NUJHS Vol. 2, No.
2, June 2012, ISSN 2249-7110
Nitte University Journal of Health Science
Original Article
A COMPARATIVE STUDY ON EFFECT OF AMBULATION AND
BIRTHING BALL ON MATERNAL AND NEWBORN OUTCOME
AMONG PRIMIGRAVIDA MOTHERS IN SELECTED HOSPITALS IN
MANGALORE
3
Albin Mathew1, Sabitha Nayak2 & Vandana K.
1
nd.
2 year M.Sc. Nursing student, Vice-Principal, Statitician, Nitte Usha Institute of Nursing Sciences,
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
includes1st stage duration (Area1), 2ndstage 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.
Introduction :
fierce labour that has been in store for them. So they
Pregnancy is a unique, exciting and often joyous time in a
demand for healthier labour, with less discomfort. Women
woman's life, as it highlights the amazing creative and
in the developing countries with meagre health facilities
nurturing powers while providing a bridge to the future.
usually lie in bed during the first stage of labour. Lying on
Pregnancy and birth are tremendously powerful stages of
the back (supine) puts the weight of the pregnant uterus on
development that bring a woman to motherhood, a
abdominal blood vessels and contractions may be less
couple, to family and a beautiful child into the world.
strong than when upright. Effective contractions help
Labour process may be viewed as a test of womanhood, a
cervical dilatation and the descent of the baby(1).
test of personal competence, a peak of experience, and the
Being upright will make contractions stronger and more
first act of motherhood. Labour process starts with the
efficient. It will allow gravity to keep the baby's head
onset of regular uterine activity associated with
pressed down, which will help the cervix to dilate faster so
effacement and dilatation of the cervix and descent of the
that labour is speeded up. (2) Birthing ball helps the mother
presenting part through the cervix(1).
to be in an upright position and also it opens pelvis,
Discomfort is one of the biggest obstacles of labour and
encouraging
delivery. Pregnant women don't want to experience the
during labour can change the shape and size of the pelvis,
A COMPARATIVE STUDY - Albin Mathew
baby to move down. Changing positions
NUJHS Vol. 2, No.2, June 2012, ISSN 2249-7110
Nitte University Journal of Health Science
which can help the baby's head move to the optimal
Research evidences have shown that ambulation and
position during first stage labour, and helps the baby with
birthing ball tend to reduce the duration of first stage of
rotation and descent during the second stage. Swaying
labour. Thus the investigator felt the need to utilise this
motions such as walking, climbing stairs, and swaying back
finding in her setting so as to reduce discomfort and
(3)
and forth are especially helpful with this.
duration during the first stage of labour.
In the first stage of labour, the cervix will dilate to 10 cms in
Methods :
diameter. In mothers having their first child, this stage
The study design adopted was a randomized control trial
usually lasts 12 to 16 hours. Discomfort can often be helped
approach with post test control group design. Population
by body positions that allow gravity to speed dilation, such
comprised of primigravida mothers in the first stage of
as walking, squatting, kneeling forward on a chair or sitting
labour in selected hospitals at Mangalore. Purposive
on the birthing ball. This will help the baby move down in
sampling technique was used for selection of samples 60
(4)
samples, and random allocation of the samples using
the pelvis faster and less painfully.
lottery method, was done to assign 20 samples to the
A pilot study conducted at two Canadian hospitals where
ambulation, birthing ball and control groups.
women in labour were randomly assigned to a regular
labour room or to an ambient room. In the ambient
Ambulation and birthing ball therapy were given to the
room, the standard hospital labour bed was removed, and
respective samples in ambulation and birthing ball group in
additional equipment was added to promote relaxation,
between cervical dilatation 1-3 cms, whereas the control
mobility, and a calm atmosphere. The evaluations from
group was not given any intervention. Then maternal and
women assigned to the ambient room were positive; they
newborn outcome was analysed by cervicograph, and
spent 50% or less time labouring in bed and reduced the
Apgar score respectively. Here maternal outcome
need for artificial oxytocic infusions.
includes1st stage duration (Area1), 2ndstage duration
(5)
(Area2), cervical dilatation rate (Area3), and type of
Birthing ball helps to shorten the first stage of labour. As
delivery (Area4) and newborn outcome includes heart rate,
one sits on the ball, they should move the hips in a circular
respiratory rate, colour, reflex and muscle tone. Data
motion. This allows the baby's head to press against the
obtained in these areas were analysed by independent t-
cervix, which promotes dilation. (6)
test expect in Area 4 which was analysed by frequency
percentage.
A randomised and quasi-randomised trial review was
conducted to determine the effect of encouraging women
Results :
to assume different upright positions (including walking,
Main findings are discussed under the following headings
sitting, standing and kneeling) versus recumbent positions
1. EFFECT OF AMBULATION ON MATERNAL OUTCOME
(supine, semi-recumbent and lateral) in the first stage of
Since the t calculated value in Area 1( 5.257), Area 2
labour on 3706 women. Result of this review revealed that
(2.781), Area 3(5.438) is greater than t table value
the first stage of labour was approximately one hour
(2.042)at 0.05 level of significance (p<0.05) (Table 1) and
shorter for women randomised to upright as opposed to
in Area 4, 75% of ambulation group underwent normal
recumbent positions (MD -0.99, 95% CI -1.60 to -0.39).
vaginal delivery(Table 2),
Women randomised to upright positions were less likely to
significant improvement in maternal outcome after the
have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).
use of ambulation.
Walking and upright positions in the first stage of labour
reduce the length of labour and do not have any negative
effects on mothers and babies wellbeing.(7)
A COMPARATIVE STUDY - Albin Mathew
it shows that there is
NUJHS Vol. 2, No.2, June 2012, ISSN 2249-7110
Nitte University Journal of Health Science
Table1:
Groups
n
mean
(Area 1: 1st stage duration)
Ambulation
18
531
group
Control group 16
763
(Area 2: 2nd stage duration)
Ambulation
18 32.7222
group
Control group 16 49.9375
Area 3: cervical dilation rate)
Ambulation
18 0.0196
group
Control group 16 0.0135
ttab(32)=2.042
t-value
SD
df
5.257 108.10950 32
148.18591
2.781 15.32321 32
16.58300
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
LOS
0.000
P<0.05
HS
0.009
P<0.05
HS
3. COMPARING THE SIGNIFICANT DIFFERENCE OF
AMBULATION AND BIRTHING BALL ON MATERNAL
5.438 0.003712 32
0.000
P<0.05
0.002683
HS
HS= Highly significant
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) ,
Table2: (Area 4: type of delivery)
(Table 5) and type of delivery(Table 6) whereas no
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
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
2. EFFECT OF BIRTHING BALL ON MATERNAL OUTCOME
The t calculated value in Area 1(7.223), Area 2 (5.556),
therapy and also no significant association was found
Area 3(6.178) is greater than t table value (2.030) at 0.05
between maternal and newborn outcome and the selected
level of significance (p<0.05)(Table 3) and in Area4, 95%
demographic variables.
of birthing ball group underwent normal vaginal
v
Table5: (Area 2: 2nd stage duration)
Table1:
delivery(Table 4). It shows that there is significant
improvement in maternal outcome after the use of
Groups
Ambulation
group
birthing ball therapy.
Table 3:
Groups
n
mean
(Area 1: 1st stage duration)
Birthing ball group 20
471
t-value
SD
df
Birthing ball group 20
v
ttab(36)=2.030
LOS
Control group 16
763
(Area 2: 2nd stage duration)
Birthing ball group 20 23.9000
0.000
34 P<0.05
148.18591
HS
23.9000
LOS
.032
P<0.05
8.40363
S
S= Significant
Ambulation group
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
8.40363
5.556
mean t-value
SD
df
32.7222 2.231 15.32321 36
Table 6: (Area 4: type of delivery)
92.97849
7.223
n
18
0.000
34 P<0.05
18.67697
HS
Control group 16 49.8125
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
ttab(34)=2.030
HS= Highly significant
4. DESCRIPTION OF THE PARTICIPANTS OPINION ON THE
USEFULNESS OF AMBULATION AND BIRTHING BALL
THERAPY
In ambulation group, 100% mothers were
comfortable while walking whereas in birthing ball
group only 95% were comfortable.
95% mothers were satisfied with ambulation and
birthing ball respectively.
A COMPARATIVE STUDY - Albin Mathew
NUJHS Vol. 2, No.2, June 2012, ISSN 2249-7110
Nitte University Journal of Health Science
85% of mothers from ambulation group and 95% of
mothers from birthing ball group, would like to
recommend its use to others.
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
With regard to family support 65% from ambulation
group & 55% from birthing ball group felt the need of
family members.
mothers in the experimental group had shorter first-stage
labour duration, less epidural analgesia, and fewer
caesarean deliveries than the control group. (10)
Discussion :
The effect of ambulation was supported by the findings in a
In another study conducted on effect of birthing ball in
similar study which was conducted in which two hundred
reduction of labour pain among primigravida mothers it
mothers were randomly assigned to one of two groups:
was noticed that birthing ball had an effect on reducing the
first group (100 parturients) authorized to ambulate and
duration of labour even though it was not statistically
second group (100 parturients) confined to bed in dorsal or
proved. No adverse effect on maternal or fetal wellbeing
lateral recumbence. The results of the study showed that
was observed as evidenced by normal FHR and maternal
ambulation reduces (for about 34%) the duration of the
physiological responses like increased rate of cervical
first stage of labour significantly (P<0.0001).(7)
dilatation and reduction in the duration of labour.(11)
In another study conducted in two hundred and twenty-
Conclusion :
one women with uncomplicated pregnancies, were
Labour being the end of the long expectation of pregnancy,
randomly divided into two groups, ambulatory and non-
marks the beginning of the extrauterine life of the new
ambulatory. The result of the study showed that there was
born. To mark a good beginning, the process and
significant difference in labour duration (2.89+/-1.83hr vs.
experience of labour should not be a misery for the mother.
3.94+/-2.17hr ; P=0.001).This study concluded that walking
There are a variety of discomforts that a woman will
shortens the labour duration.
(9)
experience during labour. Reducing these discomforts is an
important part of good nursing care. Non- pharmacologic
The effect of birthing ball was supported by the findings in a
methods like walking and birthing ball helps to decrease
study which was conducted on effects of birth ball exercise
these discomforts as it reduces the duration of labour.
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A COMPARATIVE STUDY - Albin Mathew
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