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  2. 2. TITLEEffect of Jacobsons progressive musclerelaxation technique on anxiety amongprimigravida
  3. 3. BACKGROUND OF THE STUDYWomen encounter physical, emotional, andpsychological changes during pregnancy. Theliterature indicates that some women find thesechanges to be stressful. They may respond tothis stress by feeling anxious. The frequencyand intensity of the anxiety reaction dependson how women perceive these stressors and ontheir ability to cope with the anxiety
  4. 4. Antenatal anxiety has received increasedattention with regards to both its impact oninfant outcomes and as a risk factor forpostnatal depression
  5. 5. Preterm labour and low birthweight forgestational age are the outcomes linked mostconsistently with antenatal stress or anxiety inhumans .
  6. 6. • The studies of the effects of antenatal stressand anxiety in humans have concentrated onobstetric outcome. A study found that womenwho experienced severe life events in the firsttrimester of pregnancy had a 50% increase inthe rate of congenital abnormalities incranial—neural crestderived organs (e.g. cleftpalate). Even greater risk was associated withthe most severe and rare stress, the unexpecteddeath of a child1.
  7. 7. • Another study says that preterm labour andlow birthweight for gestational age are theoutcomes linked most consistently withantenatal stress or anxiety in humans2. In onestudy of 8719 women, it was reported asignificant association between selfreportedgeneral distress at 30 weeks and an increasedrisk of preterm delivery, defined as <37weeks3.
  8. 8. • Another study have shown that individualswho experienced severe stressful events duringpregnancy showed a 50% increase in markedpremature delivery (babies born at <34 weeks).
  9. 9. • In a cohort study conducted by AvonLongitudinal Study of Parents and Children(ALSPAC)it was found that there was a stronglink between maternal anxiety in the thirdtrimester and behavioural/emotional problemsin the resulting children at 4 years.It was foundthat self-reported antenatal anxiety at 32weeks gestation predicted severebehavioural/emotional problems in both boysand girls4.
  10. 10. NEED AND SIGNIFICANCE OFTHE STUDY• Depressive and anxiety disorders are the mostcommon psychiatric illnesses duringpregnancy and the postpartum period.According to international data the prevalenceof antenatal depression is between 7% and17% and approximately 10% of pregnantwomen suffer from some kind of anxietydisorder5.
  11. 11. • More women with lower anxiety levels and amore positive state of mind had normal deliveries.Anxiety was related to lower birth weight and todifficult delivery. A positive state of mind andemotional stability were associated with having anormal delivery. Therefore, moderate levels ofanxiety were associated with complicationsduring delivery and poorer foetal outcomes,whereas a positive state of mind was associatedwith better childbirth experiences
  12. 12. • Relaxation exercises have become a standardintervention for individuals with anxietydisorders. Relaxed muscles bring on a moreserene state with less physical andpsychological tension, according to theUniversity of Missouri report. In 2010 studyreported by the National Institutes of Healthshows that progressive muscle relaxation cansignificantly alleviate stress among pregnantwomen6.
  13. 13. • Progressive muscle relaxation techniqueshave been utilized to effectively control stress,fear, anxiety, insomnia and chronic pain. Thisprocedure can also be effectively applied tonatural childbirth. Through conditionedpractice this can be quickly learnt torecognize -and differentiate- a tensed musclefrom a completely relaxed muscle.
  14. 14. • With this simple awareness, physical muscularrelaxation can be induced at the first signs oftension caused by anxiety. Physical relaxationenables mental peace-in any situation, evennatural childbirth7.
  15. 15. PURPOSE OF STUDYThe purpose of the study is to assess the level ofanxiety among primigravida, evaluate theeffect of Jacobsons progressive musclerelaxation technique on anxiety amongprimigravida, find out the associationbetween anxiety among primigravida andselected sociodemographic variables.
  16. 16. STATEMENT OF THE PROBLEMA study to assess the effect of Jacobsonsprogressive muscle relaxation technique onanxiety among primigravida admitted inTDMCH, Alappuzha.
  17. 17. OBJECTIVESTo assess the level of anxiety among primigravida.Evaluate the effect of Jacobsons progressivemuscle relaxation technique on anxiety amongprimigravida.Find out the association between anxiety amongprimigravida and selected sociodemographicvariables.
  18. 18. OPERATIONAL DEFINITIONSEffectEffect refers to the change in the level of anxiety ofprimigravida brought about by progressive musclerelaxation as measured by the anxiety assessmenttool.
  19. 19. Jacobsons progressive musclerelaxation techniqueIn this study Progressive muscle relaxation (or PMR)refers to a technique for reducing anxiety related topregnancy in primigravidas by alternately tensing andrelaxing the muscles.
  20. 20. AnxietyA feeling of worry, nervousness, or unease,typically about pregnancy and its outcome,andwhich is measured using spielberger anxietyinventory.PrimigravidaA woman who is pregnant for the first time.
  21. 21. Socio personal variablesRefers to the data regarding the age, socioeconomic status,occupation, educational status,gestational age etc.Low riskPrimi gravid women between 18-35yrs, withoutany diseases complicating pregnancy
  22. 22. CONCEPTUAL FRAMEWORKRoys adaptation model
  23. 23. ASSUMPTIONSThe study assumes thatAll primigravida experience some level of anxiety.Primigravida are willing to learn progressivemuscle relaxation exercise.PMR exercise has no known harmful effect onpregnancy.
  24. 24. HYPOTHESISH1 There is significant difference between thelevel of anxiety of primigravida in theexperimental and control group before andafter intervention.H2 There is significant association between thesocio personal variables and levelof anxietyamong primigravida.
  25. 25. RESEARCH APPROACHExperimental approach is adopted
  26. 26. RESEARCH DESIGNQuazi experimental with non equivalent controlgroup design
  28. 28. TOOLSpielberger anxiety inventory
  29. 29. SETTING OF THE STUDYThe Antenatal ward (Ward 2) of MCHAlappuzha was selected for the study.
  30. 30. POPULATIONThe population for the study is low riskprimigravida of ward 2 admitted at MCH,Alappuzha
  31. 31. SAMPLE AND SAMPLINGTECHNIQUESThe sample size is 60 primigravida, 30 each inexperimental and control group. The criteriafor selection of subjects are the following
  32. 32. INCLUSION CRITERIAprimigravidaAdmitted in the MCH Alappuzha.Primi gravid women in third trimester after 36 weeks ofgestation.With low risk pregnancy.Willing to participate in the study.Able to read and write Malayalam.
  33. 33. EXCLUSION CRITERIAprimigravidaWith impairment in vision and hearing.With psychiatric illness.With disease complicating pregnancy.
  34. 34. THE SAMPLING TECHNIQUEnon probability convenient sampling.
  35. 35. PLAN FOR DATAANALYSISData was analysed using descriptive andinferential statistics.
  36. 36. PILOT STUDYPilot study undertaking 6 primigravida admittedin antenatal ward TDMCH Alappuzha.
  37. 37. REFERENCES• 1,Carmen Hernandez Martinez,Victoria ArijaVal,Michelle Murphy,Pere Cavalle Busquets,;RelationBetween Positive And Negative Maternal EmotionalStates And Obstetrical Outcome;Journal-Women AndHealth,Vol51,No.2,Pp124-135,2011• 2,Vivette Glover,Thomas G O Connor,Effects OfAntenatal Stress And Anxiety,Abstracts FromWorkshop Presentation In Manchester 15 Oct 2008• 3,Vivette Glover,Thomas G O Connor,Effects OfAntenatal Stress And Anxiety,Abstracts FromWorkshop Presentation In Manchester 15 Oct 2008
  38. 38. • 4,niloufer S Ali,iqbal S Azam,badar S Ali,ghurnata Tabbusum,sana SMoin,frequency And Associated FACTORS For Anxiety And DepressionIn Pregnant Women;a Hospital Based Cross SectionalStudy,january22,2002.• 5, P H C Rondó, R F Ferreira, F Nogueira, M C N Ribeiro, H Lobert, RArtes Maternal Psychological Stress And Distress As Predictors Of LowBirth Weight, Prematurity And Intrauterine Growth Retardation(Citations:81)• Journal: European Journal Of Clinical Nutrition - Eur J Clin Nutr , Vol. 57,No. 2, Pp. 266-272, 2003• 6, Alder J, Urech C, Fink N, Bitzer J, Hoesli Iresponse To InducedRelaxation During Pregnancy: Comparison Of Women With High VersusLow Levels Of Anxiety. Source:ob/Gyn, University Hospital Basel, Basel,Switzerland. Jalder@uhbs.Ch 2011 Mar;18(1):13-21.
  39. 39. • 7, Farideh Bastani, Msc, ,Author VitaeAlirezaHidarnia, PhdAuthor Vitae, AnoshirvanKazemnejad, PhdAuthor Vitae, Maryam Vafaei,PhdAuthor Vitae, Maryam Kashanian, MD ARandomized Controlled Trial Of The Effects OfApplied Relaxation Training On ReducingAnxiety And Perceived Stress In PregnantWomen. Journal Of Midwifery & WomensHealthvolume 50, Issue 4, July–August 2005,Pages E36–E4•