CHAPTER- II

REVIEW OF LITERATURE

The review of related literature is a essential aspects of scientific research. Its entails the systematic identification, reflection, critical analysis and reporting of existing information in relation to the problem of interest. The purpose of review of literature is to obtain comprehensive knowledge and in depth information about the effectiveness of ambulation on improve maternal comfort reduction of pain perception, outcome of labour during first stage of labour.

The purpose of review literature is to obtain comprehensive knowledge and in depth information about the effectiveness of ambulation on maternal comfort, pain perception &outcome of labour.

The literature gathered from exclusive review is depicted under the following heading.

• Section A: Literature related to pain perception during first stage of labour.
• Section B: Literature related to various maternal positions for maternal comfort, pain perception and outcome of labour during first stage of labour.
• Section C: Literature related to ambulation to improve maternal comfort, outcome of labour and reduce pain perception.
• Section D: Literature related to non pharmacological pain relief methods during first stage of labour for maternal comfort, pain perception and outcome of labour.

Section A: Literature related to pain perception during first stage of labour.

Campbell & Kurtz (2004) conducted a descriptive study characterized the labour pain at two stages of cervical dilatation with selected group 78 labouring mothers and compared the pain experienced at 2 stages of dilation(2-5 cm and of 6-10 cm) with women in Greenville. Stage’s of pain measured by Visual Analogue Scale, Present Pain Intensity, and the McGill Pain Questionnaire, and 1 observational measure, the nurse-rated Behavioural Index of Pain. The study results revealed that there was significant increase in pain with increased dilation occurred for all mothers both prim and multigravidas. He concluded that labour pain was equalin primi gravida than the multigravidas.

Lopez & Pires (2000) conducted the randomized control trail study was designed to evaluate the relationship between the parturients position and her abdominal and lumbar (continuous and contraction) pain during the first stage of labour. A homogeneous group of 100 parturients was selected in obstetric department of a general hospital, Argentina. Samples were randomly assigned to alternately assume the horizontal or the vertical position for 15-min periods. Positions were safely selected by the parturients. Thus, the mother adopted (a) a self-elected position, (b) recumbent (or erect), (c) a self-elected position, (d) erect (or recumbent), and so on. Pain intensity was measured by the Argentine Pain Questionnaire’s Present Pain Intensity and the Huskisson’s visual analogue scale. The findings revealed that a majority of parturients felt less abdominal and lumbar pain, either continuous or due to contractions, during recumbency. The effect was more remarkable when dilation exceeded five cm and less intense during the first half of the first stage of labour. He concluded that position may helpful to reduce the pain level during first stage of labour.

Mikolajczyk, Sundaram & Beaver Fraser (2010) conducted a survey study in aimed to examine labour patterns in a large population and to explore an alternative approach for diagnosing abnormal labour progression. The study were selected total of 26,838 parturient, who had a singleton term gestation, spontaneous onset of labour, vertex presentation, and a normal prenatal outcome in Maryland. An interval-censored regression method was used .The results revealed that Nulliparous women had longest and most gradual labour curve and start the active phase after 5 cm of cervical dilation and may not necessarily have a clear active phase and multiparous women of different parities had very similar curves. Researcher concluded that active phase of labour may not start until 5 cm of cervical dilation in multiparous and even later in nulliparous and after 6 cm dilatation only the progress in all pregnancy during labour .

Niven & Gijsbers (2004) conducted the exploratory study aimed to examine the nature, origin, and effectiveness of pain coping strategies used during childbirth with 51 British women was assessed around the time of birth. Pain was measured by visual analogue scales and the McGill Pain Questionnaire. Analysis of data obtained in an extended semi-structured interview. Subjects were found to use a range of strategies during labour, many of which they had previously used to cope with pain. In findings that the total number of strategies used in labour was negatively correlated with levels of labour pain.

Section B: Literature related to various maternal positions for maternal comfort, pain perception and outcome of labour during first stage of labour

Andrews CM & chrzanowski (1985) Conduct a randomized clinical trial to evaluate the maternal comfort by providing various upright positions in 40 labouring women’s randomly assigned to either upright recumbent position. During the phase of maximum slope of labour. When the cervical dilatation from 4cm to 9cm,Every hour during the phase of maximum slope. The investigator examined each sample vaginally to determine her cervical dilatation and assessed her level of comfort by using maternal comfort assessment tool the women in upright position group had significantly shorter phase of maximum slope of in labour and facilitating uterine contractions & increasing comfort to the mother.

Bauer et al (1987) Conducted a comparative study to assess the effects of standing position and supine position on spontaneous uterine contractions and other aspects of labour in twenty normal term mothers they were given by standing and supine position vice versa with the time duration of thirty minutes the investigator examined each sample every thirty minutes for cervical dilatation and pain perception. The investigator found that the intensity of contractions was significantly higher in fifteen out of twenty mothers in standing position frequency of contraction diminished and Reduced duration of labour .the investigator concluded that there is no adverse effects and complications in standing position during labour.

Carlson (1999) in an article a study by providing different maternal positions to evaluate the comfort status foetal out come &duet ion of labour. In eighty primigravida uncomplicated mothers. The positions chosen by mothers. The investigator found that the different positions improved maternal comfort & foetal out come. & reduce length of labour.

Chen shin-zon (2003) in an article stated that a study to assess the effectiveness of sitting position on labour pain during first stage of labour .the investigator found that in sitting position the increased resting pressure in the sitting position is of some importance in the supplementing the down ward delivery force and increasing bearing down pressure in the sitting position could help to significantly shorten the duration.

Gupta et al (2000) In an article stated study To evaluate the safe birth good maternal & foetal out come by providing upright positions at Birmingham women’s hospital Edgbaston, UK the positions adopted natively by women during birth has been described as early 1882 by Engel am. The investigator found that by providing various upright positions [like holding Rope , birthing chair , unfeeling, squatting]the mother will have safe birth decreased perinatal problems.

Liu (2003) conducted a descriptive study to evaluate the reduce duration of labour by providing up right positions in 68 primi gravida mothers between the age of 18 to 25 years were assigned to three groups . One group used a 30 degree upright position with no bearing down instructions and second group used a 30 upright position with bearing down instructions the investigator found that the upright position enhanced the descent head with shorter duration of labour in both first and second stage of labour.

May berry et al (2003) in an article stated descriptive study to evaluate the facilitating progress of labour by providing various upright positions. At New York university. The study sample is 74 labouring healthy women. Providing upright positions for all women. The investigator founded that facilitating progress of labour reduction of vaginal bleeding improve neonatal out come.

Miquelutti et al(2007) conducted a explanatory