Marwa 2

Academic Journal of Nursing and Health Education
Vol.9, No.1, 2020;

ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
EFFECT OF IMPLEMENTING OBSTETRIC FINE NURSING CARE ON

WOMEN’S CHILDBIRTH SATISFACTION, SELECTED OBSTETRIC
OUTCOMES AND POSTPARTUM RECOVERY
1
Marwa A. Shahin, 2Eman Seif Ashour, 3Wafaa Aljohani, 4Mai M. Yaseen
1
Assistant professor of Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Egypt
1
Associate professor of Maternal and Newborn Health Nursing, Batterji Medical College for Science and Technology, KSA
2
Lecturer of Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Egypt
3
Assisstant professor of Medical Surgical &Critical Care Nursing, Faculty of Nursing, King Abdul Aziz University, KSA
3
Assisstant professor of Medical Surgical &Critical Care Nursing at Batterji Medical College for Science and Technology, KSA
4
Assisstant professor of Nursing Administration at Batterji Medical College for Science and Technology, KSA
Abstract: Fine care is a personalized approach of care involves guidance and intervention based on the woman’s
psychological, physical and social needs taking into consideration woman culture and the surrounding environment of
maternity. Aim: The study aimed to investigate the effect of implementing obstetric fine nursing care on women’s
childbirth satisfaction, selected obstetric outcomes and postpartum recovery. Method: A quasi-experimental research
design (case/control) was utilized to achieve the aim of the study. Settings: This study was conducted at obstetrics and
gynecology departments affiliated to University Hospital and Shebin El-Kom teaching hospital, Menoufia Governorate,
Egypt. Sample: Purposive sample of 180 women admitted to labor room were recruited in the study. Instruments: Four
instruments were used for data collection: A structured interviewing questionnaire, Numeric Pain Intensity scale,
Questionnaire to assess clients’ satisfaction(CliSQ) and Apgar score. Results: The study revealed that there was
statistically significant differences between obstetric fine nursing care and routine care group regarding women’s
childbirth satisfaction, selected obstetric outcomes and postpartum recovery. Conclusion: Women who received obstetric
fine nursing care during labor and postpartum period had higher level of childbirth satisfaction, better selected obstetric
outcomes and early postpartum recovery than women who received only routine hospital care. Recommendations:
Integrating obstetric fine nursing care into care of woman during childbirth and early postpartum period. Provide
continuous training for maternity nurses regarding application of obstetric fine nursing care during childbirth and
postpartum period. Further studies should be conducted to apply and demonstrate the research on a larger population for
generalization of the results.
Keywords: fine nursing, childbirth satisfaction, postpartum recovery
1.INTRODUCTION involves deep physical, psychological, and emotional

In every woman’s life who encountered impacts. However, this event is highly associated with
pregnancy, delivery is a uniquely important event that labor pain, psychological strain, vulnerability, social

An official Publication of Center for International Research Development
Double Blind Peer and Editorial Review International Referred Journal; Globally index
Available @cirdjounals.com/AJNHE: E-mail: ajnhe@cirdjournals.com
pg. 1
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
change, physical changes and rarely could lead to death and fear of giving birth again, which may lead to a
(1)
. Every woman perceive and expect childbirth preference for cesarean birth in future pregnancies and
differently, and varied according to the woman level of cause impacts on reproduction (8). The study conducted by
knowledge, experience, belief, culture, social and family Mirmolaei et al. (2008) (9) in Tehran University of
backgrounds (2). Here comes the responsibility of Medical Sciences showed that most of the mothers were
maternity nurses and midwives to provide individualized fully satisfied with the manner of receiving three kinds of
care of each mother in delivery while considering these support (informational, emotional and physical).
differences to provide the right fine care. Fine care is a As highlighted in the World Health Organization
personalized approach of care involves guidance and (WHO) framework of a holistic, human rights-based
intervention based on the woman’s psychological , approach to achieve the desired person-centered
physical and social needs taking into consideration outcomes, it is necessary to ensure the experience of
woman culture and the surrounding environment of women care during childbirth is important to any
maternity (3). necessary clinical interventions to optimize the quality of
Petronella et al. (2018)(4) stated that maternity nurses care provided to the woman. However, the experience of
and midwives should be familiar with women’s care considered a non-clinical intrapartum practices
emotional, physical and informational needs and added involved emotional support through labor, effective
that good interpersonal relationships between laboring communication and respectful care. Although, these
women and care providers could reduce fear associated practices are inexpensive to implement, there are
with childbirth and subsequently contribute to a regarded as priorities in many settings (6).
satisfactory birth experience. According to Public Health Ibone et al. (2017) (10), stated that maternity nurses
Agency of Canada (2018) (5), the overall aim of caring for and midwives require a deep understanding of the
women during labor and birth is to ensure a positive emotional aspects of childbirth in order to meet the
experience for women while maintaining their health and emotional and psychosocial needs of laboring women and
the health of their babies, preventing complications and added that several factors enhances a positive birth
responding to emergencies. experience of women during childbirth including having a
World Health Organization (WHO) (2018) (6) sense of control during birth, providing the opportunity of
recognizes that every women undergoing labor will active involvement in care and support, and responsive
achieve the significant end point labeled as a “positive care from relatives and care providers during childbirth
childbirth experience”. The term positive childbirth .Lack of maternity nurses knowledge about the
experience defined as one that involve delivering a psychological dimensions of childbirth can lead to
healthy baby in a clinically and psychologically safe mismanagement of the birthing process, in which a
environment with the continuum of practical and woman may experience a traumatizing birth that can be
emotional support from a competent clinical staff. overwhelming (10).
Women who encountered fewer difficulties in caring for Effective communication is considered important
newborn and tend to breastfeed their babies for long part in care of women during childbirth. A recent review
periods and adapt easily with the new motherhood of the importance of communicating with women during
functions were actually satisfied during childbirth (7). childbirth concluded that the way caregivers relate with
Dissatisfaction with childbirth increases the risk of the laboring women impacts the woman’s experience of
negative health outcomes, such as postpartum depression birth. The review identified a number of important themes
pg. 2
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
to do with communication. The first is that women value as possible (15). Breastfeeding care is conducive to help
being treated as individuals, with respect and care. The women learn the correct feeding posture, and reduce the
second is that most women need information and discomfort caused by improper feeding (3).
explanations if they are to feel guided and supported Searching the literature indicates that studies about
throughout the birth. The review findings is summarized obstetric fine nursing care in relation to childbirth
in the words that the interviewed women used to describe satisfaction, obstetric outcomes and postpartum recovery
the feelings that encompassed a positive birth experience: are very limited. Therefore, this present study was
caring, considerate, understanding, competent, conducted to investigate the effect of implementing
trustworthy, empathic, tender, kind, friendly, calm, alert, obstetric fine nursing care on women’s childbirth
peaceful, and unhurried and concluded that “women want satisfaction, selected obstetric outcomes and postpartum
to receive information and assistance, to be involved, to recovery.
feel safe and secure, to feel at ease and to be able to be 1.2.Aim of the Study: This study aimed to investigate
themselves (5). the effect of implementing obstetric fine nursing care on
Maternity nurses can positively affect a laboring women’s childbirth satisfaction, selected obstetric
woman’s comfort and labor progress through the use of outcomes and postpartum recovery.
non-pharmacological nursing strategies which fall under 1.3. Research Hypothesis:
four categories: physical, emotional, - Women who will receive obstetric fine nursing
instructional/informational, and advocacy in addition to care during labor and immediate postpartum
the implementation of these strategies requires special period will have higher level of childbirth
knowledge and a commitment to the enhanced physical satisfaction than women who will receive routine
and emotional comfort of laboring women (11). hospital care.
1.1.Significance of Study - Women who will receive obstetric fine nursing
Various problems may result from childbirth, such care during labor will have better selected
as pain, poor postpartum recovery and many other obstetric outcomes than women who will receive
problems therefore, mothers need fine care. Guidance, routine hospital care.
care and support involved with fine care including - Women who will receive obstetric fine nursing
psychological care, physical care; behavioral care, dietary care during the immediate postpartum period will
guidance, pain care and breast feeding care. have early postpartum recovery than women who
Psychological nursing care can effectively suppress will receive routine hospital care.
negative emotions such as fear and depression. It is 2. METHOD
expected that with fine care women will have a positive 2.1. Research Design: A quasi-experimental research
and optimistic attitude. In addition, incidence of design (case/control) was utilized to achieve the aim of
postpartum depression will be reduced (12). the study.
Dietary guidance can help maternal nutrition, 2.2. Research settings: This study was conducted at
promote lactation and enhance neonatal immunity (13). obstetrics and gynecology departments affiliated to
Whilst behavioral care; helps maternal uterine University Hospital and Shebin El-Kom teaching
contractions, promotes blood stasis elimination, and hospital, Menoufia Governorate, Egypt.
wound healing (14). Moreover, pain care can alleviate 2.3. Sample: Purposive samples of 180 women admitted
patient pain and repair trauma during childbirth as early to labor room were recruited in the study.
pg. 3
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
2.4. Sample size calculation: C- Data about the postpartum recovery was the
The sample size was calculated at power 80%, confidence occurrence of postpartum pain, sleeping pattern, lactation
level 95% and margin of error 5%. It was 180 women. pattern and occurrence of postpartum hemorrhage.
The following equation was used: Instrument II: Numeric Pain Intensity Scale: It was
- SS=Z2*P* (1-P)/M2 adopted from National Institutes of Health (2003) used to
- SS= (z-score) 2*P * (1-P)/ (margin of error) 2 assess the degree and severity of pain. It is 0 to 10 pain
- SS= Sample size for infinite population. scale. The values on the pain scale correspond to pain
- Z=Z- value= 1.96 for 95 % confidence level. levels as follows: 1 – 3 = mild pain, 4 – 6 = moderate
- P= Population proportion (expressed as decimal) pain, 7 – 10 = severe pain (17) .
(assumed to be 0.5(50%) Instrument III: Questionnaire to assess clients’
- M= Margin of error at 5% (0.05) satisfaction (CliSQ) (18). It was adopted from Simbar et al.,
- SS adjusted = (SS)/ (1+ (SS-1)/population) 2009 to assess the women satisfaction and contained 39-
- Sample Size (n) for 95% confidence levels was 180 items which measures three aspects of satisfaction:
women (16). environment condition, care procedures and provided
The study sample was divided into two similar groups. education. Total scores are changed into percentages of
The first group (obstetric fine nursing care group) 0–39, 40–59 and 60–100 are used to represent
includes those who received obstetric fine nursing care, dissatisfaction, neutral, and satisfaction respectively.
whilst the second group (routine care group) includes Validations of psychometric measures were relatively
those who received only routine hospital care. Subjects limited. Content and face validity were done, There is
who met the following inclusion criteria were recruited in many evidence of the construct validity of the measure as
this study: there was correlation (r = 0.28) between women’s desired
 Primigravida. care and their satisfaction with care. The total scale
 No history of drug allergy. showed high reliability (α = 0.74).
 Without medical diseases. Instrument IV: Apgar score : This is a simple method to
 Without pregnancy complications. assess the condition of newborn, performed at the first
 Without cesarean section indications. and five minutes of fetal expulsion. It is based on
 On labor (first stage of labor; active phase). assessment of five physical signs, namely heart rate,
2.5. Date collection instruments: respiratory effort, reflex irritability, muscle tone, and
Instrument I: A structured interviewing questionnaire color. The total score ranges from 0 to 10 ; newborn score
developed by the researchers was used to assess the from 7 to 10 indicates good newborn condition. A score
socio-demographic data, selected obstetric outcomes from 4 to 6 indicates moderate newborn condition, and
during labor and postpartum recovery: from 0 to 3 indicates very bad newborn condition(19).
A- Socio-demographic data of the study women includes 2.6. Validity: The content validity of the instruments was
age, educational level, occupation, residence and income. ascertained by a group of subject area experts, medical
B- Obstetric outcomes during labor as the mode of and nursing staff who reviewed the instruments for
delivery, length of first stage of labor, length of second content accuracy. Also, they were asked to judge the
stage of labor. items for completeness and clarity. Suggestions were
considered and modifications were made.

pg. 4
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
2.7. Reliability: Test – retest reliability was applied by researchers divided them into two groups, Obstetric fine
the researchers for testing the internal consistency of the nursing care group and routine care group. The
instruments. It refers to the administration of the same researchers filled the questionnaire regarding socio-
instruments to the same subjects under similar conditions demographic data and obstetric history at the interview
on two or more occasions. Scores from repeated testing settings.
were compared. Step 2: Implementation of obstetric fine nursing care:
2.8. Pilot Study: Pilot study was carried out before The intervention included application of obstetric fine
starting data collection; this was done to estimate the time nursing care to obstetric fine nursing care group. the
required for filling out the instruments and also to check researchers performed the following:
the clarity, applicability, relevance of the questions. The During labor:
pilot study was conducted on10% of total sample (18  Regarding to the psychological and mental needs:
women). Based on the results of the pilot study, the  Communication: The researchers practiced effective
necessary modifications were carried out. communication with the participating women to
2.9. Ethical considerations: Official letters from the establish and maintain a good relationship with
Dean of Faculty of Nursing in Menoufia University has them. It aimed at reducing the fear, pessimism
been sent to the involved hospitals authority, and and anxiety of the normal labor. The researcher
approval for conducting the study was obtained. An follow communication guidelines during labor
informed consent to participate in the current study was and birth adopted from National Institute for
taken after the purpose of the study was clearly explained Health and Care Excellence,(2014) (20) which
to each woman. Confidentiality of obtained personal data, includes the followings:
as well as respect of the study participants’ privacy was - Welcoming the woman and her family person in
totally ensured. A summary of the intervention was a personal manner.
explained to each woman before volunteering to - Keeping calm and confident manner to reassure
participate in the study and women were informed that the woman.
they can withdraw from the study at any time. No - Assessing the woman’s need for knowledge
invasive procedure was required. about pain management.
2.10. The procedure and field work: The data collection - Asking woman permission before performing a
took three months. The researchers were available in the procedure.
study settings three days/week, at the morning shift from - Focusing on the woman rather than
8.00 A.m to 2.00 P.M. They introduced themselves to the documentation.
medical and nursing staff members in the previously - Engaging the woman in communication with
mentioned settings. The nature and the aim of the study other health care providers.
were explained.  Emotional Support: Continuous emotional support
The field work process completed in 3 steps: was given by researchers to participating women
Step 1: An interview and data collection: Women that during all phases of labor process through
came to the obstetrics and gynecology department for encouragement and using calming words.
labor at the previously mentioned settings and fulfilled Furthermore, the effort being made by them was
the inclusion criteria are recruited by the researchers to acknowledged, and all their questions were
collect the data after informed consent was obtained. The
pg. 5
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
answered with maintaining constant visual - Baby’s back and head is dried thoroughly when
contact. the baby is on the mother’s chest
 Information: Researchers provided simple - After drying the baby all wet bedding was
explanation about the delivery process. They kept removed and replaced with warm and dry
the participating women informed about how blanket(N.B, the women privacy were
their labor was progressing and, in words that maintained by placing nursing cover around
were clear and easy to understand. In addition all women and their consent were taken)
procedures during labor such as fetal monitoring,  Regarding the physical needs:
and medications given were explained to them.  Labor Pain (Pain care): The researchers practiced
 Orientation: the researchers oriented the woman to and educated the women about measures of
the labor unit. relieving pain during labor which are evidence
 Coping strategy: Women were encouraged to based and include the followings:
express their fears regarding labor and the - Relaxation technique including breathing
researchers provided strategies to cope with technique (rapid, shallow breathing was
childbirth fear through counseling and usage of encouraged in the active phase) and visualization
(22)
nonmedical coping methods (e.g. Relaxation .
techniques and Visualization techniques). - Positioning: The upright position in first stage is
 Conversation: the researchers kept up a conversation recommended by researchers to laboring women
so that the woman would not feel alone. as offer benefits including reduced pain in the
 Skin to skin contact between the mother and her first stage of labor, better descent of the fetal
newborn : After delivery of the baby and before head and reduction in the duration of labor and
delivery of placenta , the researcher apply skin to reduced risk of assisted birth/caesarean birth,
skin contact between mother and her new born episiotomy and the need for epidural (23).
using the following guidelines which based on  Nutrition: After taking permission from obstetric
Dumas &Widström (2016) (21) procedure of safe physician the women is allowed to take small
skin-to-skin contact between mother and baby: amount of clear fluid .
- Before birth, the mother is informed by  Ambulation (behavioral care): laboring women
researchers that her baby will be placed on her were educated by researcher about the importance
chest immediately after birth. of walking during labor unless contraindicated.
- Immediately after birth, the baby is placed  Maternal and fetal care: It was given during
directly on the mother’s chest without drying the labor according to women condition and needs
baby first. e.g. monitoring uterine contraction , monitoring
- The baby is placed vertically between the fetal heart rate.
mother’s breasts: the largest part of the baby’s During the immediate postpartum period (After
body is flat against the mother’s chest. delivery till women discharge from hospital):
- The newborn is assured that can breathe easily  Regarding psychological needs:
through its nose and mouth.  Immediate contact between the mother and the
newborn: The researchers encouraged immediate

pg. 6
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
contact between the mother and the newborn, encourage the mother to face breastfeeding with
promote skin-to-skin contact of the mother and an optimistic attitude. Also, practiced and
the newborn and also encouraged and facilitated encouraged the mothers to perform breast care.
the first breastfeed when the newborn shows  Regarding Environment; during labor and
signs of readiness, usually within the first hour immediate postpartum period
after delivery. The researchers improved the surrounding
 Physical needs: atmosphere via maintaining a calm and comfortable
 Postpartum pain (pain care): The researchers environment, and ensuring the privacy through closing
practiced and educated the women about pain the door and curtains around each woman. In addition,
relief techniques during the postpartum period women were informed about the importance of
such as relaxation technique and message. Also, maintaining calm environment at home.
each woman was instructed to urinate as early as  During all intervention phases: The researchers
possible. respected and appreciated each woman culture. The
 Uterine message: The researchers practiced effective researchers provided the nursing intervention based
uterine message of the fundus to promote on women’s needs.
drainage, observations of vaginal bleeding In the routine care group: the women received routine
volume and color. obstetric care including routine natal and postnatal care.
 Nutrition: The researchers instructed the women to Step3: Evaluation phase: The researchers evaluate the
eat more high-protein and high-fibers foods with outcomes of implementing the obstetric fine nursing care
different choices, to increase their energy and compared to the routine care through assessment of
enhance the healing process. selected obstetric outcomes, woman satisfaction and
 Postpartum exercises (behavioral care): The postpartum recovery; the researchers assessed postpartum
researchers educated each woman about the recovery during immediate postpartum period and after
importance of postpartum exercise and its women discharge through contacting women by
techniques. Women were helped to get out of bed telephone..
as soon as possible after childbirth. 2.11.Data Analysis: The collected data were organized,
 Postoperative hygiene (behavioral care): due to the tabulated and statistically analyzed using SPSS software
large physical exertion during the childbirth and version 22. For quantitative data, the range, mean and
the sweating, the researchers aided and educated standard deviation were calculated. For qualitative data,
each woman to keep the body dry and clean to comparison between two groups was done using Chi-
prevent getting cold. Pads are changed frequently square test. For comparison between means of two related
to keep the vulva clean. groups (before & after intervention) of non-parametric
 Breast feeding (breast feeding care): The data, T test was used. Significance was adopted at p <
researchers educated each woman about 0.05 for interpretation of results of tests of significance.
breastfeeding, the researchers explained the 3. RESULTS
advantages of breastfeeding for the mother, Results revealed that there was no significant
breastfeed as soon as possible, stimulate the difference between the obstetric fine nursing care group
breast to secrete milk as soon as possible, and and routine care group in terms of socio demographic
variables (Table 1). However, there was a statistical
pg. 7
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
significant difference between obstetric fine nursing care statistically significant difference found in Apgar score
group and routine care group regarding pain severity as between the two groups at 5 minutes. on the other hand, ,
54.4% of women in obstetric fine nursing care group had there was no statistically significant difference found in
mild pain compared to 27.8% in routine care group Apgar score between the two groups at 1 minute which
(Table 2). Moreover, there was no significant difference indicates improvement in new-born condition (Table 3).
between obstetric fine nursing care group and routine care Another finding of this study revealed that 52.2% of
group regarding pain relief medications taken during women in obstetric fine nursing care had child birth
labor as 36.7% of women in routine care group took pain satisfaction compared to 22.2% in routine care group
relief medications during labor compared to 23.3% in (Figure 1)
obstetric fine nursing care group (Table 2). Lastly, this study finding revealed that there was
Additionally, study findings revealed that was statistically significant difference between obstetric fine
statistically significant difference between obstetric fine nursing care group and routine care group regarding
nursing care group and routine care group regarding postpartum pain as in obstetric fine nursing care group
mode of delivery as 91.1% of women in obstetric fine 46.7% of women reported mild pain. Whilst, 73.3%
nursing care group delivered normally compared to reported good sleep pattern and 57.8% reported adequate
77.8% in routine care group. Regarding length of first lactation pattern, and only 10% suffered from immediate
stage of labor, 67.1% of women in obstetric fine nursing postpartum haemorrhage. While in routine care group
care group and 48.6% of women in routine care group 33.3% of women reported mild pain, 46.7% reported
took less than twelve hour in first stage. Regarding length good sleep pattern, 44.4% reported adequate lactation
of second stage of labor 73.2% of women in obstetric fine pattern and 13.3% suffered from immediate postpartum
nursing care group and 55.7% in routine care group took haemorrhage (Table 4).
shorter duration (0-30 minutes). In addition, there was

pg. 8
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
Table 1: Socio-demographic data of the study

partici
pants
(N=18 The Study participants 2 P value
0)
Variables
Obstetric fine Routine care group
nursing care (N=90)
group (N=90)
No. % No. %
t test
Age
2.97 ns .103
Mean ±SD
27.31 ±6.12 30.42 ±7.8
Educational level
5 5.6% 0 0.0%
Read and write
56 62.2% 36 40.0% 6.87 ns .932
Secondary education
29 32.2% 54 60.0%
Higher education
Occupation
House wife
75 83.3% 68 75.5% 2.67 ns
Worker
3 3.3% 7 7.8% .444
employer
12 13.3% 15 16.7%
Income
Enough 22 24.4% 18 20.0% .514 ns .473
Not Enough 68 75.6% 72 80.0%
Residence
Urban 36 40.0% 29 32.2% 1.180 ns .277
Rural 54 60.0% 61 67.8%

pg. 9
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
Table 2: Pain severity during labour among the study participants (N=180)
The Study participants 2 P value
Variables
Obstetric fine Routine care
nursing care group (N=90)
group (N=90)
No. % No. %
Pain severity 15.46(HS) .000
Mild 49 54.4% 25 27.8%
Moderate 30 33.3% 38 42.2%
Severe 11 12.2% 27 30.0%
Pain relief medication taken 3.81ns .051

during labor
Yes 21 23.3% 33 36.7%
No 69 76.7% 57 63.3%

pg. 10
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
Figure1: Women’s childbirth satisfaction among the study participants (N=180)

pg. 11
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
Table 4: Postpartum recovery among the study participants(N=180)
The Study participants 2 P value
Variables
Obstetric fine Routine care
nursing care group (N=90)
group (N=90)
No. % No. %
Postpartum pain 12.45(S) .002
Mild 42 46.7% 30 33.3%
Moderate 39 43.3% 32 35.6%
severe 9 10.0% 28 31.1%
Sleep Pattern 13.33(HS) .000
Good 66 73.3% 42 46.7%
poor 24 26.7% 48 53.3%
3.202ns .074
Lactation pattern
Adequate 52 57.8% 40 44.4%
38 42.2% 50 55.6%
inadequate
.485ns .486
Occurrence of immediate post
partum hemorrhage
9 10.0% 12 13.3%
Yes
81 90.0% 78 86.7%
No

pg. 12
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
5. DISCUSSION Another finding of the current study indicated that

Fine care is an emerging pattern which requires the there were lower percentages of women in obstetric fine
nurses not only to strengthen the attention of patients, but nursing care group undergone emergency C-Section
also to pay attention to the factors affecting the (nearly one tenth)compared to women (nearly one fifth)
rehabilitation of diseases, such as patient’s psychological in the routine care group. Regarding the length of first
condition, environment, and physical factors (3). and second stages of labor, the majority of women in
This study aimed to investigate the effect of obstetric fine nursing care group reported shorter labor
implementing obstetric fine nursing care on women’s duration in the first and second stage of labor compared
childbirth satisfaction, selected obstetric outcomes and to the routine care group.
postpartum recovery. The findings of the present study These findings could be as a result of the mother in
supported the hypothesis and showed that women who the fine care group are fully prepared during giving birth
received obstetric fine nursing care during labor and by researchers, positively facing and accepting the
postpartum period had higher levels of childbirth situation during the childbirth, cooperating with care
satisfaction, better selected obstetric outcomes and early providers during all labor stages which may lead to
postpartum recovery than women receiving routine care. shorter duration of first and second stage of labor.
The current study findings revealed that there was non Additionally, if the woman not psychologically prepared
significant difference between the obstetric fine nursing due to the complexity delivery process, it is easy for the
care and routine care group regarding the mother to have negative emotions, thus the heart rate is
sociodemographic data. accelerated, the gas exchange in the lung is insufficient,
One of the major findings of this study is the labor resulting in uterine hypoxia and lack of contraction which
pain, as nearly half of women in obstetric fine nursing may lead to prolonged labor and emergency caesarean
care group had mild pain compared to one third of section (25).
women in the routine care group. This could be as a result Consistent with the literature, a study conducted
of the breathing technique that women can practice with by Man Wang et al. (2018) (26) who studied continuous
the researchers while receiving obstetric fine nursing support during labor in childbirth. The study revealed that
care, which reduces labor pain. This finding is consistent the estimated length of labor for women with routine
with Youliang et al. (2018) (3) who reported that the hospital maternity care was 2.03 times the duration of
number of cases with moderate pain in the observation women with supportive care. In addition, the emergency
group was significantly lower than that of the control caesarean section rate was significantly lower in women
group. This indicated that the maternal pain of fine care with supportive care compared to women with routine
is lower than that of women receiving routine care. The hospital maternal care (3.3% vs 24%).
study findings also matching with study conducted by Additionally, a major finding of this study is
Yildirim M. (2004) (24) who studied the effect of breathing women’s child birth satisfaction, the current study
and skin stimulation techniques on labor pain perception findings revealed that nearly half of women in obstetric
of Turkish women and found that mothers who received fine nursing care group were satisfied with child birth
education about labor and nonpharmacological pain compared to only one fifth in the routine care group. This
control methods and nursing care expressed significantly study findings was consistent with the findings of a study
lower labor pain levels than mothers who did not. conducted by Belén et al (2016) (27) who stated that
support from the caregivers during labor was a strong
pg. 13
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
predictor of childbirth satisfaction and added that, the complications, and also stimulate the mother to produce
most important aspects of professional support were: milk (30).
communication, information, allowing the mother to Conclusion:
become involved in decision-making and to express her  The study findings revealed that nearly half
feelings during labor. of women in obstetric fine nursing care group
Consistent with current study findings ,Bohren et al had child birth satisfaction compared to about
(2017) (28) who studied continuous support for women one third of women in routine care
during childbirth reported that a recent review of studies group.This support the first study
found that women who received continuous labor support hypothesis.
were more satisfied with their labor experience; had  The study findings revealed that there were
shorter labors; were less likely to have operative or statistically significant differences between
assisted births (e.g., caesarean, vacuum or forceps); and obstetric fine nursing care group and routine
were less likely to use pain medication. care group regarding pain severity during
The current study finding showed there was labor as nearly half of women in obstetric
statistically significant difference found in Apgar score fine nursing care group had mild pain
between the two groups at 5 minutes which demonstrated compared to nearly one third in routine care
improvement in Apgar score at 5 minutes in obstetric fine group. Also, the study findings showed that
nursing care group than in routine care group. The study there was statistically significant difference
findings is congruent with the findings of study between obstetric fine nursing care group and
conducted by Donna,(2017) (29) who studied the effects routine care group regarding mode of
of labor support on mothers, babies, and birth outcomes delivery as majority of women in obstetric
and demonstrated that the newborns of mothers who fine nursing care group delivered normally
experience labor support have higher Apgar scores than compared to nearly two thirds of women in
mothers who did not . routine care group. Regarding length of first
Lastly, Consistent with the findings of the study stage of labor, about three quarter of women
conducted by Youliang et al. (2018) (3) who studied the in obstetric fine nursing care group had
effect of obstetric fine nursing care on pain during natural shorter duration of first and second stage of
childbirth and postpartum recovery and revealed that the labor compared to nearly half of women in
number of maternal cases with good postpartum sleep, routine care group. In addition, there was
good lactation and mental health in the observation group statistically significant difference found in
was significantly higher than that in the control group Apgar score between the two groups at 5
(P<0.001). The current study findings revealed that the minutes. on the other hand, , there was no
majority of women in obstetric fine nursing care group statistically significant difference found in
reported mild postpartum pain, good sleeping pattern, Apgar score between the two groups at 1
adequate lactation pattern and reduction of the occurrence minute which indicates improvement in new-
of postpartum hemorrhage. This study findings may be born condition. This support the second
due to early postpartum contact between the newborn and study hypothesis.
the mother and sucking the nipple can stimulate the  The study findings showed that there were
release of maternal oxytocin to reduce the incidence of statistically significant differences between
pg. 14
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
obstetric fine nursing care group and routine meta-synthesis. BMC Pregnancy and Childbirth ,2018. 18
care group regarding postpartum recovery as (167).
in obstetric fine nursing care group nearly 5- Public Health Agency of Canada. Care during labour
half of women reported mild pain, good sleep and birth.2018.
pattern and adequate lactation pattern, and 6- WHO recommendations: intrapartum care for a
only ten percent suffered from immediate positive childbirth experience. Geneva: World Health
postpartum haemorrhage. Meanwhile in Organization; 2018
routine care group nearly one third of women 7- Jolivet R. Respectful maternity care: the universal
reported mild pain, good sleep pattern, rights of childbearing women. Washington DC: White
adequate lactation pattern and 13.3% of them Ribbon Alliance; 2011
suffered from immediate postpartum 8- Sawyer A, Ayers S, Abbott J, Gyte G, Rabe H, Duley
haemorrhage. This support the Third study L. Measures of satisfaction with care during labour and
hypothesis birth: a comparative review. BMC Pregnancy Childbirth
Recommendations: 2013; 13:108.
 Integrating obstetric fine nursing care into care 9- Mirmolaei S, Khakbazan Z, Kazemnead A, Azari M.
of woman during childbirth and early Tehran Uni Med Sc J (Hayat) 2008; 13 (2): 31-40.
postpartum period 10- Ibone O., Patricia L., Yael B., Maria. Women’s
 Continuous training for maternity nurses psychological experiences of physiological childbirth: a
regarding application of obstetric fine nursing meta-synthesis. BMJ journal, 2017; 8(10).
care during childbirth and postpartum period. 11- Iliadou M.Supporting women in labour. Health
 Further studies should be conducted to apply Science Journal. 2012; 6 (3) .
and demonstrate the research on a larger 12- Chowdhary N., Sikander S., Atif N. The content
population for generalization of the results. and delivery of psychological interventions for perinatal
depression by nonspecialist health workers in low and
REFERENCES middle income countries: a systematic review. 2014.
13- Clarke MA, Haire-Joshu DL, Schwarz CD, Tabak
1- Naghizadeh S, Azita Fathnejad Kazemi , Mehdi RG, Joshu CE. Influence of home and school
Ebrahimpour. European. Journal of Experimental environments on specific dietary behaviors among
Biology, 2013, 3(6):132-139 postpartum. Prev Chronic Dis, 2015. 12: E68.
2- Mina - Iravani, laheZarean, Mohsen Janghorbani. 14- Lovic V., Fleming AS. Propagation of maternal
Women's needs and expectations during normal labor and behavior across generations is associated with changes in
delivery.International Journal of Health Promotion and non-maternal cognitive and behavioral processes. Behav
Education, ,2015. 4:6 Processes. 2015; 117: 42-47.
3- Youliang OU, Yanli Z., Ping X. Effect of obstetric 15- Ebneshahidi A., Akbari M., Heshmati B. Patient-
fine nursing on pain during natural childbirth and controlled versus nurse-controlled post-operative
postpartum Recovery.Iran J Public Health. 2018 ,47(11): analgesia after caesarean section. Adv Biomed Res, 2012;
1703–1708. 1: 6
4- Petronellah L., Catharina S., Petronella B. Women’s 16- Cochran.Sampling technique, 3rd ed., New York:
experiences of continuous support during childbirth: a John Wiley & Sons. , 1977.
pg. 15
Vol.9, No.1, 2020;
ISSN (5733 – 7155);
p –ISSN 4056 – 7396X
Impact factor: 3.33
17- National Institutes of Health. Numeric Pain 25- McGrath L., Peters S., Wieck A., Wittkowski A.
Intensity Scale. 2003. The process of recovery in women who experienced
18- Simbar, M., Ghafari, F., Zahrani, S., Majd, H. psychosis following childbirth. BMC
Assessment of quality of midwifery care in labour and Psychiatry, (2013),13: 341
delivery wards of selected Kordestan Medical Science 26- Man Wang, Qing Song, Jun Xu, Zheng
university hospitals.Int J Health Care QualAssur, (2009), Hu, Yingying Gong, Arier C. Lee, .Continuous support
22: 266-277. during labour in childbirth: a Cross-Sectional study in a
19- Apgar V., Holsdy D., James L., Weisbort I., and university teaching hospital in Shanghai. BMC Pregnancy
berrinc., (1958); Evaluation of newborn infant: 2nd Childbirth. 2018; 18: 480.
report. American of maternal child born infant, pp. 168. 27- Belén Ma C., Manuel C., Carmen B., César C.
20- National Institute for Health and Care Excellence. Comparative study analysing women’s childbirth
Intrapartum care for healthy women and babies [Internet]. satisfaction and obstetric outcomes across two different
London (UK): NICE; 2014. Available from: models of maternity care. BMJ Open 2016;6.
https://www.nice.org.uk/guidance/cg190 28- Bohren MA., Hofmeyr G., Sakala C., Fukuzawa
21- Dumas L, Widström AM. Safe skin-to-skin RK., Cuthbert A. Continuous support for women during
contact between mother and baby. Procedure and childbirth. Cochrane Database Syst Rev. 2017(7).
important notes. 2016 29- Donna J. Sauls, Effects of labor support on
22- Smith CA, Levett KM, Collins CT, Crowther CA. mothers, babies, and birth outcomes. JOGNN,clinical
Relaxation techniques for pain management in labour. issues.2017.
Cochrane Database Syst Rev. 2011. 30- Praveen P., Jordan F., Priami C., Morine MJ. The
23- Lawrence A, Lewis L, Hofmeyr GJ, Styles C. role of breast-feeding in infant immune system: a systems
Maternal positions and mobility during first stage labour. perspective on the intestinal microbiome. Microbiome,
Cochrane Database Syst Rev. 2013. 2015; 3:41.
24- Yildirim G., Nevin P. The effect of breathing and
skin stimulation techniques on labour pain perception of
Turkish women. Pain Res Manage,2004, 9 (4).
31-

pg. 16

Marwa 2

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Marwa 2

Uploaded by

Copyright:

Available Formats

Academic Journal of Nursing and Health Education

Vol.9, No.1, 2020;

EFFECT OF IMPLEMENTING OBSTETRIC FINE NURSING CARE ON

1.INTRODUCTION involves deep physical, psychological, and emotional

Academic Journal of Nursing and Health Education

Academic Journal of Nursing and Health Education

Academic Journal of Nursing and Health Education

Academic Journal of Nursing and Health Education

Table 1: Socio-demographic data of the study

Academic Journal of Nursing and Health Education

The Study participants 2 P value

Pain relief medication taken 3.81ns .051

Academic Journal of Nursing and Health Education

Figure1: Women’s childbirth satisfaction among the study participants (N=180)

Academic Journal of Nursing and Health Education

Table 4: Postpartum recovery among the study participants(N=180)

The Study participants 2 P value

Academic Journal of Nursing and Health Education

5. DISCUSSION Another finding of the current study indicated that

Academic Journal of Nursing and Health Education

You might also like