|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 3 | Page : 341-343
Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test
Reshmi Siby1, MS Vinsi2, Rebecca Mathew3
1 Principal and Head of Department, Department of OBG Nursing, Bhandari Group of Hospitals and Institutions, College of Nursing, Indore, Madhya Pradesh, India
2 Principal Professor and Head, Department of Psychiatry Nursing, Bombay Hospital College of Nursing, Indore, Madhya Pradesh, India
3 Nursing Department, Fatima College of Health Sciences, Institute of Applied Technology, Ajman, United Arab Emirates
|Date of Submission||07-Oct-2021|
|Date of Decision||08-May-2022|
|Date of Acceptance||25-May-2022|
|Date of Web Publication||22-Sep-2022|
Principal Bhandari Group of Hospitals and Institutions, College of Nursing, Indore, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups – supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.
Keywords: Antenatal mothers, comfort, fetal parameters, maternal position, nonstress test
|How to cite this article:|
Siby R, Vinsi M S, Mathew R. Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test. Indian J Public Health 2022;66:341-3
|How to cite this URL:|
Siby R, Vinsi M S, Mathew R. Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:341-3. Available from: https://www.ijph.in/text.asp?2022/66/3/341/356594
Antepartum assessment of fetal heart rate monitoring is the commonly used strategy for the estimation of oxygen perfusion in a fetus. This contributes significantly to the early detection of fetal hypoxia; thus, fetal mortality is reduced and brings healthier fetomaternal outcomes. Nonstress test (NST) is often regarded as the first choice for fetal health and survival assessment, which is a simple and noninvasive method of assessing fetal well-being by observing the fetal heart rate and acceleration in response to fetal movement.
NST is a procedure that may last for about 20–40 min. The mother's comfort during the test turns into a significant variable in deciding the exactness of the outcomes. The antenatal mother should be placed in a suitable position that will provide comfort to her and thereby does not affect the physiological parameters and NST result. Hence, positioning the mother during an NST in this period is one of the considerations a nurse needs to keep in mind. In this way, the ideal position that could be given to a mother undergoing an NST ought to be chosen, so it does not interfere with her comfort and physiological parameters, as these can result in misinterpretations of the NST.
An experimental study was conducted at Taluk Hospital, Tiruvalla; District Hospital Kozhencherry; General Hospital, Pathanamthitta; and Tiruvalla Medical Mission (TMM) Hospital, Tiruvalla of Pathanamthitta District, Kerala, India. The study recruited 450 antenatal mothers who met the inclusion criteria, which included antenatal mothers ≥ 34 weeks of gestation, with a relaxed nonirritant uterus, and who are not in active labor. The study took place in the antenatal outpatient department, antenatal wards, and NST observation rooms of the selected hospitals. Three instruments were used for collecting the data – A Structured Questionnaire containing Demographic Variables and Clinical Data/Baseline Maternal Characteristics; Nonstress Tracing and Comfort Assessment Tool. The content validity was established by experts from the department of obstetrics and gynecology. The test–retest reliability for the NST was r = 0.8. The Verbal Numerical Rating Scale was adopted for the assessment of the comfort level of the antenatal mothers. The study subject was asked to rate the level of comfort during the NST procedure from 0 to 10. Zero indicated that the client is lacking comfort and requires help during the procedure. A score of 10 indicated that the mother had full comfort during the procedure. The test–retest reliability for the Verbal Numerical Rating Scale was r = 0. 85 (P < 0.001), indicating that the instrument is reliable. The research protocol was reviewed and ethical clearance was obtained from the Ethical Review Board of TMM Hospital (Tmm1819/MS/011/Ethical; dated April 27, 2018). A no-objection certificate was obtained from the Administrative Head of the four hospitals, and the permission to conduct the study was also obtained from the Directorate of Medical Education, Thiruvananthapuram, Kerala, India. Informed consent was taken from the study participants.
The participants were assigned to one of the experimental groups, with 150 participants in each group. A rotation proposal was prepared for the random assignment of samples to the groups in the below-given format: supine–left lateral–semi-fowler's; left lateral–semi-fowler's–supine; semi-fowler's–supine–left lateral. The mothers were positioned based on the order indicated in the three experimental groups and administered NST for 20 min. Recordings of NST results were assessed. The comfort level of maternal position during the NST was assessed using the Verbal Numerical Rating Scale.
The findings indicated that majority of the samples given supine, left lateral, and semi-fowler's position for NST were in the age group of 25–29 years (44%, 49.33%, and 47.33%, respectively) and primiparous (34%, 40%, and 29.33%, respectively); and few of them (8.67%, 9.33% and 6.67%) had a history of single abortion. Majority (37.33% and 27.33%, respectively) of the study subjects given supine position and left lateral position for NST were in their gestational age of 36 weeks+, while most (33.33%) of the participants given semi-fowler's position were 37 + weeks of gestation. Subjects in the supine and left lateral position were having gestational diabetes mellitus (14.67%, 9.33%), whereas participants in the semi-fowler's position had pregnancy-induced hypertension (17.33%) in their present pregnancy. It was also observed that majority (54%) of the samples in the left lateral position had a fetal heart rate of 131–145 bpm, while participants in the semi-fowler's position (52%) had 146–160 bpm. Most (96%) of the participants in the semi-fowler's position had moderate variability (5–25 beat-to-beat variability). The subjects who received semi-fowler's position had more acceleration comparing the left lateral and supine position (73.33%, 18%, and 4%, respectively). Most (73.33%, 72%, and 66.67%, respectively) of the study subjects had 3–4 accelerations in the semi-fowler's, supine, and left lateral positions. The number of decelerations in the semi-fowler's position (7%, 52%, and 41%, respectively) is less than left lateral (6%, 40%, and 54%, respectively) and supine position (4.67%, 31.33%, and 64%, respectively). Majority (90.67% and 85.33%, respectively) of the study subjects in the left lateral and semi-fowler's position had 2–4 fetal movements compared with the supine position (61.33%).
Chi-square (χ2) value for association between baseline FHR and selected maternal position is 166.81 whereas for beat-to-beat variability is 57.34. χ2 value for association between the number of accelerations, decelerations, and number of fetal movements and selected maternal position is 17.22, 16.52, and 45.48, respectively. All these values show that there is a significant relationship between the position of mothers and fetal parameters on NST tracing at P < 0.05 level [Table 1].
|Table 1: Chi square value showing the association between maternal positions and fetal parameters (n=450)|
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The mean score of the supine, left lateral, and semi-fowler's positions is 5.25, 6.92, and 7.97, respectively. The mean square between the treatments is 282.14 whereas within the treatment is 1.61. The result reveals that the variation between the samples and the variation within the samples F= 174.848 is significant at P < 0.05 level. Therefore, this proves that there are significant differences between supine, left lateral, and semi-fowler's position with the comfort level of mothers [Table 2].
|Table 2: ANOVA for comparison of comfort level with selected maternal positions|
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The study revealed that the mean comfort scores of supine–left lateral position, semi fowler's–left lateral position, and semi fowler's–supine position have a significant difference among each other. The study revealed that the mean comfort scores of supine–left lateral position (t= 13.73), semi fowler's–left lateral position (t=7.11), and semi fowler's–supine position (t=4.56) has a significant difference among each other. The mean comfort scores is 5.25 for supine position, 6.92 for the lateral position, and 7.97 for semi-fowler's position, proving that semi-fowler's position is the most comfortable position for antenatal mothers during NST.
In this study, we observed that NST reactivity was found to be higher in semi-fowler's than in the other positions. It was noted that the baseline heart rate of the fetus, the average number of accelerations, the variability in beat-to-beat heart rate, and the mother's perception of fetal movements in the supine position were significantly less. The findings explored that women felt most uncomfortable in the supine position and expressed dyspnea, backache, and exhaustion. Hence, it is always suggested to adopt a semi-fowler's position even when the mother is taking a rest.
This study could generate a protocol for NST, which can help the staff nurses to enhance their competencies and help pregnant women to be comfortable during the test and thereby consume less time while monitoring during the NST. The future directions of this research are the strategies formulated that could be modified and used as the guidelines for further experimental investigation, which are beneficial for better maternal and neonatal outcomes. The research findings can be disseminated to increase the use of alternate positions during NST, and also, the innovative research can be conducted that invigorates effective listening and reflects the women's necessity in improving nursing care. The major limitation of this study was the presence of extraneous variables, which may cause variations in fetal parameters in individual antenatal mothers.
The study concluded that semi-fowler's posture invokes the greater receptive results and sustaining is the most comforting position for the antenatal mothers. This experimental evaluation facilitates the scientific body of professional knowledge, according to the demands and interventions identified to support the prenatal woman during her hospital stay. Immediate assessment of the demands of high-risk antenatal women on hospitalization enriches the quality of antenatal care, delivers guidance for the management of risk conditions, and sets up interventions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]