Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„¢, Midwifery Essay Example

Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery Essay Sun, Y.C. Hung, Y.C. Chang, Y. and Kuo, S.C. (2009) Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery. [Online] DOI: 10.1016/j.midw.2009.01.005 (Assessed: 9 April 2010) In this 21st century, people are more educated and are more aware on products they are using or services that are provided. When they purchase a product, they will demand for evidence which proves the effectiveness of the item. Not only that, people are more health concern, they will consume food that are proved to benefit the body, for example, oranges are proved to eliminate flu and etc. As we can see, we live in a world flooded with evidence. As compared to many years before, nurses practice through experience, tradition, culture or patientsâ„ ¢ need and yet they value the clinical experience, patientâ„ ¢s experience, local culture as evidence (Rycroft-Malone et.al., 2004). As today, we are being instilled on evidence-based practice. Even that, nurses must be clear of the basis of practice despite knowing that the practice is not evidence-based to provide a sensible care to the patients (Zeitz McCutcheon, 2003) We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you FOR ONLY $16.38 $13.9/page Hire Writer In health care, many of our practices are evidence-based. The policies and procedures, medications and treatment, included nursing care are practiced base on the evidence shown. By practicing evidence-based practice, we need to search for the best evidence available from research done recently (Sackett et.al., 1996) and evidence-based practice should not be argue and should not be any disagreement as the practice is proved (Goding Edwards, 2002). Once we practice with evidence, we can surely observe the outcomes from patients as in the piece of research. However, Scudder (2006) states that it is difficult to practice based on evidence as patients in this modern world would prefer to make their own treatment methods which might not have evidence to prove the effectiveness. When we evaluate our own practice, are all of the practices that we are following still the safest or still the most effective way in promoting health and preventing diseases This is in doubt. As health care personnel, it is important to keep ourselves updated with latest evidence-based practice to improve our care to patients. In order to do that, the most effective way is to search for research articles to compare and evaluate the findings. Hence, we can improve or initiate new practices based on the research done. Nurses have to take the lead in initiate new practices and to perform effective leadership to improve nursing care. The top management of an organization should take the lead to transform research knowledge into real practice and change the culture of the hospital (Stetler, 2003). There are five steps leading healthcare workers to evidence-based practice, we must be able to question what practice is good, nurses must be able to structure the information provided and critically appraise the information found also nurses be able to search for research articles and evaluate critically, then to implement the new practices (Cleary-Holdforth Leufer, 2008). However, in selecting research articles, we need to critically analyse the validity and reliability of the researchers and the research process before adapting the practice. Nurses should not follow blindly with orders and policies that are being set except that nurses need to critically analyse the strength and weakness of current practice, policies and procedures and theories that we have learn (Timmins, 2006). At times, we notice that some research has insufficient data to conclude the results and some has no definite findings (Aveyard Sharp, 2009). It is a good practice that nurses form a group in a ward to seek for better practices and discuss new policies which is supported by evidence. With this practice, it will not only build up leadership in every staff and also will improve the standard of care in the ward. I am a Staff Midwife working in a 10 bedded delivery suite in a private hospital in Malaysia as well as a part time pregnancy yoga instructor. I have a great interest in womenâ„ ¢s health and promoting healthy pregnancy. Most of the pregnant mothers in Malaysia prefer to stay home and refuse to perform any form of exercise throughout their pregnancy. They think it is a taboo for pregnant women to be active as this will cause miscarriage or preterm labour. Moreover, there are limited exercise can be done during pregnancy and most of the pregnant ladies in Malaysia are not exposed to information regarding exercise during pregnancy. Hence, they are afraid to exercise without guidance as well as support from health care workers and this is supported by the research of Duncombe et.al. (2009) shows that majority of the pregnant women thinks that exercise specially designed for pregnant mothers are the safest and they are more willing to learn those exercise. During pregnancy, yoga is one of the safest exercises to stay healthy and fit. On top of that, yoga relieves stress and promotes relaxation to eliminate mood swings. When the pregnant mother has pain or other discomfort during pregnancy, it will encourage mood disorders (Beddoe et.al., 2009). This is supported by the research of Furlow et.al. (2008) and Beddoe et.al. (2009) said that yoga is widely practice in pregnant mothers in obstetrics and gynaecology condition as well as meditation and it is one of the top choices of physicians in providing alternative care to the patients in the United States. With yoga practices, most of the mothers are able to cope with stress and have a healthier body as there is a link between our mind and body, when our mind is relaxes and calm, our body will follows; hence reduces stress not only in our mind and also in our body. By practicing yoga postures, chanting om, breathing exercise and yoga nidra (deep relaxation) will improve physical stre ngth and flexibility, improve self-awareness and also calm the body and mind (Chuntharapat et.al., 2008). In addition to that, when the level of stress hormones in the motherâ„ ¢s body is high, it will affect the health of the mother and the baby (Tiran Chummun, 2004). Wadsworth (2007) noted that exercises can relief minor discomfort and have lower incident of gestational diabetes, preeclampsia, preterm labour and etc. Pregnancy is a natural process and it is not a type of disease. Hence, many doctors or midwives do not prescribe medications to pregnant mothers if there are no medical conditions such as diabetes or hypertension and etc. because by consuming unnecessary medications will cause complications not only to the mother and also to the baby. Tiran Chummun (2004) commented that the use of drugs must be prevented in making sure that the side effects of the drugs will not affect the fetusâ„ ¢ wellbeing. For this reason, complementary therapies such as yoga, meditation, relaxation, reflexology and etc are the recommended techniques to promote healthy pregnancy. Thus, as a midwife and a certified pregnancy yoga instructor; I would like to discover some information from research regarding exercises during pregnancy and the effectiveness in practicing yoga during pregnancy. With this information, I would like to promote pregnancy yoga including relaxtion in my practice area especially in antenatal classes that are conducted in the hospital in order to maximize the health of pregnant mothers. Tiran Chummun (2004) and Satyapriya et.al. (2009) agreed that promoting relaxation in antenatal class helps mothers stay in more relaxed state when they preparing for labour. This piece of research that I have chosen is from a journal named Midwifery and it is published by Elsevier, the leading publisher of science and health. Midwifery is a journal that publishes all information regarding midwifery to enhance the knowledge, skills and attitudes of all midwives. Hence, this is a reliable source for the research article that I have chosen. This research article is regarding the outcome and the experience of pregnant mothers in terms of minor discomforts and the outcome of handling the labour process after the practice of yoga. As stated clearly in the title of this research, the words used attract readers and readers are be able to form an outline on what is the focus of this research from the title. However, as this is a quantitative research, the title should emphasize on the population of pregnant mothers was benefitted on the yoga programme as the format of a quantitative research focus much on the quantity or frequency of the study (Aveyard et.al., 2009). There are four researchers in this research study. They come from different field of work, including nursing division, midwifery, social culture and welfare, and an instructor for exercise and health science. This mixture of different discipline can enhance the flow of the research as they have different opinion and experience irrespective of nursing point of view, social culture or in the view of exercise. With this, the research can only proceed with a correct direction and then the study objective can be met. There is an abstract for this research article. The objective of the research, the design, place, participants, intervention, measurements, conclusions and implications are clearly identified. Readers can have a clear outline regarding this piece of research article by studying the information in the abstract of this paper. Yoga has been proving to relieve tension and improve health in practitioners and to promote relaxation, improves flexibility and relieves some minor discomfort, for example, backache and cramps etc. has shown in the wide range of the primacy source of literature reviews by the researchers ranging from the year 1991 till year 2008 included a research conducted in India regarding yoga on pregnancy outcome was clearly been evaluated. The aim of the researchers is to find out the incidence of minor discomforts occur during pregnancy and the self efficacy in labour and by practicing yoga during antenatal period by seeing that there are no studies conducted regarding this subject in Taiwan. The aim and objectives are clearly identified in the introduction of this piece of research article which leads the readers into the research findings. This is a qualitative research using a non-randomised controlled experimental study, the researchers chose participants who had antenatal checks and decided to deliver in the study hospital. The researchers used statistical power analysis to calculate the sample size which was around 41 participants per group. The sampling process conducted in the antenatal clinic in an urban hospital in Taiwan. There are few inclusion and exclusion criteria while choosing the participants. The inclusion criteria includes primigravida 18 years old at the 26-28 gestational weeks with a singleton pregnancy who are be able to listens and speaks in Chinese and has no experience in practicing yoga before, besides that, she had not been exercising for at least a year. The exclusion criteria includes pregnant mother who experienced premature labour or used epidural anaesthesia as the form of pain relieve and caesarean section is the delivery method. The researchers select the participants for control group from January to March 2004 while the participants in experimental group from April to June 2004. After the fine selection, the total of 96 participants was allocated into 2 groups â€Å" the control group consists of 45 participants and the experimental group consists of 51 participants. After the allocation of the participants, a double-blind procedure is used to avoid bias during the selection procedure to ensure that the researchers will not select the desire samples. Along this sampling process, participants were provided a written and informed consent in maintaining the confidentiality of democratic data and questionnaires during this research process. Researchers are advice to consider ethical issues in research to prevent discomforts in participants; hence, the findings are more authentic (Robson, 2007). According to Guillemin Gillam (2004) reflexivity in research not only helps researchers to reflect on the research process and construct the whole research and also to maintain the ethics in the research. Both the control group and the experimental group received the standard obstetric care and usual antenatal information including information on yoga practice in pregnancy. But only the experimental group receive a yoga programme which prepared by professionals. Throughout the research study, 2 participants from control group and 6 participants from experimental group was removed by the researchers due to various reasons such as unable to contact participant while follow up procedure; participants had preterm labour during the research period and etc. Therefore, only 43 participants in the control group and 45 participants in the experimental group participate in this research study. With total number of 88 participants is not a good sample size to conclude the research findings. There is only small percentage of urban pregnant ladies in Taiwan being studied which unable to conclude the results for most pregnant women in Taiwan which has different culture background and educatio n level in the rural area. There is no power calculation done to ensure the reliability of the sample size. Power calculation is very important in determining sample size. if the sample size is too big, researchers will waste their time and resources to conclude the data which normally will have minimal gain; whereas if the sample size is too small, the reliability of the findings to determine the research questions is suspicious (Hill Lewicki, 2007). This yoga programme in experimental group was evaluated by 5 experts using the context validity index (CVI) to ensure the content validity. The CVI is a measurement measured by content experts for a particular tool used in a research is appropriate in collecting data and conducting the research to ensure the objective of the research is met (Polit Beck, 2006). As stated in the research article, the CVI of this yoga programme was 0.96 which is a good validity. Participants were given a 10-pages booklet and a 30-minutes videotape yoga workout to practice at home and the researchers will make phone calls to all participants every week in the first 2 weeks then every 2 weeks till delivery. The researcher learnt the yoga exercise from a yoga instructor after which the researcher will teach the participants by following the videotape which consists of 9 exercise and meditation. Participants were asked to practice at home for an hour at least 3 times a week for 12 to 14 weeks. Noneth eless, Yoga is an art to improve health; it is best practice from the pregnancy yoga instructors. Participants might interpret the information wrongly by practicing from the videotape. Injuries could happen when there is no guidance during the practice. Although follow up phone calls was made, the compliances to the practice were unknown. In the study of Chuntharapat et.al., (2008), noted that the participants who can fulfill the research process are mostly housewife who can practice consistently in the yoga center in Thailand. Participants might have inconsistency in practice which will affect the research findings. For these reasons, it is best to have participants to attend yoga classes 3 times a week for 12-14 weeks instead of videotape practice. There are 2 methods used by the researchers. They are the discomforts of pregnancy questionnairesâ„ ¢ and childbirth self-efficacy inventoryâ„ ¢ (CBSEI). The discomforts of pregnancy questionnaires consists of 20 questions that reviewed by antenatal experts. Each question in this questionnaire was scored by five-point scale. The scale was composed as very severe (5 points) to none (1 point). The higher the score for this questionnaire indicates that the more discomfort of pregnancy occurs. As indicated by the researchers of this research article, the CVI value for this questionnaire was 0.92 shows that the questionnaires have a fine validity. CBSEI was the diagnostic tool to assess the self efficacy in pregnant mothers during labour. There are 4 measurements needed to conclude the results for CBSEI. The self-efficacy expectancy during active phase of labour; the outcome expectancy during labour; the self-efficacy expectancy during second stage of labour and the outcome expectancy during second stage of labour. It is measured by a 10-point likert scale. In self efficacy expectancy scale, 10 points indicates very sure to 1 point indicates not at all sure. Whist in outcome expectancy scale, 10 points indicates very helpful to 1 point indicates not at all helpful. Before the questionnaires was distributed and before videotape with booklet was hand out to participants, pilot tests was conducted to make sure that participants understand the video content and the booklet also be able to practice the yoga exercises alone at home. Pilot test allow researchers to test the public before the real data collection and to make amendment on any uncertainties (Robson, 2007). Three sets of data collection were done. Demographic information and discomforts of pregnancy questionnaires was collected during 26 weeks to 28 weeks for pre test, this procedure was carry out when the researchers distribute and explain the consent once the participants agreed to participate in this research. The 2nd time of data collection for discomforts of pregnancy questionnaires was during 38-40 weeks gestation (post test) before delivery. The third data collection was during active phase of labour (when the participant having a contraction in 3 to 5 minutes) that participants were asked to complete the CBSEI along with another CBSEI data was collected 1 to 4 hours after second stage of labour. Data was evaluated by researchers after collection. All data ware analyse using Mann-Whitney U-test. The researchers used a statistical package in assisting them to get an accurate result. It is important for the researchers to know and be familiar with the statistical test to analyse the data collected. Robson (2007) thinks that the researchers must seek help if they are not an expert in using the statistical test in order to interpret results accurately. A research cannot contribute evidence to guide clinical practice if the findings of the research are not accurate, biased or fail to accurately represent the experiences of the experimental group, for example, the scale given to evaluate the discomfort of pregnant women must be clear and understandable to participants so that the participants answer accurately. The findings of this research presented clearly by the researchers. The differences between control group and experimental group clearly stated. The p values of this research are less than 0.5. This shows that the reliability of this research is high. Besides that, the questionnaires and the methods used were evaluated by experts. Hence, the reliability, validity and trustworthy of this research was maintain. However the analytical process was not clearly identified. From the research findings, there are no significant differences in birth weight of baby in control group and in experimental group. The findings for pregnancy discomfort in control group were increase during the post test compare to pre test; whereas in experimental group, there is not much difference in pregnancy discomfort. Participants from experimental group had increase in self efficacy in childbirth. In addition to this, there are extra findings regarding physical responses after each yoga session such as chances of pregnant women experience contractions while practicing yoga and feelings of pregnant women after the yoga programme in experimental group. Most of the participants have no contractions during the practice of yoga, but experience sweating and slight panting after practice. However, most of the participants felt yoga ease discomforts in pregnancy and meets their needs by practicing yoga. The limitations of this research are clearly stated. For example, the sample size is small, it is unable to conclude the population in Taiwan and the participants are primigravidas also a further research needs to be done on multigravida mothers too. Furthermore, the timing of data collection for CBSEI is varies between participants; for instance that some participants need longer time to have a close contractions while the other do not; Some participants fill up the CBSEI 1 hour after delivery while the others complete the CBSEI at 4 hours after delivery. This will cause some difference in the findings as the timing was not fixed. From this research, it shows the benefits of practicing yoga during antenatal in helping pregnant ladies to cope with stress, relieves discomforts during antenatal and also increases the coping mechanism during labour through the practice of breathing exercise and relaxation techniques. As a midwife and a yoga instructor, I have witness some cases which the mother had learned yoga during antenatal and have a positive outcome in coping labour contractions. As in a study done by Chuntharapat et.al. (2008), the result shows by practicing yoga or three times a week for 30 minutes a day will decrease discomfort during pregnancy, decrease pain during labor and shorten the labor process due to the enhancement of coping mechanism. As in Malaysia, most of the women do not exercise during pregnancy. From this assignment, I would like to propose to the hospital management to encourage yoga programme as one of the programme in antenatal class to build awareness in pregnant mothers and the public in this country, bringing from good care of the hospital to excellent care! However, the hospital that I am practicing is a catholic hospital, most of the Muslims and Catholics in my country do not practice yoga as their perception on yoga is a religious practice and it is related to meditation. Hence, to respect different religions in a multiracial country, I would like to look for more evidence on this matter to clarify the uncertainties, so that the Muslims women and Catholics women can also beneficial on this programme. In order to implement new practices, a clear vision, a good leadership and sufficient evidences are needed to help change the culture of practice. Hockenberry et. al. (2008) noted that if there is no incorporation of the hospital environment, there will be no significant changes in practice. On top of that, audit on current practices is important to ensure the quality in current practice; audit need to be done to encourage quality improvement. When an organization need to change a practice, evidences are needed to encourage change and audit is to decide which evidence to follow will benefit the patients most as well as to monitor the staff compliances to the new practices. Audit need to make sure that the hospital staff are trained and accreditated by experts before commencing new practices to guarantee safe practice. Research, audit and quality improvement work hand in hand to provide quality care to patients (Hill Small, 2006). In conclusion, as a healthcare worker, we are encouraged to update our knowledge constantly not only by reading evidence based research and also to analyse the content critically whether it is valid and reliable before turning it to the new practice in our practice area and it is supported by Haynes et. al. (2002), he thinks that there is no purpose of an excellent research done but there is nobody to implement the research findings into practice. 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