A STUDY TO ASSESS THE EFFECTIVENASS OF IMMEDIATE BREAST FEEDING ON DURATION OF THIRD STAGE OF LABOUR AND BLOOD LOSS DURING THE SAME IN SELECTED HOSPITALS

An experimental study was conducted to assess the effectiveness of immediate breast feeding on duration of third stage of labour and blood loss during the same in selected hospitals of Pune city. The conceptual framework adopted for the study was General System Model. The sample size was 60 full term mothers in active labour, divided into two groups. Purposive sampling technique was used for selection of sample. Where, Group I is experimental group and Group II is an control group. Each consisted of 30 samples. Data collection was accomplished by using observation check list as a tool. It consists of three sections. First section dealt with demographic profile of the samples. Second section dealt with observation check list to assess duration of labour.Third section dealt with amount of blood loss.Pilot study was conducted to assess the feasibility of the study. It was conducted on 14 mothers.Final data collection was done. Data gathered was analysed by using descriptive and inferential statistics. interpretations were made.The study analysis shows that immediate breast feeding statistically reduces the duration of


Sampling Technique:
In this study purposive sampling technique was adopted to select the subjects. Purposive sampling is a nonprobability sampling technique where subjects were chosen to be part of the sample with a specific purpose in mind and according to the study objectives.

Criteria for Samples Selection: Inclusion Criteria:
Subjects who 1. At term and spontaneous onset of labour 2. With vertex presentation. 3. Without undue prolongation. 4. Normal termination with minimal aids. 5. Without having any complications affecting the health of the mother and/or the baby 6. Study is confined to women who are willing to participate.

Exclusion Criteria:
Those who were not willing to participate 1. Women with medical problems like diabetes mellitus, hyper tension, epilepsy, heart disease. 2. Women with breech,shoulder,face or brow presentation.

Socio demographic variables:
Information on socio demographic variable of the subjects contains three items, which included Age, Gravida, Weeks of gestation, Nipples, and suckling of baby at breast

Observation check list: Reliability:
After establishing the validity of the tool to be used for the study, the final tool is made and then the reliability of the tool is done.
The reliability of the tool is tested by 'Cronbach Alpha test'. This method is used as the data is of qualitative type and this method gives exact error in the reliability score. The method of 'Cronbach Alpha test' stresses internal score relations of the items in the tool as well as correlation of each item with the test.
Inter observer reliability is used to establish the reliability of the observation check list. There is 89% agreement present.

Data collection procedure:
Data collection is done in various hospitals of Pune city like,Bharati Ayurvedic hospital and Y.C.M. hospital,Nigdi.Formal administrative approval is sought from the administrator, Matron, Head of the department Obstetrics and Gynaecology. Samples are explained about the study and consent is taken for their participation in the study. 1. Demographic data is collected from both the groups.Immediate breast feeding is given to the babies by mother's in experimental group. 2. Mothers in control group did not breast feed babies immediately. 3. Duration of third stage of labor and blood loss is assessed and compared in both the groups.

Plan for data analysis:
The analysis will be made on the basis of objectives and hypothesis. The data analysis will be done by using descriptive and inferential statistics. The data shows that 12% mothers were <20 years of age, 78% mothers were in the age group of 21-25 year of age,8% of mothers were in the age group of 26-30 years and 2% that is only one mother was above age of 31 year. The data presented shows 43% are primi gravida, 45% are second gravida and 12% are third gravida. Among 60 mothers, 72%mothers were between 37-40 weeks of gestation, and remaining 28% were more than 40 weeks of gestation.

Figure:-
In experimental group 8 mothers had 5-6 hrs of first stage of labor, while 5 mothers in control group had 5-6 hrs of first stage of labor. Eight mothers in experimental group had 7-9 hrs of duration of first stage of labor, while there were 6 mothers in control group.

Weeks of g eatation
In experimental group 6 mothers had 9-11hrs of first stage of labour, while 10mothers in control group had 9-11hrs of first stage of labour.
Eight mothers in experimental group had 11-13hrs of duration of first stage of labour, while there were 9 mothers in control group.
First stage of labour 5 to 7 hrs: Signs of Placental Separation: N=13

Figure:-
Apparent lengthening of cord ,gush of blood and feeling of firm uterus per abdomen was felt within 10 minutes in 7 mothers in experimental group and in one mother in control group.
Apparent lengthening of cord ,gush of blood and feeling of firm uterus per abdomen was felt within 11-20 minutes in 1 mother in experimental group and in no mother in control group.
Same signs were observed within 21-30 minutes in 4 mothers in control group and no one in experimental group.   As proportion calculation value is 0, there is no significant difference between time duration of stoppage of cord pulsation between experimental group and control group. It took 21-30 minutes for 2 mothers in experimental group and 5 mothers in control group.
As P value is very small,(0.0000519417)as compared to table value. In experimental group time require was significantly less than in control. Placenta is expelled by twisting movements within 10 minutes in 6 women in experimental group .Placenta is expelled by twisting movements within 21-30 minutes in 2 women in experimental group and 5 women in control group.  Signs of placental separation, gush of blood, feeling of firm uterus per abdomen within 10 minutes was seen in 5 mothers in experimental group. Signs of placental separation, gush of blood, feeling of firm uterus per abdomen within 11-20 minutes was seen in 3 mothers in experimental group and 3 mothers in control group. It took 21-30 minutes for three mothers in control group to show above signs.  The placenta and membrane were separated and seen at perineum within 11-20 minutes in 3 mothers in experimental group.

Duration Of Time Of Placenta For Expulsion
The placenta and membrane were separated and seen at Perineum within 21-30 minutes in 6 mothers in control group.
Table no-vii:-comparison of time duration of experimental and control group in relation to placenta and membrane separated and seen at perineum. N=14 As proportion calculation value is more than table value,time required is less in experimental group than in control group.
Placenta expelled by twisting movement and removed:-N=14

First stage of labour between 9hrs 1min-11 hrs:
The first stage of labour was completed within 9hrs 1min-11 hrs by 16 mothers. Signs of placental separation, gush of blood, feeling of firm uterus per abdomen within 10 minute was seen in 3 mothers in experimental group.

Signs
Signs of placental separation, within 11-20 minutes was seen in 2 mothers in experimental group and 7mothers in control group.
It took 21-30 minutes for 1 mother in experimental group and for 3 mothers in control group to show above signs.  The pulsation of cord stopped within 10 minutes for 6 mothers in experimental group and 9 mothers in control group.Only one mother in control group took 11-20 minutes   The placenta and membrane were separated and seen at perineum within 10 minutes in 2 mothers in experimental group.
The placenta and membrane were separated and seen at perineum within 11-20 minutes in 3 mothers in experimental group and one mother in control group.
The placenta and membrane were separated and seen at perineum within 21-30minutes in 1 mother in experimental group and 9 mothers in control group. In experimental group time require was significantly less than in control group. Placenta expelled and removed by twisting movement within 11-20 minutes in 3 mothers in experimental group. One mother in control group.

Placenta To Be Expelled By Twisting Movements And
Placenta expelled and removed by twisting movement within 21-30 minutes in 1 mother in experimental group and 9 mothers in control group. In experimental group time require was significantly less than in control group. Signs of placental separation, like gush of blood, feeling of firm uterus per abdomen within 10 minutes was seen in 2 mothers in experimental group.

Duration of First
Signs of placental separation like, gush of blood, feeling of firm uterus per abdomen within 11-20 minutes was seen in 5 mothers in experimental group and 3 mothers in control group.   The pulsation of cord stopped within 10 minutes for all the 8 mothers in experimental group and 9 mothers in control group. Proportion calculation is Zero. Thus there is no significant difference in time duration of cord pulsation between experimental group and control group.  The placenta and membrane were separated and seen at perineum within 11-20 minutes in 4 mothers in experimental group and no mother in control group.

Separation of Placenta and Membrane And Seen
The placenta and membrane were separated and seen at perineum within 21-30minutes in 4 mother in experimental group and 8 mothers in control group    The amount blood loss is between 101-250 ml is seen in 25 mothers in experimental group and the amount of blood loss between 251-500 ml is seen in 21 mothers from control group. The figures indicate more mothers in experimental group has less blood loss while,more mothers in control group has more blood loss. No mother had blood loss <100ml either in control group or in experimental group. Therefore H 0 is rejected and H 1 and H 2 is accepted.i.e. there is a significant difference in duration of third stage of labour between experimental group and control group of mothers with immediate breast feeding.
Also there is significant difference in amount of blood loss between experimental group and control group of mothers with immediate breast feeding.

Discussion:-
This chapter entails a summary of the study major findings with the conclusion drawn, limitation and implication for nursing practice, education, nursing administration and nursing research. It also gives an account of suggestions and recommendations for future research in the field of Midwifery Nursing Practice.
The function of final sections of research is to discuss, interpret and identify the limitations and generalization relevant to the investigation thereby furthering nursing research..

Nursing Education:
Education is the key to the development of excellence in nursing practice. Education faces tremendous challenges in keeping pace with the change in nursing practice to maintain its high quality. Nurses with higher education and up to date knowledge will deliver cost effective and quality care.
Therefore, in order to ensure nursing student assist the mothers to breast feed baby immediately or within one hour of life. Students should be taught about holistic care. There are different non-pharmacological measures, which can be used by the nurses effectively and independently. So the students should be taught in detail about the all nonpharmacological measures to reduce the blood loss and prevent post partumhemorrhage.

Nursing Administration:
Our rapidly and changing an expending world makes it necessary for us as nurses to increase our knowledge and skill concerning many aspects of MCH care. We must not only keep abreast of scientific and technological advances in health field of developed countries, but also device ways for more creative use of our existing knowledge and resources, so that the best possible nursing care be provided to mothers as well as babies in developing countries.
The study has important implication for the Nursing administration. The over all nursing responsibility of quality nursing care is on the nurse administrator. The nurse administrator should accept the new treads in health care that is immediate breast feeding than oxytocin.Administrator should motivate the staff nurses to learn new methods to reduce incidence of PPH.
Administrator should be aware of recent research findings, through professional conferences and in-service education facility.

Nursing Research:
No profession can exists without research to develop it's body of knowledge to test it's strategies ,to ensure that it's action makes a difference. The health care environment today is dynamic and more demanding. There is a need to promote research based practice and the use of evaluation methods to measure outcome and document the quality and cost effective care as nursing moves towards an independent professional practice mode.
Research has vital and significant role in nursing. Nurses must take up extensive research in the field of immediate breast feeding.
Emphasis should also be laid on publication of findings of research in Journals to disseminate the research based evidence for nurse practitioner. It also can be presented at various nursing forums so that more number of nurses become aware of the therapy and feel the need to include this therapy in their routine patient care.

Community Education:
Nursing staff working in the community as community health nurse ,health worker,Dais etc. Can help and educate antenatal mothers from community about how to reduce the blood loss and they should be aware of new methods for treating more blood loss or PPH.

Conclusion:-
The present experimental study was undertaken to assess the effectiveness of immediate breast feeding on duration of third stage of labour and the blood loss during the same.