and physical comfort will minimize the anxiety level and will promote safe labour
and delivery.
A study of Sauls in (2004) primigravida mothers, especially the young adolescent
mothers, needs the help of any support system during labor since they are less prepared compared
to adults. These mothers apparently have less mental preparation. The presence of support system
and understanding the needs of these young adolescents is crucial for them to in order to endure
labour and childbirth.
As stated by Bahri Binabaj, Latif Nejad and Taffazoli in (2003) primigravida mothers
who received continuous professional support during labour expressed that they felt more
satisfied with their labour experience. Satisfaction of their labour experience is a good indication
that these mothers are psychologically healthy and could possibly cope up better with
motherhood.
According to RAJIV in (2007) women in labor not only have discomfort, they also have
signs of pain such as facial tenseness, flushing or paleness of the face, and hands are fist, rapid
breathing or rapid pulse rate. Other signs and symptoms of onset of labor are lightening, increase
in level of activity, uterine contractions, ripening of the cervix involve uterine cervical changes.
More women especially primigravida women, dont know the signs of true labor. All women
response to labor also may be reflect in the vital signs and blood pressure, fear, anxiety and
fatigue can cause alteration in baseline findings.
A study by Bhure in (2008) reveals that in qualitative analysis of data obtained from
semi-structured interviews of 100 primigravida attending antenatal care and previous painful
experiences, knowledge and expectation of labour pain, attitude towards labour pain. Many were
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highly motivated to deal with labour pain, although some were anxious, and a few women
expressed fear. None of the patients knew about adverse effects of labour pain and why it should
be relieved. The fact that some informants in this study considered pain a positive feature of
labour and that a few opposed the idea of relieving labour pain, may reflect traditional social
values, according to which labour pain is welcomed, and successful bonding is seen to depend on
the experience of pain in labour.
A study by Linthoingambi Chanu in (2013) stress is common during pregnancy. But too
much of stress can make pregnant women uncomfortable. Research has shown that pregnant
women undergo psychological, physical and social changes during pregnancy. Stress can make
trouble sleeping, headaches, lose appetite or overeat. High levels of stress that continue for a long
time may cause health problems, like high blood pressure and heart disease. During pregnancy
this type of stress can increase the chances of having a premature baby or a low-birth weight
baby, may lower baby's IQ, etc.
A study conducted by Panthumas (2012) investigated the predictive factors of the selfcare behaviours among Thai teenagers with primigravida pregnancy. The samples of 206
primigravida teenagers attending ANC clinics of six hospitals in the North-Eastern region of
Thailand were included. Data collection was done through self administered-questionnaire.
The results of the yielded that these teenage pimigravida mothers needed education on
self-care since the majority of the respondents of the study attained the secondary level of
education. They proposed that their local centers should provide health teaching that may provide
them a better of knowledge on self-care during pregnancy.
A study conducted by Sadawarte in (2007) analysed the knowledge and expectations of
pain of labour and knowledge of labour analgesia methods among primigravida women attending
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an antenatal care clinic in a teaching hospital in a rural part of central India. The results of this
study were aimed to be utilized to improve the analgesic care of women.
The results were showed that patients were poorly informed about pain of labour. Many
women appeared highly motivated concerning their ability to cope with labour. All the patients
expected pain, many of them expected pain to be severe but had no concept of duration of the
pain, and knew very little concerning methods available for pain relief in labour.
They concluded that women attending antenatal care clinic in teaching hospital in rural
part of central India were poorly prepared for the experience of delivery. Antenatal programmes
should incorporate education concerning pain of labour and methods available to alleviate pain.
A research by Bharathi in (2010) during labour, the woman experiences some degree of
stress as her system responds to the physical changes that prepare her to give birth. Nearly every
woman in labour experiences some degree of discomfort. Perception of pain is highly unique and
differs from one individual to another though the intensity of pain stimuli is same. An
appreciation of each womans unique experience of pain is possible when perinatal nurses
understand the physiological basis of pain, physiological responses to pain, and psychosocial
factors influencing pain perception.
A study conducted by Duman in (2012) aimed at determining the effect of sociodemographic and obstetric factors during pregnancy period on depression levels of the pregnant
women was a descriptive research. The results found out in the study that most of the women
experienced depression (75.0 %). However; a statistically significant difference was found
between mean depression scores and family type, number of the pregnancy, spontaneous
abortion, desired pregnancy and harmony between spouses. They conclude that there was a
positive correlation between some socio-demographic and obstetric factors and depression during
pregnancy.
15
The basis of childbirth preparation is the belief that pain during childbirth is a vicious
cycle. As fear and massage, and positioning are also widely used ways of handling the
discomfort.
A study by Adin, Leena in Karnataka,Bangalore (2007) labour process more painful
situation of the every primigravida women. They will have stress and anxiety during the labour &
some will have knowledge of their past experience about the labour and studies have proven if
women have support from the family members and partner, the labour becomes shorter. Planned
teaching programme prior to the labour is one of the most effective teaching strategies which can
be used for improving the coping strategies for the primigravida women during birth process.
Objectives of the study:1. To identify the coping strategies adopted by the primigravida women in
the experimental group after planned teaching on birth process. 2. To identify the coping
strategies of women in the control group during the birth process. 3. To compare the coping
strategies adopted by the primigravida women between experimental and control group. 4. To
find out the association between the copings strategies adopted by the primigravida in the
experimental and control group with the selected demographic variables. Methods Post-test
control group design was used for the study. Interpretation and conclusion finding of the study
showed that the planned teaching for primigravida women was effective with the positive coping
strategies during birth process which was evident in post-test scores. Hence planned teaching was
an effective method for providing the information and improving their confidence and knowledge
and reduce stress and anxiety which made primigravida with positive ability to cope with during
labour.
Local
A study by NCRFW in (2010) state that three of the four women interviewed chose the
modern day approach of giving birth in a hospital setting, while the fourth woman opted for a
16
home birth with the guidance of a lay mid-wife and other female family members. One woman
stated that she remained silent throughout her labor and delivery, and also endured the pain
naturally, while the others received the epidural. These women stated that although they chose the
modern day approach, they still carried on some of the Filipino traditions.
A research by Bono, Pastrano, Ladonga, Ramirez, Laureano, Sellote and Navotas in
(2010) states that pain interventions, especially non-invasive interventions, are crucial for
primigravida mothers in enduring labour. The application of visual biofeedback with the use of
mirrors during labour shortens the duration of the second stage of labour reduces its time span.
The reduction in time span during labour means that primigravida mothers will endure less. The
pain they experience during labour may affect their perception of their labour experience.
According to Ysmael, Elizon, Bejoc, Gonzaga and Caneda in (2010) music therapy
during labour for primigravida mothers are also found to be beneficial in hastening the second
stage of labour. The playing fast music during this stage of labour hastened the time duration
compared to those who used normal and paced music. The hastening of the time duration during
the second stage of labour means that woman has less to endure. This could possibly affect the
perception and interpretation by women of their labour experience.
A study conducted by James Abas et.al. in (2007) pregnancy and childbirth are a
happy and joyous time for some women , but for others the experience can be one of
anxiety , fear, and confusion. Due to the fact that our society holds pregnancy and
motherhood in high regard, many women suffer in silence when their experiences is
anything less than sublime, fearing they will be negatively judged. Some women may
feel very anxious. This is postpartum anxiety, and/or panic, and it is characterized by
intense anxiety and/ or fear etc.
17
Synthesis
Primigravida refers to a woman pregnant for the first time (Elsevier, 2009). All
the experience that they will encounter is new to them. According to the studies most
primigravida mothers, experienced anxiety and fear. Lack of knowledge regarding labor
process was one of the factors that contributes to the anxiety and fears among
primigravida mothers.
The related studies included in this review lead the researchers to conduct
a research about the Common Fears during childbirth and the various Coping
Mechanisms utilize by Primigravida Mothers. The studies are very useful for the
researchers in conducting the study, gathering of relevant information, and proper
interpreting of data that are to be collected. It will also serves as a guide in gathering
relevant data from the selected respondents specifically from primigravida mothers who
are admitted at Bago City Health Office, Bago Cityduring summer 2014.
METHODOLOGY
Methodology deals with the research design used the subject and respondents of
the study, the instrument used for gathering data, the analytical procedures and the
statistical tools employed.
Research Design
18
Research instrument
19
20
Respondents consent
It is a waiver with the respondent signature as an approval that she is willing to
participate in the study. It is essential to gain the full cooperation of the interviewee.
Interview schedule
It is a formal questionnaire that will serve as a guide for the researchers during the
interview of the respondents. It will help in ensuring the consistency of the interview.
Statement Treatment
In analyzing the data according to the research design, appropriate tools were
employed depending on the nature of specific questions.
For specific question number 1, on what is the demographic profile of the
primigravida mothers admitted at Bago City Health Office, Bago City year 2014 in terms
of personal variables such as: age, educational achievement, occupation, and civil status,
necessitated the use of frequency and percentage distribution.
For specific question number 2, on what are the common fears related to
childbirth among primigravida mothers admitted at Corazon Locsin Montelibano
Memorial Hospital, Bacolod City year 2014, necessitated the use of mean, frequency, and
percentage. The mean is equal to the sum of all values divided by the number of
respondents which is referred to as the average. The frequency is a symmetric
arrangement of numeric from the lowest to the highest together with a count (or
percentage) of the number of times each value was obtained (Polit & Beck, 2010)
21
For specific question number 3, on what are the coping mechanism employed by
the primigravida mothers admitted at Bago City Health Office, Bago Cityyear 2014,
necessitated the use of mean, frequency, and percentage.
22
Percent = rf x 100
REFERENCES
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APPENDICES
A. Letters
25
Dear Dr. Cadena:
Greetings!
In line with the requirements in Nursing 3 Introduction to Nursing Research under Dr. Merle
Salvani, we the Group 2, BSN-3B students will be conducting a research study entitled Common
Fears related to Childbirth and Coping Mechanisms among Primigravida Mothers. The group
will conduct this study to Corazon Locsin Montelibano Memorial Regional Hospital. We hereby
assure you that the data that we will be gathering will be kept confidential and for research
purpose only.
Thank you for your great support.
In St. La Salle,
Christy Jane Rasimo
Group Leader
Approved By:
Mrs. Merle Salvani RN, MN,PhD
Nursing Research Instructor
Noted By:
Mrs. Ida Amor Cuenca RN, MN
Level 3 Chairperson
University of St. La Salle
Bacolod City
College of Nursing
26
In line with the requirements in Nursing 3 Introduction to Nursing Research, we the Group 2,
BSN-3B students would like to ask for your approval to allow our group to conduct our research
entitled Common Fears related to Childbirth and Coping Mechanisms among Primigravida
Mothers. The group is to distribute questionnaires to our selected respondents that are
primigravida patients admitted at the maternity ward. We will be choosing 30 primigravida
patients aging from 16-25 years old. The sampling design is a non-probability and is purposive,
therefore we are asking for your help to allow our group to conduct our study in your institution.
This will be of great help for us in accomplishing our tasks in doing our research study.
Thank you so much.
In St. La Salle,
Christy Jane Rasimo
Group Leader
Approved By:
Mrs. Merle Salvani RN, MN,PhD
Nursing Research Instructor
Noted By:
Mrs. Ida Amor Cuenca RN, MN
Level 3 Chairperson
27
In line with the requirements in Nursing 3 Introduction to Nursing Research, we the Group 2,
BSN-3B students would like to ask for your approval to allow our group to conduct our research
entitled Common Fears related to Childbirth and Coping Mechanisms among Primigravida
Mothers. The group is to distribute questionnaires to our selected respondents that are
primigravida patients admitted at the maternity ward. We will be choosing 30 primigravida
patients aging from 16-25 years old. The sampling design is a non-probability and is purposive,
therefore we are asking for your help to allow our group to conduct our study in your institution.
This will be of great help for us in accomplishing our tasks in doing our research study.
Thank you so much.
In St. La Salle,
Christy Jane Rasimo
Group Leader
Approved By:
Mrs. Merle Salvani RN, MN,PhD
Nursing Research Instructor
Noted By:
Mrs. Ida Amor Cuenca RN, MN
Level 3 Chairperson
B. Interview Schedule
Instruction: Put a mark on the blank provided. Choose the ones that apply to you.
28
2) Labor
__ Episiotomy
__ Loss of sexual enjoyment
__ Stillbirth
__ Accidental body function
__ Forceps delivery
__ Meconium complications
__ Cord around babys neck
__ Premature birth
__ Pain
__ Not knowing what to do if something goes wrong
__ Not making it to the hospital
3) Delivery
__ Not making it to the hospital
29
2) Emotional
__ Crying
__ Shouting
__ Displacement
3) Psychological
__ Visualization of positive outcomes
__ Diversion of attention
__ Health conscious
4) Social
__ Expressing fears to others
__ Recreational activities
30
THANK YOU!
_____________________
Signature of Respondent
C. Validation Tool
31
1 - Poor
NA - Not applicable
Encircle only one option for each item
Criterion for evaluation
1. The questionnaire is short enough such that the
NA
it.
2. The questionnaire has a face appeal such that the
NA
NA
NA
NA
NA
NA
NA
NA
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D. Reliability Tool
Chronbachs Alpha
Where:
N the number of questions
33
34
E. Schedule of Activities
NOVEMBER
2013
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
10
11
12
13
14
15
16
21
22
23
Making of
Chapter 1
28
Finalizing
Chapter 1
29
30
17
18
19
Making of
Chapter 1
20
24
Making of
Chapter 1
25
Making of
Chapter 1
26
Making of
Chapter 1
27
Chapter 1
presentation;
Making of
Chapter 2
35
DECEMBER
2013
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Revision of
Chapter 1
10
Making of
Chapter 2
11
Making of
Chapter 2
12
Finalizing
Chapter 1& 2
13
14
Chapter 2
presentation;
Making of
Chapter 3
Making of
Chapter 3
Making of
Chapter 3
17
Making of
Chapter 3
18
19
20
21
Submission of
Chapters 1,2 & 3
25
26
27
28
Wednesday
Thursday
Friday
Saturday
15
16
Finalizing
Chapters 1,2& 3
22
23
24
29
30
31
JANUARY
2014
Sunday
Monday
Tuesday
36
10
11
12
13
14
15
16
17
18
21
22
Submission of
Chapters 1,2 & 3
23
24
25
28
Revision of
Chapters 1,2& 3
29
30
Revision of
Chapters 1,2& 3
31
Revision of
Chapters 1,2& 3
Finalizing
research study;
Submission of
research study
19
26
20
27
Revision of
Chapters 1,2& 3
Printing of hard
copy
FEBRUARY
2014
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
37
1
2
10
11
Mock defense
12
13
14
15
Revision of
research study
Revision of
research study
Revision of
research study
Revision of
research study
Finalizing
research study
16
17
18
19
20
21
23
24
25
26
27
28
Monday
Tuesday
Wednesday
Thursday
Friday
22
APRIL 2014
Sunday
Saturday
38
10
11
12
13
14
15
16
17
18
19
20
Gathering of
data
21
Gathering of
data
22
Gathering of
data
23
Gathering of
data
24
Gathering of
data
25
26
Gathering of
data
29
Gathering of
data
30
Gathering of
data
Gathering of
data
27
Gathering of
data
28
Monday
Tuesday
Wednesday
Thursday
Friday
MAY 2014
Sunday
Saturday
39
10
Tallying of data
Tallying of data
11
12
13
Interpretation of
data
14
Interpretation of
data
15
Revision of
research study
16
17
Finalizing
research study
20
Printing of hard
copy
21
Book binding
18
Finalizing
research study
19
22
Submission of
hard copy
23
24
25
26
27
28
29
30
31
40
F. Budget Estimate
Month
Cost
November
Printing of research study
Internet usage
P _____
P _____
December
Printing of research study
Internet usage
P _____
P _____
January
Printing of research study
Materials used for the research study
Internet usage
P _____
P _____
P _____
February
Printing of research study
Photocopy of research study
Internet usage
P _____
P _____
P _____
April
Printing of interview schedule
P _____
41
P _____
May
Statistician
Book binding
Printing the hard copy
Internet usage
Total Cost
P _____
P _____
P _____
P _____
P _____
42