EFFECTIVENESS OF MUSIC THERAPY ON LABOUR PAIN AMONG ANTENATAL MOTHERS AT
SELECTED HOSPITALS, SALEM.
By
Mrs. JASMIN.P Reg. No: 30109421
A DISSERTATION SUBMITTED TO
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
(OBSTETRICS AND GYNAECOLOGICAL NURSING)
APRIL – 2012
CERTIFICATE
Certified that this is the bonafide work of Mrs. JASMIN.P, final year M.Sc (Nursing) student of Sri Gokulam College of Nursing, Salem, submitted in partial fulfilment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M.G.R. Medical University, Chennai, under the Registration No. 30109421.
College Seal:
Signature: ………
Prof.Dr. A. JAYASUDHA, Ph.D.(N).,
PRINCIPAL,
SRI GOKULAM COLLEGE OF NURSING, 3/836, PERIYAKALAM,
NEIKKARAPATTI, SALEM - 636 010.
EFFECTIVENESS OF MUSIC THERAPY ON LABOUR PAIN AMONG ANTENATAL MOTHERS AT
SELECTED HOSPITALS, SALEM.
Approved by the Dissertation Committee on: 21.12.2011
Signature of the Clinical Speciality Guide:………...
Prof. Dr. A. JAYASUDHA, Ph.D.(N).,
HOD, Obstetrics & Gynaecological Nursing Dept, Sri Gokulam College of Nursing,
Salem-636 010.
Signature of Medical Expert: ………..
Dr. P. CHELLAMMAL, M.D., DGO, Consultant Obstetrician and Gynaecologist, Sri Gokulam Hospital,
Salem-636 004.
______________________________ _________________________________
Signature of the Internal Examiner Signature of the External Examiner
with date with date
ACKNOWLEDGEMENT
“Gratitude is the fairest blossom which springs from the soul”
- Henry Ward Beecher I’m very grateful to Almighty God for his abundance of grace, mercy and blessing to complete this study.
I wish to express my deep sense of gratitude and thanks to Dr. K.Arthanari, M.S., Managing Trustee Sri Gokulam College of Nursing, for
providing me an opportunity to undertake the course under Sri Gokulam Trust, Salem.
I express my sincere gratitude to Dr. P.Chellammal, M.D., DGO, Consultant Obstetrician and Gynaecologist, Sri Gokulam Hospital, for validating the tool and her constant guidance and valuable suggestions.
I express my sincere thank to Dr.A.Akila, M.S.(OG)., Consultant Obstetrician and Gynaecologist, Sri Gokulam Hospital, for her constant guidance and support throughout this study.
My deep sense of gratitude to Prof. Dr. A. Jayasudha, Ph.D.(N)., Principal, Sri Gokulam College of Nursing, Salem, for her guidance that she has rendered throughout this study. I consider this as a great honor and privilege to complete the study under her supervision.
I express my sincere gratitude to Prof.Dr. K.Tamizharasi, Ph.D.(N)., Vice Principal, Sri Gokulam College of Nursing, Salem for her valuable suggestions and guidance.
I would like to express my heartful thanks to Mrs. K.Amudha, M.Sc (N)., Associate Professor, Obstetrics and Gynaecological Nursing Department, for her constant encouragement, valuable guidance, supervision and timely help during the entire course of study.
I am very grateful to Mrs.R.Nalini, M.Sc(N), Mrs.R.Sheela Theres,M.Sc(N), Mrs.Radha, M.Sc(N), Mrs.J.Vijyalakshmi, M.Sc(N), Ms.Arthi, M.Sc(N)., Lecturers, Obstetrics and Gynaecological Nursing Department for
their help and support throughout the study.
I express sincere gratitude to the class Co-ordinator Mrs.P.LalithaVijay, M.Sc.(N), Professor and Mrs. Devikanna, M.Sc.(N), Lecturer, Sri
Gokulam College of Nursing, for their timely help and guidance.
I thank all the Nursing, Medical and Non-nursing Faculty of Sri Gokulam College of Nursing for their guidance and encouragement.
My special thanks to Experts for their valuable suggestions and constructive comments.
I widen my genuine gratitude to the Dissertation committee for offering constructive criticism and due sanction for carrying out this research work.
I extend my sincere thanks to the Managing Directors of St.Mary’s Hospital and Saraswathy Nursing Home for granting permission to conduct the study in their hospital.
My sincere thanks to Mr. S.Sivakumar, M.Sc, M.Phil., Ph.D., for his assistance in statistical analysis of this study.
I extend thanks to Mr. Jayaseelan, M.Sc., Librarian, Sri Gokulam College of Nursing, Salem and special thanks to Librarians of The Tamil Nadu Dr.M.G.R. Medical University and Apollo College of Nursing for extending necessary library facilities throughout the study.
I owe my loving thanks to the Samples who participated in this study, without them it would have been impossible to complete this study.
I express my sincere thanks to Mrs. Shakila Banu, M.Phil., Wings English Academy, Salem, for editing the dissertation.
I wish to extend sincere thanks to Mr. Murugesan, Sri Krishna Computers, who helped me to print this dissertation with technical perfection and a complete success.
With profound sentiments and gratitude I express my heartiest thanks to my Husband Mr.John Peter, Parents, my Sisters and Brother for their strong support and unconditional support, which enabled me to complete this study. I shower my great deal of thanks to those who helped directly and indirectly in this work.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO
I INTRODUCTION 1-11
• Need for the study 3
• Statement of the problem 5
• Objectives 5
• Operational definitions 6
• Assumptions 7
• Hypotheses 7
• Delimitations 7
• Projected Outcome 7
• Conceptual framework 7
II REVIEW OF LITERATURE 12-24
• Literature related to labour pain
• Literature related to music therapy
• Literature related to the effectiveness of music therapy on labour pain
12 17 21
III METHODOLOGY 25-31
• Research approach 25
• Research design 25
• Population
• Description of setting
27
• Sampling 27
• Variables 28
• Description of the tools 28
• Validity and Reliability 29
• Pilot study 30
• Method of data collection 30
• Plan for data analysis 31
IV DATA ANALYSIS AND INTERPRETATION 32-41
V DISCUSSION 42-45
VI SUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS
46-50
BIBLIOGRAPHY 51-54
ANNEXURES i-xii
LIST OF TABLES
TABLE NO TITLE PAGE NO
3.1 Scoring Procedure 29
4.1 Frequency and percentage distribution of samples according to their demographic variables in experimental and control group.
33
4.2 Mean, SD and mean difference of samples on level of labour pain among experimental and control group.
38
4.3 Mean, SD and independent ‘t’ value of samples on level of labour pain among experimental and control group during O1, O2 and O3.
39
4.4 Association on level of labour pain among samples with their demographic variables in experimental and control group.
40
LIST OF FIGURES
FIGURE NO. TITLE PAGE NO 1.1 Conceptual framework based on Modified
WiedenBach’s Helping Art of Clinical Nursing Theory
10
3.1 Schematic Representation of Research
methodology.
26
4.1 Percentage distribution of samples according to their level of labour pain in experimental group.
35
4.2 Percentage distribution of samples according to their level of labour pain in control group.
36
4.3 Percentage distribution of samples according to their level of labour pain in experimental and control group.
37
LIST OF ANNEXURES
ANNEXURE TITLE PAGE NO.
A. Letter seeking permission to conduct a research
study i
B. Letter granting permission to conduct a research
study ii
C. Letter requesting opinion and suggestions of
experts for content validity of the research tool iii
D. Tool for Data Collection iv
E. Certificate of Validation xi
F. List of Experts for Content Validity xii
G. Certificate of Editing xiii
H. Photos xiv
ABSTRACT
A Study was Conducted to Evaluate the Effectiveness of Music Therapy on Labour Pain Among Antenatal Mothers at Selected Hospitals, Salem.
A Quasi experimental posttest only control group design was adopted. Non probability convenience sampling technique was used to select 60 samples, among which 30 were assigned to experimental group and 30 were assigned to control group.
Structured interview schedule was used to collect the demographic variables and Visual analogue pain scale was used to assess the level of labour pain. Music therapy was given for 30 minutes every 1hour interval for 4 times and post test was done after each intervention. The collected data were analysed and findings revealed that in experimental group 14(46.66%) samples belong to age group of 20-25 years, 12(40%) of them had high school education, 21(70%) of them were homemakers, 15(50%) of the samples were Hindus, 25(83.33%) were primi gravid women, 17(56.66%) of them had the intervention for 1 week, and 16(53.33%) samples were in 39 weeks of pregnancy during delivery whereas in control group 17(56.66%) samples belong to the age group of 20-25 years, 11(36.66%) of them had primary school education, 26(86.66%) of them were homemakers,19(63.33%) of the samples were hindus, 22(73.33%) were primi gravid women, 14(46.66%) samples were in 40 weeks of pregnancy during delivery. Mean score of experimental group were 4.07+0.37, 5.67+0.76, 7.13+1.01. The post test ‘t’ value were 0.58, 2.21 and 3.56 at p<0.05 level. Hence H1 was retained. The chi-square value revealed that in experimental group there was significant association found between level of labour pain with variables like gravida status (χ2 =4.59) and period of intervention (χ2
=5.83) at p<0.05 level whereas in control group there was no association found between level of labour pain with their selected demographic variables. Hence H2 was retained. Complementary and alternative therapies are the fastest growing areas of healthcare. Music therapy is one of the complementary therapy which is effective in reducing labour pain.
CHAPTER I INTRODUCTION
Music speaks what cannot be expressed, soothes the mind and gives it rest, heals the heart and makes it whole, flows from heaven to the soul.”
Pregnancy is a special event not only in the life of women but also to the entire family, where change occurs early to provide a favourable outcome for both mother and fetus. During pregnancy changes happen in the body to prepare for the events of labour. The ligaments of the pelvis loosen to permit the pelvis to relax and allow the baby to come out. Other changes occur to adapt the body to accommodate childbirth.
Unfortunately, despite these changes will make to feel pain. First labour is probably more painful than subsequent ones.
Labour is said to start when the women get regular contractions. Contractions increase in frequency and intensity throughout labour and become painful in a similar way as the women may experience pain in other muscles in her body when she does vigorous exercise. The delivery of a baby goes through the process of labour. Labour is the series of events by which uterine contractions and abdominal pressure expel the fetus and placenta from the woman’s body (Pillitteri, 2003).
Each labour is unique, differing from one woman to another and even from one labor to the next in the same woman. Pain is a complicated phenomenon only the person in pain can describe what he or she is experiencing and it is the most common reason people seek help from the medical profession.
Pain associated with labour has been described as one of the most intense forms of pain that can be experienced. Everyone knows that labour and delivery can be a painful and sometimes anxiety producing experience for the mother and hospital staff.
The management of labour pain is a major goal of intrapartum care. There are two general approaches, pharmacologic and non pharmacologic. Pharmacologic approaches are directed at eliminating the physical sensation of labour pain whereas non pharmacologic approaches are largely directed at prevention of suffering. Non pharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women.
Complementary medicines focus on the holistic approach to care, which recognizes the interrelationship between body, mind and spirit of each individual.
This is in keeping with the holistic approach of midwifery care.
Music is a magical medium and a very powerful tool. Music can delight all the senses and inspire every fiber of being. Music has the power to soothe and relax, bring the comfort and embracing joy. Music can be a strategy for refocusing attention during a painful experience. By acting as a competing stimulus to pain or distracter, it can reduce the perceived intensity of pain (Gfeller 2003).
Music therapy is the skillful use of music and musical elements by an accredited music therapist to promote maintain and restore mental, physical, emotional and spiritual health. A survey of research involving the application of music therapy in reducing pain and anxiety in hospital patients indicated music was effective in reducing anxiety during normal delivery and had an effect on breathing rate, heart rate, blood pressure, etc. Although the music has an impact on pain perception, researchers recommended music to be offered in medical facilities due to the variance in patient abilities to cope with pain.
Women need information prenatally about the risks and benefits of both pharmacologic and non pharmacologic methods of pain management, and
opportunities to practice in non pharmacologic pain relief methods. (Penny Simkin, 2004)
Many cultures recognize the importance of music and sound as having healing
power. There is a direct link between different parts of the body and specific sounds.
There has been an increase in the demand for non invasive nonthreatening and non pharmacological alternatives for pain and anxiety management during labour and delivery.
Music therapy is becoming increasingly popular as a tool for providing the much needed relaxation to women at the time of labour and delivery. Current research demonstrates and supports the effectiveness of music therapy as a innovative non invasive therapy for healing procedural, acute and chronic pain.
Need for the Study
The control of labour pain and prevention of suffering are major concerns of clinicians and their clients. Only about 10-20% of women do not require some form of pain relief. Since many mothers are unable to carry their labour without assistance and will require some additional pain relief, it is most important that these parturient should not feel frustration at having failed.
Many women would like to avoid pharmacological or invasive methods of pain relief in labour and this may contribute towards the popularity of complementary methods of pain management. Americans spent nearly 34 billion on alternative therapies in 2001 and there were more alternative health care provider than primary health care visits (McFarlin, Gibson, 2003). India spent 27 billion on alternative therapies.
Complementary and alternative therapies are the fastest growing areas of healthcare. The main difference between conventional medicine and complementary
medicine is the inclusion of the emotional, spiritual, and physical components of well- being; complimentary methods utilize the client's own energy to enhance the healing potential. The inclusion of complimentary therapies in maternity care vastly increases the choices available to women throughout pregnancy and childbirth (Tiran & Mack, 2000). Music therapy is one of the best cheapest alternative methods to reduce labour pain.
Music serves as a distracter, music may give the patient a sense of control, music causes the body to release endorphins to counteract pain, and slow music relaxes a person by slowing their breathing and heartbeat (Roberts, 2002).
The use of music therapy used to decrease pain and anxiety. It was used to support a research utilization project to educate nurses on the potential benefits of music therapy among laboring women. Nurses and physicians could collaborate together to educate clients on music therapy to decrease pain and anxiety (Wiand's, 2001).
Music therapy was practiced before, during and sometimes, even after the birth of the child. When the mother focuses her complete attention on the music, her mind gets diverted from the pain and suffering that she is undergoing. During delivery, music helps the mother to concentrate, relax, breathe rhythmically and divert
the mind from focusing on the pain being experienced by her.
Understanding the process of birth and having complete faith in oneself eliminates fear which creates the tension which magnifies the perception of pain.
There has been an increase in the demand for non-invasive, non-threatening and non- pharmacological alternatives for pain-management and anxiety management during labour and delivery.
A single blind controlled trial was conducted to determine the effect of music on pain intensity in primiparous women during the active phase of labor. 60 primiparous women in hajar hospital of Shahrekord were selected by convenience sampling and randomly assigned to two equivalent groups. Data were collected by means of questionnaires and Visual Analogue Scale (VAS). Women in the music group listened to their choice of soft music with earphones (calming or piano) intermittently each 30 minute during the active phase of labour. Comparing between music and control group, to music group had significantly less pain than the control group. The study findings suggest that music can decrease pain during labour. So introduce music as a technique which will make the labour pains tolerable, will decrease its severity without using any drugs, and will decrease unessential caesarean section (Safdari et.al. 2004)
The pain seemed to go on and on, there's no way to avoid these long painful labour process. Making the pain and discomfort bearable, modern obstetrics has something to offer. Music is one of the alternative methods which reduce the pain.
Music therapy is becoming increasingly popular as a tool for providing the much needed relaxation to women at the time of labor and delivery. So the investigator felt that there is a need to evaluate the effectiveness of music therapy on labour pain during active phase of first stage of labour among antenatal mothers.
Statement of the problem
A Study to Evaluate the Effectiveness of Music Therapy on Labour Pain among Antenatal Mothers at Selected Hospitals, Salem.
Objectives
• To assess the post test level of labour pain among antenatal mothers in experimental and control group.
• To evaluate the effectiveness of music therapy on level of labour pain among antenatal mothers in experimental group.
• To associate the level of labour pain among antenatal mothers in experimental and control group with their selected demographic variables.
Operational definition Effectiveness:
It is the significant difference in level of labour pain after music therapy among antenatal mothers in experimental group as observed by Visual Analogue Pain Scale.
Music Therapy :
The classical instrumental Mozart music recorded CD is given to the antenatal mothers at 37completed weeks of pregnancy and instructed them to listen the music daily for 30 mts in their home till delivery, and also the music will be played during labour in the labour room.
Labour Pain:
Refers to the pain experienced by the antenatal mothers during active phase of first stage of labour due to uterine contraction, which is measured through Visual Analogue Pain Scale.
First stage of labour :
It refers to the active phase of labour which starts with 4cm dilatation of the cervix and ends with 8cm dilatation of the cervix.
Antenatal mothers:
A pregnant woman who is at 37 completed weeks of pregnancy attending antenatal clinic at selected hospitals.
Assumptions
• Antenatal mothers may have some knowledge regarding music therapy.
• Music therapy may reduce the labour pain among antenatal mothers.
• Labour pain differs with each woman in labour.
• Music therapy has no adverse effect on antenatal mothers.
Hypotheses
H1: There will be significant difference in the level of labour pain among antenatal mothers in experimental and control group at p<0.05 level.
H2: There will be significant association in the level of labour pain among antenatal mothers of experimental and control group with their selected demographic variables at p<0.05 level.
Delimitation
• The study is limited only to antenatal mothers who are at 37 completed weeks of pregnancy.
• Data collection period is limited to four weeks.
• Assessment of labour pain is limited to first stage active phase of labour
Projected Outcome
This study was conducted to evaluate the effectiveness of music therapy on labour pain among antenatal mothers. Non pharmacological approaches incorporating traditional method may help to reduce the level of labour pain.
Conceptual Framework
The investigator adopted Wiedenbach’s helping art of clinical nursing theory (1964), which describes the desired situation and ways to attain it. It directs action towards the explicit goal. This theory has three factors,
1. Central purpose 2. Prescription 3. Reality Central purpose:
It refers to what the nurse want to accomplish. It is an overall goal towards which a nurse strives.
Prescription:
It refers to the plan of care. It will specify the nature of action that will fulfill the nurse’s central purpose.
Reality:
It refers to the physical, physiological, emotional and spiritual factor that comes into play in situations.
The five realities identified by Widenbach are agent, recipient, goal, mean activities and framework.
The conceptualization of nursing practice according to this theory consists of three steps as follows,
Step-I: Identifying the need for help.
Step-II: Ministering the needed help.
Step-III: Validating that the need for help was met.
Step-I: Identifying the need for help
During labour the women experience pain. The investigator identified the need of complimentary therapy to reduce pain.
Step-II: Ministering the needed help
After identifying the need for music therapy during first stage labour pain, provide the intervention.
Agent : Investigator
Recipient : Antenatal mothers who are in first stage labour pain.
Goal : Reduce the level of labour pain
Mean activities : Provided music therapy for experimental group and no intervention to the control group.
Frame work : Labour room.
Step-III: Validating that the need for help was met It is accomplished by mean of post-test assessment level of labour pain by
using Visual Analogue Pain Scale between experimental and control group after rendering intervention and comparing the effectiveness between the two groups.
Fig-1.1: Conceptual Frame Work Based on Modified Wiedenbach’s Helping Art of Clinical Nursing Theory (1964).
Central Purpose Reduction in level of labour pain
Ministering the needed help
Experimental group Agent: Investigator
Recipient: Antenatal mothers who are in active phase of first stage of labour
Goal: Reduction in level of labour pain
Mean activities: Provide music therapy for experimental group Frame work: Labour room
Post test assessment on level of labour pain among antenatal mothers by using Visual
Analogue Pain Scale Identifying the need for
help
Validating that the need for help was met
STEP-III STEP-II
STEP-I
Evaluate the effectiveness of music therapy on level of labour pain
Experimental group Reduction in level of
labour pain
Control group No reduction in level
of labour pain Control group
Agent: Investigator
Recipient: antenatal mothers who are in active phase of first stage of labour Frame work: Labour room Demographic
variables 1. Age
2. Educational status 3. Occupation 4. Religion 5. Gravida 6. Period of
intervention
7. Weeks of pregnancy at time of delivery
10
Summary
This chapter dealt with introduction, need for the study, statement of the problem, objectives, operational definition, assumptions, hypotheses, delimitations, projected outcome and conceptual framework.
CHAPTER II
REVIEW OF LITERATURE
The task of reviewing research literature for research involves identification, selection, critical analysis and written description of existing information on the topic of interest. It is usually advisable to undertake a literature review on a subject before actually conducting a research project. Such a review can play a number of important roles. (Polit and Hungler, 2003)
Review of Literature of the Present Study is arranged in the Following Headings:
• Literature related to Labour Pain
• Literature related to Music therapy
• Literature related to the effectiveness of Music therapy on Labour pain Literature related to Labour Pain
Larsson.C, (2011) conducted a study to evaluate the impact of personality, socio-demographic and obstetric factors on birth experience among first-time mothers at Sweden. 541 women were prospectively followed from the end of pregnancy until 9 months postpartum. Socio-demographic, psychological and somatic data as well as personality characteristics were collected. Experience of delivery was measured with a visual analogue scale and with Wijma Delivery Experience Questionnaire B. Sixty- three variables were considered to be associated with the experience of delivery.
Nineteen of these, found to be significantly associated with birth experience, were entered in a logistic regression analysis. The logistic regression analysis showed that a memory of pain during birth, high usage of analgesics postpartum, long hospital stay, worry in late pregnancy and high self-rated irritation were related to a more negative birth experience, while high confidence in the midwife was related to a more positive experience. The correlation between experiences of delivery rated by Wijma Delivery
Experience Questionnaire B and the visual analogue scale was 0.52 (p < 0.001). The study concluded that to help women, to cope with pain during and after birth could be an important factor to improve birth experience.
Bahadoran, (2010) conducted a study to assess the effect of labour preparation classes on maternal affect at Isfahan University of Medical Sciences, Isfahan, Iran.
117 samples were selected by convenience sampling, 59 were assigned in experimental group and 58 in control group. Samples of experimental group participated in delivery preparation classes since 20 weeks of pregnancy for 8 sessions. The control group was just received routine pregnancy care. The education was about pregnancy and delivery, physical exercises and relaxation skills.
Questionnaires of vitality and positive affect toward the labor were completed three times, before intervention, after the 8th session and after delivery to 2 weeks later by an interview. Data were analyzed, the study findings revealed that there was a significant difference in vitality and positive affect regarding type of delivery before and after intervention and after delivery in case group(p < 0.0001).There was no significant difference in vitality and positive affect scores after delivery and after intervention (p < 0.083, p < 0.545). There was significant difference in vitality and positive affect scores regarding between case and control groups after the intervention and after the delivery (p< 0.001, p < 0.0001). It concluded that all pregnant women should contribute in delivery preparation classes to improve their mood, confidence, vitality toward labour.
Waldenstrom et.al., (2008) conducted a study to assess the complexity of labour pain among women at Sweden. Samples were selected by convenience sampling. 278 women who gave birth over a period of 2 weeks and those with elective caesarean sections, were asked about their experience of pain 2 days after the
birth. The pain intensity and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. Samples were completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The study finding discussed that there is a difference in the character of childbirth pain compared with pain related to disease.
Tzeng YL, (2008) conducted a study to describe the characteristics of pain during labor at Taiwan. A correlational design with repeated measures was used. 93 women in labor were selected and pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed and the results showed as many as 75.3% of the participants suffered episodes of pain during labour.
The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labour progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labour was muscle soreness and pain. The pattern of pain in 45.71% women was continuous. The women in labour who suffered from low back pain during pregnancy (OR = 3.23; p < .01) and had greater body weight when hospitalized (OR = 1.13; p = .02) were most likely to be in the low back pain group. In conclusion, this study demonstrates pain intensified with the progression of labour, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.
Gross MM, (2005) conducted a study to evaluate the pain and fitness during labour at Germany. 50 samples were selected by convenience sampling. 30 nulliparas and 20 multiparas in term labour indicated pain and fitness every 45 minutes in contraction-free intervals on visual analog scales from 0 to 10. Fitness implied both physical and psychological strength. Data were analyzed cross- sectionally and longitudinally, with adjustment for analgesia and time dependency.
Women received feedback and evaluated their participation on the first day
postpartum. Measurements of pain and fitness ranged from 2 to 22 per woman (mean +/- SD: 7.4 +/- 4.4). Pain scores showed various patterns, mostly increasing
from 1.4 (+/- 1.9) at the first to 6.6 (+/- 3.8) at the last measurement in nulliparas and from 1.3 (+/- 2.1) to 6.2 (+/- 4.0) in multiparas. One half of the women declined steadily in fitness throughout labour, occasionally after a slight increase early on.
Multiparas entered labour more fit (5.9 +/- 3.0) than nulliparas (3.9 +/- 2.7), but showed a sharper decline so that the difference leveled out just before birth. Although fitness at any one time did not reflect pain levels, fitness and pain were inversely related, especially in nulliparas (p = 0.003). This study concluded that analgesia affected pain scores but not the fitness.
Melender HL, (2002) conducted a study to describe the causes, manifestations and factors associated with the fears during labour at Finland. 329 samples were selected by convenience sampling. Questionnaire was used to collect the data which was developed on the basis of semi-structured interviews and previous studies and had a 4-point scale and a dichotomous scale. Data were collected, the effects of various demographic variables were calculated. Of the 329 respondents, 78% expressed fears relating to pregnancy and childbirth. Causes of fears were negative mood, negative stories told by others, alarming information, diseases and
child-related problems, and, in multiparas, negative experiences of previous pregnancy, childbirth, and baby's health. Fears were manifested as symptoms of stress, effects on everyday life, and a wish to have a cesarean section or to avoid pregnancy and childbirth. Women's fears that are associated with pregnancy and childbirth can be explained by different factors. It is important for perinatal health caregivers to ask pregnant women about their feelings related to the current pregnancy, childbirth, and future motherhood, and to give women who express fears an opportunity to discuss them, paying special attention to primiparas and to multiparas with negative experiences of earlier pregnancies.
Ellen Hodnett, (2002) conducted a study to assess women's satisfaction with the experience of childbirth. Samples were selected by convenience sampling. Data collected from them. The study finding revealed that the high proportion of women were aged under 30 (63%) and experiencing their first birth (61.5%). Pain during labour is a more common phenomenon for first births and concluded that primagravida were over-represented in the study participants.
Kabeyama K, Miyoshi M, (2001) conducted a study to investigate various factors affecting the intensity of memorized labour pain at Japan. 196 samples were selected in which 101 were primiparas and 95 were multiparas. Labour pain and related factors, such as physical, psychological and living environmental factors at three periods post-delivery within 24 hours, at 1 month, and in year 1-2. The rate of the high group, whose intensity of memorized labour pain was larger than mean +1SD during the three postpartum phases, was 24%. The rate of the low group, whose intensity of memorized labour pain was smaller than mean + 1SD, was 9.7%. In the high group, the length of labour was longer than that in the low group, the self-control score during labour and delivery was worse and the rate of women with difficult birth
was higher and that for those with low birth weight was lower. This study concluded that the high group obtained more family support but needed a longer time to adjust to childcare.
May AE., Andelton., (2001) conducted a prospective study on labour pain at Leicester Royal University. The study was conducted over a period of 2 months. 100 samples were selected by convenience sampling technique. The pain assessment was carried out by direct questionnairre method using 4 point scale. Data was analysed by descriptive and inferential statistics, the study result showed that the labour is a painful event for every women, 95% of the primipara mothers experienced progressively increasing pain during first stage of labour from mild to severe.
Literature related to Music Therapy
Selvi, (2011) conducted a study to evaluate the effectiveness of music therapy on classroom behavior among mentally challenged children in special schools at Theni. 60 samples were selected by purposive sampling technique. One group pretest post test design was adopted for this study. Pretest was done with the help of behavior rating scale. Music was played daily for 2 hours for 4 weeks and posttest was done.
The study findings reveal that (t=14.32 >11.13, p<0.01 level) music therapy is effective in classroom behavior of mentally challenged children.
Devi, (2011) conducted a study to evaluate the effectiveness of music therapy in reduction of stress among working women at PSG Institute of Health Sciences, Coimbatore. One group pretest post test design was used for this study. 44 samples were selected and pretest was done by using 4 point stress scale. Music therapy was given daily 20 minutes for 3 weeks after that posttest done. The ‘t’ value of physical, psychological, financial, sociological and spiritual stress were 6.79,3.65, 4.24, 6.06,
5.62, p<0.5 level. The study findings reveal that music therapy is effective in reducing stress.
Sherin, (2011) conducted a study to evaluate the effectiveness of music therapy on certain biopsycological parameters among mechanically ventilated patients at Vinayaka missions hi-tech & medical college hospital, Salem. Non equivalent control group pre and post test design was used. 30 samples were selected by purposive sampling among that 20 were assigned to experimental and 10 in control group. Modified behavior assessment tool, faces anxiety scale and vital parameters was used. Pretest was done and music played 20 minutes twice a day for 5 days, after 5th day post test was done. The study findings reveal that (29.76, 22.35 p<0.05 level) music therapy is effective in certain biopsycological parameters.
Stuhlmiller et.al., (2009) conducted a study to evaluate the effect of music during critical care transport on anxiety at urban teaching hospital. In this prospective cohort study, music was played for eligible adult patients during critical care trasport while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not. 102 patients were enrolled, 23 respondents (22.5%) constituted the study group. 4 (17.4%) reported CCT as stressful (average response 4.75). 19 (82.6%) rated CCT as not stressful (average response 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort, relaxation and decrease in anxiety. Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety.
Pietro A.Modesti, (2008) conducted a study to examine the effect of music on blood pressure at University of Florence, Italy. 48 samples aged between 45 and 70 were selected by convenience sampling among 28 were assigned to experimental group and 20 in control group. Experimental group listened to 30 minutes of classical, Celtic and Indian music daily. BP monitoring done before intervention and one and four weeks after treatment. The study results revealed that there is significant systolic BP reduction in those samples who had been listening to music daily (-3.2±5.6 and - 4.4±5.3, p<0.01) at one and four weeks respectively. There is no significant BP reduction in control group. This concludes that music is effective in reducing blood pressure.
Shatin et.al., (2008) conducted a study to examine the effect of music on hypertension at elderly home Hong Kong. 30 subjects aged 63-93 years were selected by convenience sampling and randomly assigned into either a music group (n=15) or a control group (n=15). Subjects in the music group listened to selected music, 25 min every day for 4 weeks. BP was measured twice a week by a registered nurse with a sphygmomanometer during the 4-week study period and after the completion of the study. After 4 weeks, the average decrease for the music group (n=12) in systolic BP and diastolic BP was 11.8 mmHg (p=0.008) and 4.7 mmHg (p=0.218), respectively, whereas in control group there was no significant changes in BP. The study results suggest that listening to a certain type of music serves to reduce high BP and therefore music therapy may be an alternative for hypertension treatment.
Wu SJ Chou, (2008) conducted a study to investigate the effectiveness of music therapy on anxiety in patients on mechanical ventilators at Taiwan. An experimental design was used and all cases were collected from a medical center.
While the experimental group patients took a 30-minute music therapy session,
control group patients were asked to rest. Both facility anxiety and anxiety visual scales were used as research tools, with other non-invasive medical instruments employed to measure heartbeat and breathing, blood pressure and blood oxygen saturation in both patient groups. When compared with the control group, patients in the experimental group showed significant improvement in sense of anxiety (Brief Anxiety Scale, BAS, t(29) = -4.80, p < .001; Visual Analogue Anxiety Scales, VAAS, t(29) = -3.38, p = .002), diastolic pressure (t(29) = -2.74, p = .002), mean arterial pressure(t(29) = -2.26, p = .031) and breathing rate (t(29) = -4.84, p < .001). In analyzing data from the two groups, found that the sense of anxiety (BAS, t(58) = - 3.21, p = .002; VAAS, t(58) = -2.90, p = .005) and breathing rate (t(58) = -3.20, p = .002) in the experimental group decreased significantly following music therapy. This study concludes that music is effective in reduction of anxiety.
Vinodhini, (2007) conducted a Quasi experimental study to evaluate the effectiveness of music therapy in terms of reduction of anxiety and promotion of comfort among the women in labour admitted in Sivakasinadar hospital, Madurai.
Pretest post test control group design was used. 60 samples were selected by convenient sampling, 30 were assigned to experimental and 30 in control group.
Pretest was done. Modified Hamilton general anxiety scale was used to assess anxiety and observational checklist to assess comfort. 30 minutes played music and post test done, after 2 hours interval 30 minutes again music was played and post test done.
The study findings reveal that (t=19.5, p<0.05 level) music therapy is effective in reducing anxiety.
Harmat L and Takacs J, (2006) conducted a study to investigate the effects of music on sleep quality in young participants with poor sleep at Hungary. Three- group repeated measures design was used. 94 students (aged between 19 and 28
years) with sleep complaints were studied. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audio book (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. The study findings revealed a main effect of time (P < 0.0001) and an interaction between time and groups (P < 0.0001).
Post hoc tests with Bonferroni correction showed that music statistically significantly improved sleep quality (P < 0.0001). Sleep quality did not improve statistically significantly in the audio book and the control group. Depressive symptoms decreased statistically significantly in the music group (P < 0.0001), but not in the group listening to audio books. Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy method to treat insomnia.
Literature related to the Effectiveness of Music Therapy on Labour Pain
Angel Rajakumari, (2008) conducted a study to evaluate the effectiveness of music therapy on level of labour pain among primigravid women at Southern Railway Hospital, Chennai. Nonequivalent control group pre test and post test design was adopted. 60 samples were selected by non probability purposive sampling technique, 30 were allotted in experimental group and 30 in control group. Music was given to experimental group. The pre and post test level of labour pain was obtained using a modified combined Numerical pain intensity scale. The findings of the study showed that comparison of pre and post assessment ‘t’ value in session 1 and II was 21.53, 21.05 which were significant at p<0.001 level. It reveals that the women’s pain was reduced after music therapy.
Phumdoung. et.al., (2007) undertaken a factorial randomized control trial study to examine the effect of the combination of small dose analgesic and music on labour pain at Maharaj Nakorn Sri Thammarat Hospital, Thailand. A random block design was used for this study and participants were assigned to each of four groups, control (n=45), small dose analgesic (n=43), regular dose analgesic (n=45), and music plus small dose analgesic (n=47). Women in the control group received standard care in the labour room, women in the small dose analgesic group received intramuscular meperidine 25 mg; women in the regular dose group received intramuscular meperidine 50 mg. Women in the last group received instrumental music combined with small dose analgesic. Women entered the study when cervical dilation was 3-4 cm and contractions lasting 40-60 seconds occurred. The study findings reveal that there were significantly different sensations and distress of labour pain among the four groups [F(3,176)= 3.651, p<.05, power .80 and F(3,176)=4.888, p<.01, power .90 respectively]. Pairwise comparisons showed that the regular analgesic group and the music plus small dose analgesic group had lower sensation of pain and distress of labour pain than the control group. The study results suggest that the use of music together with small amounts of analgesic can decrease labour pain, similar to the use of regular doses of an analgesic drug alone.
Safdari et.al., (2004) conducted a single blind controlled trial to determine the effect of music on pain intensity among primigravid women during the active phase of labour at hajar hospital, Shahrekord. 60 samples were selected by convenience sampling and randomly assigned to two equivalent groups. Data were collected by means of questionnaires and Visual Analogue Scale (VAS). Women in the music group listened to their choice of soft music with earphones (calming or piano) intermittently each 30 minute during the active phase of labour. Comparing
between music and control group, music group had significantly less pain than the control group. The study findings suggest that music can decrease pain during labour.
So introduce music as a technique which will make the labour pain tolerable, will decrease its severity without using any drugs, and will decrease unessential caesarean section.
Satiston (2003) conducted a randomized controlled trial to examine the effects
of music on sensation and distress of pain among primiparous women during the active phase of labor at Thaiwan. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music for 3 hours starting early in the active phase of labour. Dual visual analogue scales were used to measure sensation and distress of pain before starting the study and at three hourly post tests.
While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p < .001, effect size = .15, and F (1, 107) = 14.87, p < .001, effect size = .12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p < .001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p < .05). This study reveals that music provided significant relief of severe pain across 3 hours of labour and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to labouring women for greater pain relief during the active phase when contractions are strong and women suffer.
Summary
This chapter dealt with related literature was reviewed and organized by studies related to labour pain, music therapy and effectiveness of music therapy.
CHAPTER III METHODOLOGY
The methodology of research indicates the general pattern of organizing the procedure for gathering valid data for the purpose of investigation. (Polit and Hungler, 2003)
The present study aims to evaluate the effectiveness of music therapy on labour pain among antenatal mothers at selected hospitals, Salem.
Research Approach
Quantitative Evaluative Research Approach was adopted for this study.
Research Design
Quasi experimental involves the manipulation of an independent variable.
Quasi experiments lack either randomization or control group feature that characterizes true experiments. (Polit and Hungler, 2003)
Quasi experimental post- test only control group design was used in this study, to evaluate the effectiveness of music therapy on labour pain among Antenatal Mothers.
E X O1 O 2 O 3 O4
C O 1 O 2 O 3 O4
E : Experimental group.
C : Control group.
X : Music therapy
O1: Observation at first hour O2: Observation at second hour O3: Observation at third hour O4: Observation at fourth hour
Figure-3.1: Schematic Representation of Research Methodology Research Design
Quasi Experimental Design
Population Antenatal Mothers
Experimental group St.Mary’s Hospital, Salem
Control group
Saraswathi Nursing Home, Salem
Sample
Antenatal Mothers at 37 completed weeks of pregnancy
Experimental group (n = 30)
Control group (n = 30)
Tool
Visual Analogue Pain Scale
Data Collection Procedure Structured interview schedule
Experimental Group Post-test
Control Group Post-test Demographic variables
1. Age
2. Educational status 3. Occupation 4. Religion 5. Gravida
6. Period of intervention 7. Weeks of pregnancy at
time of delivery
Data analysis
(Descriptive and Inferential Statistics) Setting
Selected Hospitals, Salem Non probability convenience sampling
technique
Intervention (music therapy)
No intervention
Population
The population under this study includes all normal antenatal mothers. The normal antenatal mothers were selected depending on the availability and who fulfill the inclusive criteria.
Description of the Setting
Setting is the location and condition in which data collection takes place for the study. (Polit and Hungler, 2003).
The antenatal mothers were selected from St.Mary’s Hospital and Saraswathy Nursing Home. St.Mary’s hospital is located at 4 roads, Salem. 1 km from New Bus stand and Saraswathy nursing home is situated at Ramakrishna Road, Salem, 3 kms away from New Bus stand. The investigator visited the antenatal mothers in the hospital.
Sampling
Sampling refers to the process of selecting the portion of population to represent the entire population. (Polit and Hungler, 2003)
Sample:
Sample of the study was normal antenatal mothers at 37 completed weeks of pregnancy selected hospitals, Salem.
Sample Size:
Sample size was 60 normal antenatal mothers, 30 in experimental group and 30 in control group.
Sampling technique:
The samples were selected using Nonprobability convenience sampling technique.
Criteria for selection of sample
Inclusion criteria:
Antenatal mothers who,
¾ are at 37 completed weeks of pregnancy
¾ are able to access CD player
¾ singleton pregnancy
¾ willing to participate in the study Exclusion criteria:
Antenatal mothers who,
¾ have history of high risk pregnancy
¾ are undergoing elective LSCS
¾ have auditory defect Variables
Independent variable: Music therapy.
Dependent variable: Level of labour pain.
Demographic variables: Age, educational status, occupation, religion, gravida, period of intervention, weeks of pregnancy at the time of deliv ery.
Description of Tool
The Visual Analogue Pain Scale was selected by the investigator with the guidance of experts.
The tool for collection of data consists of two sections. Section A and Section B.
Section-A:
The structured interview schedule was used to collect demographic variables.
Section-B:
It consists of Visual Analogue Pain Scale to assess the level of labour pain.
Scoring Procedure:
Table- 3.1 : Scoring Procedure
0 No pain
1-3 Mild pain
4-6 Moderate pain
7-9 Severe pain
10 Worst possible pain
Level of labour pain was assessed after each intervention. The samples were asked to place a score between 0-10 according to their level of labour pain.
Validity and Reliability of the Tool Validity:
Validity refers to the degree to which an instrument measures what it is supposed to be measured. (Polit and Hungler, 2003)
Validity of the tool was established with the consultation of the guide and experts. The tool was validated by the Experts from various fields like Medicine, Nursing and Music. The tool was found adequate and minor suggestions in demographic variables given by the experts were incorporated.
Reliability:
Reliability of an instrument is the degree of consistency with which an instrument measures an attribute (Polit and Hungler, 2003)
Reliability of the tool was established by implementing the tool on antenatal mothers among which three were experimental and three were control group. By
interrater method the reliability was found r1= 0.99, which indicates reliability of the tool. Hence the tool was considered for proceeding.
Pilot Study
The researcher conducted the pilot study in Sri Gokulam Hospital, Salem from 27.06.10 to 3.07.10 in order to find out the feasibility of the study. Prior permission was obtained from Dr.K.Arthanari, Managing Trustee Sri Gokulam Hospital, to conduct the study.6 samples were selected by non-probability convenience sampling method. Verbal consent was obtained from the samples. 3 of them were assigned to experimental group and 3 of them were in control group. Mozart music recorded CD was given to the samples of experimental group during antenatal visits in OPD.
During labour, music was played intermittently 30 minutes, for 4 times. Labour pain was assessed for every 1 hour with the help of Visual Analogue Pain Scale. The researcher did not find any difficulties during the pilot study. Hence it was continued in main study.
Method of Data Collection Ethical consideration:
Prior permission was obtained from Administrator, St.Mary’s Hospital and Saraswathy Nursing Home, Salem. Verbal consent was obtained from the samples, who are willing to participate in the study.
Data collection procedure:
Data collection was done for a period of 4 weeks from 13.07.11 to 06.08.11 in St.Mary’s Hospital and Saraswathy Nursing Home, Salem. The investigator selected 60 samples from OPD by non probability convenience sampling, 30 were assigned to experimental group and 30 in control group. Mozart music recorded CD and checklist was given to the samples of experimental group and instructed to hear the music daily
for 30 minutes till their delivery and document the procedure. During labour also the music was played by the investigator intermittently 30 minutes, 4 times. The post test was done by using Visual Analogue Pain Scale during active phase of first stage of labour every 1 hour starts from 4cm dilatation ends with 8cm dilatation.
Plan for Data Analysis
A master data sheet was prepared from the responses given by the samples and the data was analyzed using statistical methods such as descriptive analysis using frequency and percentage distribution and inferential analysis.
Summary
This chapter consists of research approach, research design, population, description of the setting, sampling, variables, and description of the tools, validity and reliability, pilot study, method of data collection, and plan for data analysis.
CHAPTER 1V
DATA ANALYSIS AND INTERPRETATION
Analysis is a process of organizing and synthesizing data in such a way that questions can be answered and the hypothesis can be tested. (Polit and Hungler, 2003)
This chapter deals with the description of music therapy on labour pain. Data was collected from 60 samples (30- experimental group and 30 control group) at selected Hospitals, Salem. Quasi experimental Post test only control group design was used. The samples were selected using Non Probability convenience sampling technique. Music therapy was given to the experimental group whereas it was not implemented in the control group. Labour pain assessment was done for both experimental and control group. The collected data was organized, coded, calculated and analyzed as per objectives of the study under the following headings:
Section-A: Distribution of samples according to their selected demographic variables in experimental and control group.
Section-B: Comparison of level of labour pain among samples in experimental and control group.
Section-C: Mean, Standard deviation and Mean difference on level of labour pain among samples in experimental and control group.
Section-D : Hypotheses Testing
a. Effectiveness of music therapy on labour pain among samples in experimental and control group.
b. Association on level of labour pain with their selected demographic variables in experimental and control group.
Section - A
Distribution of Samples According to their selected Demographic variables in Experimental and Control group.
Table 4.1:
Frequency and percentage distribution of samples according to their
demographic variables.
(n=60)
S.No Demographic variables
Experimental group (n=30)
Control group (n=30) Frequency % Frequency % 1 Age of the mother
a) 20-25 years b) 26-30 years c) 31-35 years
14 12 4
46.66 40 13.33
17 10 3
56.66 33.33 10 2 Educational status
a) No formal education b) Primary school c) High school
d) Higher secondary school e) Graduate
f) Post graduate
- 3 12
9 6 -
- 10 40 30 20 -
- 11
8 6 5 -
- 36.66 26.66 20 16.66
- 3 Occupation
a) Home maker b) Private employee c) Government employee d) Self employee
21 7 2 -
70 23.33
6.66 -
26 3 1 -
86.66 10 3.33
- 4
Religion a) Hindu b) Christian c) Muslim d) Other
15 10 5
-
50 33.33 16.66
-
19 6 5 -
63.33 20 16.66
- 5 Gravida
a) Primi b) Second
25 5
83.33 16.66
22 8
73.33 26.66 6 Period of intervention
a) 1 week b) 2 weeks c) 3 weeks
17 13 -
56.66 43.33
-
- - -
- - - 7 Weeks of pregnancy at the
time of delivery a) 39 weeks b) 40 weeks c) 41 weeks
16 14 -
53.33 46.66
-
12 14 4
40 46.66 13.33
The above table shows that in experimental group 14(46.66%) samples belong to age group of 20-25 years, 12(40%) of them had high school education, 21(70%) of them were homemakers, 15(50%) of the samples were Hindus, 25(83.33%) were primi gravid women, 17(56.66%) of them had the intervention for 1 week, and 16(53.33%) samples were in 39 weeks of pregnancy during delivery.
In control group 17(56.66%) samples belong to the age group of 20-25 years, 11(36.66%) of them had primary school education, 26(86.66%) of them were homemakers, 19(63.33%) of the samples were Hindus, 22(73.33%) were primi gravid women, 14(46.66%) samples were in 40 weeks of pregnancy during delivery.
Section – B
Comparison of Level of labour pain among samples in experimental and control group
100 100
43.33 56.66
0 10 20 30 40 50 60 70 80 90 100
O1 O2 O3
Level of Labour Pain in Experimental Group
Percentage of samples
Severe Moderate
Figure-4.1: Percentage distribution of samples according to their level of labour pain in experimental group
The above figure shows that in experimental group during O1 and O2 all (100%) samples had moderate pain. 13(43.33%) had moderate pain and 17(56.66%) had severe pain during O3.
O1- Observation -1 O2- Observation -2 O3- Observation -3
100 93.40
10 6.60
90
0 10 20 30 40 50 60 70 80 90 100
O1 O2 O3
Level of Labour Pain in Control Group
Percentage of samples
Severe Moderate
Figure-4.2: Percentage distribution of samples according to their level of labour pain in control group
The above figure shows that in control group during O1 all (100%) samples had moderate pain. 28(93.4%) had moderate pain and 2(6.6%) had severe pain during O2. 3(10%) had moderate pain and 27(90%) had severe pain during O3.
O1- Observation -1 O2- Observation -2 O3- Observation -3
Fig-4.3: Percentage distribution of samples according to their level of labour pain in experimental and control group.
The above figure shows that during O1 all (100%) samples had moderate pain in both experimental and control group. All (100%) samples had moderate pain in experimental group whereas in control group 28(93.4%) of them had moderate pain and 2(6.6%) had severe pain during O2.
During O3 13(43.33%) of them had moderate pain and 17(56.66%) had severe pain in experimental group whereas in control group 3(10%) of them had moderate pain and 27(90%) had severe pain.
It shows that pain increases with the labour process but it is less among experimental group than the control group.
Level of Labour Pain
Section –C
a) Mean, Standard deviation and Mean difference on level of labour pain among samples in experimental and control group.
Table 4.2:
Mean, Standard deviation and Mean difference of samples in Experimental and Control group.
(n=60)
Observation
Experimental group (n=30)
Control group (n=30)
Mean difference
Mean SD Mean SD
O1 4.07 0.37 4.13 0.51 0.06
O2 5.67 0.76 6.07 0.64 0.40
O3 7.13 1.01 7.87 0.51 0.74
The above table shows that in experimental group during O1 labour pain mean score is 4.07+0.37 whereas in control group it is 4.13+0.51. During O2 labour pain mean score is 5.67+0.76 in experimental group whereas in control group it is 6.07+0.64. During O3 labour pain mean score is 7.13+1.01 in experimental group whereas in control group it is 7.87+0.51. The mean difference shows that music therapy was effective in reducing labour pain among antenatal mothers.
Section - D Hypotheses Testing
a) Effectiveness of music therapy on level of labour pain among samples in experimental and control group
Table 4.3:
Mean, standard deviation and independent ‘t’ value of samples on labour pain during O1, O2, andO3.
(n=60)
Observation
Experimental group (n=30)
Control group (n=30)
‘t’ value
Mean SD Mean SD
O1 4.07 0.37 4.13 0.51 0.58
O2 5.67 0.76 6.07 0.64 2.21*
O3 7.13 1.01 7.87 0.51 3.56*
* significant at p<0.05 level. df-58, table value-2.01.
The above table reveals that in experimental and control group O1 calculated
‘t’ value is 0.58 whereas O2 and O3 the calculated ‘t’ value are 2.21 and 3.56 which is significant at p<0.05 level. Hence the stated hypothesis H1 is retained only O2 and O3
and concluded that Music therapy is significantly effective in decreasing the level of labour pain among samples.
b) Association on level of labour pain among samples with their selected demographic variables.
Table 4.5 : Association on level of labour pain among samples in experimental and control group with their selected demographic variables.
(n=60)
Sl.
No Demographic variables
Experimental
group (n=30) Table value
Control group (n=30)
df χ2 df χ2
1 Age of the mother 2 0.814 5.99 2 4.16
2 Educational status 3 0.249 7.82 3 1.25
3 Occupation 2 0.814 5.99 2 0.33
4 Religion 2 0.679 5.99 2 1.24
5 Gravida 1 4.588 3.84 1 0.78
6 Period of intervention 1 5.13 3.84 - -
7 Weeks of pregnancy at the time of delivery
1 3.09 3.84 2 3.15
*significant at p<0.05 level.
The above table shows that there is a significant association between level of labour pain among samples in experimental group with their selected demographic variables gravid and period of intervention whereas in control group there is no significant association between level of labour pain and all selected demographic variables. Hence H2 is retained only in case of gravida status and period of intervention and no significant association was found with other demographic variables.
