INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA

SULTAN AZLAN SHAH PERAK

ADVANCED DIPLOMA MIDWIFERY

DISEMBER 2023

RESEARCH PROJECT PROPOSAL

EFFECTIVENESS OF EARLY AMBULATION IN POST OPERATIVE

RECOVERY AMONG POST CAESAREAN MOTHERS AT HOSPITAL RAJA

PERMAISURI BAINUN

KASIAMMAH NITHIA A/P SUBRAMANIAM - ADMW 1/2023(06)-0005

NAME OF SUPERVISER:

PUAN. RITA BINTI MOHD KIR

DATE OF SUBMISSION: 15 DISEMBER 2023

1
NO Topic Page
1 Acknowledgement 3
2 Chapter 1 Introduction 4-5
1.1 Background of the study 6-7
1.2 Problem statement 8
1.3 Objectives of the study 8

1.4 Research questions 9

1.5 Research hypotheses (if any) 9

1.6 Significance of the study 10

1.7 Definitions of terms 10-12

3 Chapter 2 Review of Literature

2.1 Review of relevant studies 12-14
2.2 Conceptual framework 14-15
4 Chapter 3 Methodology

3.1 Design of the study 16

3.2 Population and sampling 17-19

3.3 Research instrumentation 19-20

3.4 Data collection procedures 21

3.5 Framework for data analysis 21

3.6 Ethical consideration 21

3.7 Limitations of the study 21

5 References 22-24

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 ACKNOWLEDGEMENT

First and foremost, thanks to the Almighty, for His showers of blessings
throughout my research work. Secondly, I would like to express my deep and
sincere gratitude to my research supervisor Puan Zaharah binti Mahmood for
giving me this opportunity and provide invaluable gu idance throughout this
research. I would also like to thank my family members, especially my husband
and my kids for this unconditional love and support throughout doing this
research. Last but not least, I would like to express my gratitude to my fellow
colleagues whom assist me all the while I’m doing my research and help me to
complete it successfully. Thank you.

3
CHAPTER 1

INTRODUCTION

The survival and well-being of mothers and children are critical to the
well- being of societies. When moms endure and prosper, so do their offspring,
and the communities in which they reside flourish. In addition to being vital in
and of themselves, moms' and kids' survival and wellbeing are essential to
addressing larger economic, social, and develop mental issues (Fay et al., 2019). A
woman's health is not just a reflection of her physical well-being but also of the
various duties she plays in the family as a wife, mother, and carer. Giving birth is
considered a significant life event. It is a physiological process that occurs
naturally and brings about fresh sensations for women during their reproductive
years. Childbirth events are associated with intense physical pain and anxiety of
bleeding, operating room procedures such as Caesarean section, and potential
death (Meng et al., 2021). The carer ought to treat her with tact, sensitivity, and
respect. A healthy, full-term pregnancy delivered vaginally is a typical
physiological process. But during the last few decades, the number of Caesarean
births has gradually climbed. A caesarean section is thought to be a risky
procedure. It's one of the most common operations done worldwide these days
(Fay et al., 2019). A Caesarean section involves making incisions through the
uterus and abdomen of the woman in order to deliver one or more babies.
This

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procedure is typically carried out when a vaginal birth may endanger the mother's
or child's life or health.

Compared to vaginal births, Caesarean sections require greater care

because the mother who has one has a dual responsibility for post-operative and
maternal care (Meng et.al., 2021). Beyond the physical elements, delivery is an
experience. It's been said that a woman's life is more than just an average day. This
event shapes a woman's perspective on life, her relationship with her partner, her
children, and her level of self-confidence and self-esteem. For a woman, it might
be among the most significant events.

The ability of a patient to get out of bed as soon as possible is known as

early ambulation. Early ambulation prompted the mother to get up and walk in
order to heal quickly (Fay et al., 2019).

A crucial part of the post-operative therapy after open upper abdominal

surgery is early ambulation. Early ambulation hastens recovery and lowers the
frequency of post-operative pulmonary problems, two benefits that were initially
noticed in the 1940s (Darwish et al., 2022). In actuality, the steps involved in
post- operative recovery will determine tissue healing as well as the return of
regular daily functioning. Early ambulation promotes uterine involution and
lochia discharge in moms who have had caesarean sections (Fay et al., 2019).
Knowing the advantages would therefore help to encourage doing so even in the
face of this period's considerable discomfort.

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1.1 Background to the study

According to estimates from the World Health Organization, 10% to 15%

of all births in wealthy nations result in a Caesarean section. In the United
Kingdom, the Caesarean rate was approximately 20% in 2004, whereas in
Canada, it was 22.5% between 2001 and 2002. The Caesarean rate in the United
States increased by 46% between 1996 and 2009, peaking at 30.2% (Darwish et
al., 2022).

The number of Caesarean sections performed is gradually increasing. In

the industrialized world, the Caesarean rates have skyrocketed in the last several
decades. The rate of Caesarean sections skyrocketed among developing nations
like Brazil and China as well. Rates of Caesarean Section rose from 21.8% in
1988–89 to 25.4% in 1993–94 in India (Fay et al., 2019). According to a
population-based cross-sectional study carried out in Madras, South India, a
Caesarean Section of 32.6% has been reported. 419 births in all occurred in east
Delhi; the remaining births occurred vaginally.

A mother delivering by Caesarean section will have many of the same

physical discomforts associated with any major abdominal surgeries (Altahrawy,
2022). Although there will be no episiotomy the same changes occur in the uterus,
pelvic floor, urinary tract, gastrointestinal tract, respiratory tract and moreover
wound problems, blood clots and delayed recovery (Darwish et.al, 2022). The post
Caesarean mothers who had early ambulated were more satisfied in the early
postoperative period without apparent harm and benefit.

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 Early ambulation in post operative period is the key to get rapid and
maximum muscle function and restoration of mother’s health. By maintaining
adequate blood circulation, encouraging gastric motility, improving breathing,
lowering the risk of thrombophlebitis, avoiding orthostatic hypotension, and
enhancing physical strength, ambulation helps to reduce the majority of the
complications (Altahrawy, 2022). Completing an ambulation programmed now
can help avoid issues later in life.

Many of the physical aftereffects of any major abdominal surgery will be

experienced by a woman who gives birth by Caesarean section. Even thou gh there
won't be an episiotomy, the uterus, pelvic floor, urinary tract, gastrointestinal
tract, respiratory tract, wounds, blood clots, and delayed recovery all experience
the same changes. Postoperative moms who were ambulating early following a
Caesarean section reported greater satisfaction and no apparent risks or benefits
(Darwish et al., 2022).

In order to achieve optimal muscle function and restore the mother's

health, early ambulation during the recovery phase is crucial. Early ambulation of
post-operative patients in the hospital has a strong historical precedent, according
to a Needham study conducted in the Department of Physical Medicine and
Rehabilitation in the USA (Huang et al., 2019). Reducing sedation and
encouraging early ambulation are two new strategies for post-operative patient
care. Preliminary research in this area supports early ambulation after surgery as
safe, feasible, and possibly beneficial for post-operative patients.

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 Rehab is necessary for postnatal Caesarean moms in order to provide

high-quality pain relief following the procedure, which enables early ambulation
and positive mother-child interaction. The investigator gained insight into the lack
of early ambulation practices among mothers following Caesarean section
through research studies and work experience. Therefore, research on the impact
of early ambulation among post-Caesarean moms is necessary.

1.2 Problem statement

A study to assess the effectiveness of early ambulation in post-operative recovery

among post Caesarean mothers.

1.3 Objectives of the study

To evaluate the effectiveness of early ambulation in post-operative recovery

among post- Caesarean mothers at Hospital Raja Permaisuri Bainun.

Specific objectives:

I. To assess the level of demographic factors such as age, level of education,

parity, type of delivery, type of family, religion, and occupation.

II. To determine the level of knowledge and effectiveness of early

ambulation among Caesarean mothers.

III. To determine the relationship between the level of demographic and the
level of knowledge.

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1.4 Research questions

In this study, few common research questions have been stated to achieve the
objectives that are in lie with the topic of this study. Research questions that can
be commonly found in these journals are:

1. Does early ambulation give impact on the maternal outcome of mothers

with Caesarean birth?
2. Does early ambulation effect on activity of daily living among the
mothers who have undergo LSCS (lower segment Caesarean section)?
3. Does time duration taken by mothers with Caesarean section to
ambulate effect the outcome in post-operative recovery?

1.5 Research hypotheses

(H1) There is relationship between the level of knowledge and the demographic
factor.

1.6 Significance of the study

 The result of this study can have great implications in nursing education
which can guide nurses and nursing students in providing teaching to patients
which can aid in providing care independent of medical practice.

 It can place emphasis on childbirth to a normal holistic experience.

 This can provide significant contribution to lower risk to clients and thus
improve the outcome.

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 This can stimulate further research in the field.

1.7 Definitions of terms

Early ambulation

In this study, it refers to placing mothers in an upright position and requiring them
to walk for 10 to 24 hours after giving birth to mothers who received both spinal
and general anesthesia. After ten hours of delivery, the mothers are forced to
spend five minutes sitting on the bed. They are examined for headache, nausea,
and edginess. Individuals who do not display the aforementioned symptoms are
required to stand for two to three minutes, followed by fifteen minutes of
supported walking every two hours throughout the ward. Up to 24 hours after
giving birth, mothers who experience headaches, nausea, or uneasiness will be
allowed to rest completely.

Late ambulation
In this study it refers to ambulate the mothers after 24 hours of Caesarean delivery.

Cesarean
It is an operative procedure where by the fetuses after the end of 28 th week is
delivered through an incision on the abdominal and uterine walls.

Maternal outcome
In this study it refers to incidence of deep vein thrombosis, volume of lochia,
involution of the uterus and infant caring behavior.

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Deep vein thrombosis
In this study it refers to the thrombosis of the leg veins of the mother within 7
days of delivery.

Post cesarean mothers

Those mothers who have already undergone cesarean delivery and abated from
the anesthetic effects and willing to participate in the study (Huang, Cao, Nelson,
& Wilson, 2019).

Impact
In this study it refers to the extent to which early and late maternal ambulation
after Caesarean birth helps in improving maternal outcome.

Lochia
It refers to the uterine flow after the delivery, consisting of blood , fragments of
decidua , white blood cells and mucus.

Effectiveness

In this study it refers to Statistical Measurement of difference between pre and

post-test knowledge score.

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CHAPTER 2

Review of Literature

2.1 Review of relevant studies

In order to determine the effects of early and late ambulation on the outcomes of
mothers who had Caesarean sections performed at particular hospitals in
Mangalore, (Paul et.al, 2019) conducted a study. For this study, an evaluate
approach using a quasi-experimental time series design was employed. Group I
and Group II are the two randomly assigned groups of the fifty mo ms in the
sample who had Caesarean births. Ten hours after a Caesarean section, mothers in
group I were able to walk, while mothers in group II were able to do so 24 hours
later. Fisher's exact test, unpaired "t" test, and descriptive statistics were used to
analyses the data. There was a significant difference between the mothers in
groups I and II, according to the computed "t" value. The outcome demonstrates
that early ambulation is a useful strategy for enhancing the natural recovery of
mothers who had Caesarean sections.

In order to restore the mother's health (Hanan et al., 2020) and achieve maximum
muscle function quickly after surgery, early mobilization is essential.
Ambulation

12
ensures proper blood circulation, stimulates gastric motility, improves respiration,
and strengthens the body, all of which contribute to the reduction of most
complications. The purpose of this study was to look into how early progressive
bed exercise and movement affected post-section recovery. Furthermore, a
woman who has a CS experience more issues than one who delivers a baby
naturally through the vagina. Longer hospital stays, discomfort following surgery,
issues with the bladder and bowel, difficulties nursing, increased time needed to
resume a regular diet, and congestion in the breasts are some of the symptoms.

Early ambulation is studied by (Singh, S. et al.,2020) to reduce opioid use in post -

operative and postpartum Caesarean section moms. This study used a total sample
of 80 Post caesarean mothers and Simple Random sampling at post caesarean
section mothers of Queen Mary’s hospital Lucknow Following any procedure, it
has been shown that early ambulation is beneficial. Early ambulation at 6 hours
can be started after a caesarean section for a quick post-operative recovery and to
avoid post- operative complications, according to the findings of the current
study, which evaluated the effectiveness of early ambulation on post -operative
recovery in caesarean mothers.

In order to determine whether early ambulation aids in post-operative recovery for

post-Caesarean mothers admitted to Mansoura University Hospital in (Hassan, El.
et.al., 2019) conduct a quasi-experimental study. The target population for this
study is elective CS patients who were recruited from a list of patients who had an
odd number of caesarean deliveries. The study's female participants were
chosen over the course of the investigation using a methodical sample technique.

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The purpose of (Carol KA, et al., 2023)’s study is to evaluate how certain
postnatal activities of patients who have had caesarean sections are affected by
planned early ambulation. The study, which involved 500 lower segment
caesarean patients at particular Jalgaon tertiary care hospitals, was carr ied out
between 2010 and 2013. Random assignment was used to place patients in the
experimental or control groups. There are 250 caesarean section patients in each
group. For the patients who were chosen, the researcher implemented the planned
intervention of early ambulation. For the first five days, the ambulation guidelines
include deep breathing exercises, coughing exercises, leg exercises, and
movement. The evaluation revealed a significant difference between the
experimental and control groups' chosen post- section activities during the post-
section period.

2.2 Conceptual framework

Theories use concepts as building blocks to categorise the phenomenon of

interest. The description and categorization of phenomena are made possible by
the development of theoretical concepts. Theoretical linkages provide an
explanation for the possible connections between the variables in the theory.
Compared to theories, conceptual frameworks are a less formal way of organising
a phenomenon. Concepts serve as the foundation for both conceptual frameworks
and theories. The conceptual framework used in this study, which refers to the
journals, is shown below:

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 Figure 1: List of assessments of mothers with Caesarean birth

CHAPTER 3

Methodology

3.1 Design of the study

Paul, et.al. use evaluate approach with a quasi-experimental time series design for
his study which is named as ‘Effectiveness of Early Ambulation on Post Operative
Recovery among the Women with Caesarean Section CS’ at Hospital Raja
Permaisuri Bainun.

Hanan Awed, M, et.al. use evaluative approach for their study. The research
design selected for this study was true experimental research design and the
name of their
15
research article is ‘Effect of Early Progressive Bed Exercise and Movement on
Recovery after Caesarean Section’.

Singh S, et.al. use evaluative approach for their study. The research design
selected for this study was true experimental research design and the name of their
research article is ‘Effectiveness of Early Ambulation on Post-Operative Recovery
Among Caesarean Mothers’.

Hassan El, et.al. use quasi experiment design for this study. The name of their
research is ‘Effectiveness of Postpartum Enhanced Recovery Pathway Intervention
on The Occurrence of Postoperative Complications for Primiparous Women
Undergoing Elective Caesarean Section’.

Carol KA, et.al conduct their study using quantitative-quasi experimental

approach. The name of their research is ‘Effectiveness of Planned Early
Ambulation on

Postoperative Recovery among Caesarean Mothers: A Quasi-experimental study

in Mangalore’.

3.2 Population and sampling

Population

The research population is the postnatal mother admitted in ward of Hospital Raja
Permaisuri Bainun in the month of November 2023.

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 Sampling

The process of choosing a portion of the population to gather information about a

problem is known as sampling (Mc Combes, 2023). The technique of purposeful
sampling was employed due to the constraints of time and subjects. For this
research, the non-probability sampling will be used since it is a convenience
sampling. Inclusion sample is postnatal mothers age above 18 years old.
Exclusion sample is postnatal mothers with psychotic disorder, and language
barrier in either Bahasa Melayu and English, antenatal mothers below 18 years.
Moreover, spontaneous vaginal delivery (SVD) is also excluded.

 Population and Sampling method used in the research

The researcher identifies the sample size for this study by referring to the table
sample for determining sample size for a finite population by Krejcie and Morgan
(1970) table as illustrated in Table 3.1 below. The table is constructed using
formula (refer appendix) by Krejcie and Morgan (1970) theory. For this research,
the researcher has identified the (0.7 / 300) = 0.00023.

For the research carried out by Paul et.al., on the topic "Effectiveness of Early
Ambulation on Post Operative Recovery among Women with Caesarean Section
(CS)" likely discusses the impact of early mobility and walking on the recovery of
women who have undergone a cesarean section. This topic may explore whether
encouraging women to start walking soon after their surgery can lead to faster
and

17
smoother recoveries, reduced complications, and improved overall well -being
following a C-section. The study may involve assessing the benefits of early
ambulation in terms of pain management, incision healing, and overall
postoperative recovery outcomes for women who have had cesarean sections.

For the research carried out by Hanan Awed, M, et.al., on the topic "Effect of
Early Progressive Bed Exercise and Movement on Recovery after Caesarean
Section" likely investigates the impact of introducing progressive bed exercises
and movement shortly after a cesarean section surgery. The study aims to assess
whether these activities contribute to a faster and smoother recovery, reduced
postoperative complications, and enhanced well-being in women who have
undergone a C-section.

For the research carried out by Singh S, et.al., on the topic " Effectiveness of
Early Ambulation on Post-Operative Recovery Among Caesarean Mothers "
likely explores the current study evaluating the impact of early ambulation on
caesarean mothers' post-operative recovery and the difference in post -operative
recovery between the study group and the control group of caesarean moms. This
study also determined the relationship between the posttest level of postoperative
recovery and specific obstetrical and demographic characteristics in the study
group and control group among mothers who have had caesarean sections.

For the research carried out by Hassan El, et.al., on the objective of to assess how
an intervention for primiparous women undergoing CS affected the likelihood of
postoperative complications. It was thought that this intervention might improve
women's support and bridge the gap in continuity of care. Women who had
elective

18
caesarean sections at Mansoura University Hospital were consecutively enrolled
in a prospective evaluation. Using random number generation, the intervention
and control groups were assigned. Maternal health indicators were documented by
phone and written communication on the first, third, second-, and third-days
following delivery.

For the research carried out by Carol KA, et.al., on the topic of quasi-
experimental study conducted in Mangalore, the effectiveness of planned early
ambulation. The postoperative recovery among Caesarean mothers was
investigated. This research likely compared outcomes between a group of mothers
encouraged to engage in early ambulation and a control group receiving standard
postoperative care. The study aimed to determine whether planned early
ambulation positively impacted factors like pain management, incision healing,
and overall recovery experience for mothers who had undergone Caesarean
sections.

3.3 Research Instrumentation

A research instrument is a tool or a means used by researchers to collect data and

information for their research studies or investigations. These instruments are
designed to gather data in a systematic and structured manner, allowing
researchers to obtain accurate and reliable information (Pentang, 2023). Research
instruments can take various forms, including:

 Questionnaires: Structured sets of questions that respondents answer,

often used for surveys or self-report studies.

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The choice of a research instrument depends on the research objectives, the type
of data needed, and the nature of the research question. Researchers select the
instrument that best suits their study and helps them collect accurate and relevant
data.

3.4 Data collection procedures

The process of gathering information from respondents using the instrument such
as a questionnaire form is known as data collection. Because the method of
survey question selection can collect data more rapidly and precisely, it is widely
utilized. After receiving responses, the researcher will hand out the questionnaire
and read it aloud the same day. A brochure serving as a guide will be distributed
along with information on the significance of the study (Huang et.al, 2019).
However, since secondary data from journals pertaining to early ambulation are
being used as guidance, no data collection will be done for this study.

3.5 Framework for data analysis

3.6 Ethical consideration

The researcher's name and the research findings will be cited whenever they are
mentioned in this study because secondary data from other journals will be used
in it.

3.7 Limitations of the study

Mothers who had C-sections were the subjects of this study. In this study,
spontaneous vaginal delivery (SVD) is excluded. The data that will be utilized in
this

20
investigation is another drawback. For this study, only secondary data that has
been sourced from journals will be used. The data that will be used may not
accurately represent the situation for our mothers who had Caesarean sections
because all of the research was conducted in a foreign nation.

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 Altahrawy, A. G. M. (2022, November 1). Assessment of Enhanced Recovery
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 Hou, D., Jia, Y., Han, A., Hu, Q., Li, J., & Liang, W. (2023, January 1).
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 Zhao, L., & Wei, H. (2022, December 13). The research frontier of cesarean
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 Fibroids. https://doi.org/10.1155/2022/5606998

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 APPENDICES

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3. All my questions relating to this research and my participation therein have been
answered to my satisfaction.

4. I voluntarily agree to take part in this research, to follow the study procedures and to
provide all necessary information to the investigators as requested.

5. I may at any time choose to withdraw from this research without giving reasons.

6. I have received a copy of the Subjects Information Sheet and Consent Form.

7. Except for damages resulting from negligent or malicious conduct of the researcher(s), I
hereby release and discharge ILKKM SAS, Perak and all participating researchers from all
liability associated with, arising out of, or related to my participation and agree to hold them
harmless from any harm or loss that may be incurred by me due to my participation in the
research.

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Name of respondent: Signature:

I/C Number: Date:

Name of witness: Signature:

I/C Number: Date:

Name of consent taker: Signature:

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I/C Number: Date:

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 *SAMPLE QUESTIONNAIRE*

The purpose of this research to identify effectiveness of deep breathing exercise among
mothers in labour in OB 1 Hrpb. Your responses will be confidential. If it is possible for the
participant to complete the questionnaire anonymously. Do NOT write your name on this
questionnaire, so your responses will never be linked to you personally. Only the researchers
involved in this study will see your responses. Your participation in this study is voluntary. If
you do not want to participate, please return the questionnaire to the researcher. Tujuan kajian
ini ialah untuk mengenal pasti keberkesanan senaman pernafasan dalam dalam kalangan ibu
dalam labour di OB 1 HRPB . Maklum balas anda adalah sulit. Peserta kajian boleh
melengkapkan kajian ini tanpa dikenali. JANGAN tulis nama anda pada borang soal selidik
supaya maklum balas anda tidak boleh dikaitkan dengan anda. Hanya penyelidik yang
terlibat dengan kajian ini dapat melihat maklum balas anda. Penyertaan anda dalam kajian
ini adalah secara sukarela. Jika anda tidak ingin menyertai kajian ini, sila pulangkan borang
soal selidik kepada penyelidik.

Section A : Demographic
Bahagian A: Demografi

Instruction: Please tick one for the following questions.

Arahan: Sila tandakan satu jawapan bagi setiap soalan berikut.

1. What is your age?

Berapakah umur anda?

20-30 years old 31-40 years old

20-30 tahun 31-40 tahun

41-50 years old 50 years old and above

41-50 tahun 50 tahun dan ke atas

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2. What is your highest level of education you have completed?
Apakah pendidikan tertinggi yang anda telah sempurnakan?

SPM STPM/Diploma
SPM STPM/Diploma

Degree Master PhD

Ijazah Sarjana Muda Ijazah Sarjana PhD

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Section B: Effectiveness of deep breathing exercise during labour

Bahagian B: Keberkesanan senaman pernafasan dalam dalam kalangan ibu dalam labour (
booking )
Instruction: Please mark one box per line to indicate your response
Arahan: Sila tandakan satu kotak bagi setiap baris untuk memberikan maklum balas

BIL SOALAN YES/ Ya NO/Tidak

1.
Do deep breathing exercises help in reducing
labor pains?

Adakah senaman pernafasan mendalam

membantu mengurangkan sakit semasa
bersalin?
2.
Can deep breathing exercises
assist in managing stress and
anxiety during labor?

Adakah senaman pernafasan

mendalam membantu menguruskan
tekanan dan
kegelisahan semasa bersalin?
3.
Is there evidence suggesting that deep
breathing techniques shorten the duration
of labor?

Adakah terdapat bukti yang menunjukkan

teknik pernafasan mendalam
memendekkan tempoh
bersalin?

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4.
Do deep breathing exercises improve oxygenation
for both the mother and the baby during labor?

Adakah senaman pernafasan mendalam

meningkatkan pengoksigenan untuk ibu dan bayi
semasa bersalin?
5.

Are deep breathing exercises effective in

promoting relaxation and reducing muscle tension
during contractions?

Adakah senaman pernafasan mendalam berkesan

dalam mempromosikan relaksasi dan
mengurangkan ketegangan otot semasa
kontraksi?
6.
Can practicing deep breathing techniques lead to a
smoother and more controlled labor process?

Bolehkah amalan teknik pernafasan mendalam

membawa kepada proses bersalin yang lebih
lancar dan terkawal?
7.
Does the consistent practice of deep
breathing exercises contribute to a more
positive birth experience?

Adakah amalan konsisten senaman pernafasan

mendalam menyumbang kepada
pengalaman kelahiran yang lebih positif?
8. Are deep breathing exercises known to decrease the
need for pain-relief medication during labor?

Adakah senaman pernafasan mendalam diketahui

mengurangkan keperluan ubat penahan sakit
semasa bersalin?

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9. Do deep breathing techniques contribute to better
maternal and fetal outcomes during childbirth?

Adakah teknik pernafasan mendalam

menyumbang kepada hasil yang lebih baik bagi
ibu dan bayi semasa kelahiran?

10. How do you get information about antenatal booking ?

Bagaimanakah anda dapat maklumat mengenai senaman pernafasan dalam

Friends
Family
Health Care Worker

Social Media

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35
 Duration of Study (Gantt Chart)

The estimated duration of study is around 6 months from January 2023 until June 2023.

Activity / Months January February March April May June

of 2023
Data collection X X
Data entry X X
Data analysis X X
Finalize results/

carry out plan

Formula for constructing table:

s = X² NP (1-P) ÷ d² (N-1) + X² P (1-P)

Where,

s = required sample size

X² = the table value of chi square for 1 degree of freedom at the desired confidence
level (0.05 = 3.841)
N = the population size

P = the population proportion (assumed to be 0.50 since this would provide the
maximum sample size
d = the degree of accuracy expressed as proportion (0.05)

*The table sample size calculation of the Krejcie and Morgan was based on p= 0.05 where
the probability of committing type I error is less than 5% or p < 0.05.

Source: Krejcie and Morgan,1970

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