Abstract
Objective: To evaluate the application of painless nursing in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia. Methods: A total of 124 parturients who were transferred to cesarean delivery due to the failure of natural childbirth via labor analgesia were selected and randomly divided into two groups. The control group received routine nursing, while the research group was given painless nursing in the operating room, which mainly included interventions in terms of the environment, labor process, and delivery procedure. The visual analog scale (VAS), gestation outcome, stress response, anxiety, sleep quality, and nursing satisfaction were compared between the two groups. Results: Compared with the control group, the sleep quality score was significantly lower in the research group (all P<0.001). Compared with before nursing, the anxiety and VAS scores of the two groups were significantly decreased after nursing (P<0.001). Additionally, the anxiety and VAS scores of the research group after nursing were significantly lower than those of the control group (P<0.001). There was no significant difference for the gestation outcome between the two groups (P>0.05). Compared with before nursing, the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) after nursing were significantly downregulated, while the level of superoxide dismutase (SOD) was significantly upregulated in both groups (all P<0.001). Compared with the control group, the levels of MDA and ROS were significantly lower, while SOD level was significantly higher in the research group after nursing (all P<0.001). Compared with the control group, the nursing satisfaction was significantly higher in the research group (P<0.05). Conclusion: The painless nursing for cesarean delivery parturients in the operating room due to the failure of natural childbirth via labor analgesia can effectively improve the sleep quality and negative moods of the parturients, reduce the degree of pain and stress response in the process of delivery, and result in better satisfaction and compliance.
Keywords: Painless nursing, cesarean delivery, stress response, visual analog score, gestation outcome, nursing satisfaction
Introduction
In natural childbirth, parturients often confront 12 grades of labor pain, which severely affects their physical and mental health. Some of the parturients even have to be transferred to cesarean delivery due to unbearable labor pain [1]. In recent years, epidural labor analgesia has been developed rapidly and is widely applied in the labor analgesia of obstetrics and gynecology, which can effectively alleviate the pain during childbirth. However, in other scenarios, parturients need to be subject to cesarean section due to dystocia and other factors causing natural delivery failures, which contributes to different degrees of negative impacts on their psychology [2]. Therefore, it is essential to carry out an active nursing intervention for these parturients in clinical practice [3]. Painless nursing is a patient-centered approach, which leverages the preoperative painless technique, intraoperative comfortable and painless nursing, and postoperative recovery nursing and follow-up to ensure that under no pain or less pain condition, nursing is implemented to improve the treatment comfort for patients. Zhao et al. have conducted a painless nursing approach for 160 patients undergoing scheduled surgery so that the patients could be in a better preoperative state, which helps to alleviate patients’ fear of surgery and improve the quality of nursing in the operating room [4]. Although labor analgesia has been implemented, some parturients are still required to be transferred to cesarean delivery resulting from the failure of natural childbirth, which will exert a certain pressure on parturients’ psychology. Therefore, it is of great importance to apply painless nursing intervention in the operating room. This study focused on the application of painless nursing in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia, aiming to provide an insight into the clinical practice.
Materials and methods
General information
One-hundred and twenty-four parturients who were transferred to cesarean delivery due to the failure of natural childbirth via labor analgesia were recruited in our hospital from January 2017 to May 2018. None of the participants had a history of cesarean section. Inclusion criteria: 1) Complete clinical data and cooperating compliance during the study; termination of painless delivery while trasnferred to cesarean section; 2) women who did not participate in other clinical studies during this research period; 3) age >18; 4) normal cognitive function to sign the informed consent; 5) parturients with normal coagulation and liver and kidney functions; gestation >37 weeks; pregnancy <6 times; 7) scheduled surgery; 8) with epidural analgesia [5]. Exclusion criteria: 1) Major organ damage; 2) contraindications to anesthesia; 3) non-term pregnancy; 4) immune system diseases; 5) overweight fetuses [6]. The parturients were randomly divided into two groups, the research group (n=62) and the control group (n=62). The study was approved by the Ethics Committee of our hospital, and parturients understood relevant contents of the study and signed inform consent.
Methods
The corresponding nursing was applied to parturients once entering the operating room.
(1) The control group was received routine nursing. Nurses closely observed the delivery process, evaluated the physical condition, developed safe and effective nursing procedures, and observed the maternal and infant conditions during delivery. (2) The research group was given painless nursing in the operating room. 1) Environmental intervention: nurses introduced the environment of the operating room, informed parturients of the delivery position and the method of anesthesia, which helped relieve the depression and fear [7]. Because parturients underwent combined spinal-epidural anesthesia, patients should be transferred to the cesarean section immediately after the failure of natural childbirth via labor analgesia, which increased the parturients’ psychological stress and affected the delivery process. Therefore, the process should be guided by experienced nurses to proactively communicate with parturients, give them encouragement, comfort, and care, and accompanied with them all the time, which was beneficial to the relief of negative emotions. 2) Dynamic observation of the maternal delivery process: nurses should understand the clinical data of parturients, proactively encourage them, and engage the communication, which was helpful to objectively assess the mental state of parturients [8]. Parturients were introduced to cases of successful childbirth, which helped to improve their confidence and compliance and reduce the childbirth pain to a certain extent. Playing quiet and peaceful music can distract parturients’ attention and reduce their psychological distress. 3) Introduction of the childbirth process: currently, some parturients were not very aware of the knowledge regarding painlessness in the operating room and the principle of anesthetics. Nurses should explain the principle of anesthesia to the parturients and inform them that anesthetics would not harm the fetus, while at the same time, it can regulate the level of catecholamines of parturients and benefit the fetuses and their mothers. In addition, nurses should confidently analyze the data regarding maternal comorbidities and medical history and introduce the ward environment to parturients, which was conducive to eliminating the sense of helplessness and strangeness in order to relieve the pain. 4) Care intervention: nurses assisted the parturients to choose a suitable position, used blankets to cover the private parts, and applied care intervention to improve their cooperation [9]. 5) Intervention of post-childbirth: after the childbirth was done, nurses should inform parturients of the newborn status, while parturients should appropriately comfort the fetuses to maintain a stable mood. Secondly, nurses should control the amount of bleeding and ameliorate the anxiety and distress.
Outcome measurements
(1) Comparison of general information between the two groups. The general information such as age, gestational weeks, pregnancy times, parity, anesthesia method, operation time, and intraoperative blood loss was compared between the two groups. (2) Comparison of sleep quality between the two groups. The quality of sleep (QS) scale was applied to evaluate the sleep quality of the parturients, which mainly included daytime function, subjective sleep quality, hypnotic time, sleep obstacle, time to fall asleep, sleep efficiency, sleep time, etc. At the end of the cesarean section, parturients’ sleep quality on the same day was evaluated. The lower the score, the better the sleep quality. (3) Comparison of anxiety and VAS between the two groups. The VAS was used to evaluate maternal anxiety before and after nursing [10]. The scale was grouped into 3 levels, including 72-100 points: severe anxiety; 63-72 points: moderate anxiety; 53-62 points: mild anxiety. The higher the score, the higher the anxiety. When the delivery was done, expected mothers’ physical strength was recovered, and vital signs such as breathing, heart rate, and blood pressure were stable, the pain of parturients were evaluated using VAS, which was divided into 4 categories, 7-10 points: severe headache; 4-6 points: moderate headache; 1-3 points: mild headache; 0 points: no pain. The total score was 10 points, the lower the score, the better the recovery of the maternal condition [11]. (4) Comparison of the gestation outcome between the two groups. After delivery, the number of normal newborns, low birth weight infants, fetal malformations, and stillbirths were quantified, and the incidence was calculated. (5) Comparison of oxidative stress reaction between the two groups. A fasting venous blood (3 mL) was collected from the two groups of parturients before and after nursing, followed by a centrifugation at 3500 rpm. Indicators such as ROS, SOD, and MDA were measured according to the manufacture’s protocol. The higher the positive values, the better the intervention [12]. The kit was provided by Shanghai Yansheng Biochemical Reagent Co., Ltd. The normal ranges of SOD, MDA, and ROS were 180-235 U/mL, 1530-850 nmol/mL, and 2-4 U/L, respectively [13]. (6) Comparison of satisfaction, including dissatisfied, satisfied, and strongly satisfied between the two groups. After delivery, the number of corresponding parturients was counted and the incidence was calculated. Satisfaction = (strongly satisfied + satisfied)/total number cases *100%. The higher the satisfaction, the better the intervention.
Statistical analysis
The statistical analysis was conducted using SPSS19.0 software. The quantitative data were presented as mean ± standard deviation (x̅ ± sd). The comparison before and after nursing within the same group was analyzed by paired t-test, while the comparison between 2 groups was done by independent sample t-test. The counting data were presented as rate (%) and analyzed by χ2 (%) test. P<0.05 indicated a statistically significant difference.
Results
Comparison of general information between the two groups
There was no significant difference regarding the general information between the two groups of parturients (P>0.05) (Table 1).
Table 1.
Comparison of general information between the two groups (x̅ ± sd)
| Group | Research group | Control group | t | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| Average age (year) | 26.8±1.4 | 26.6±1.5 | 0.768 | 0.444 |
| Average gestational weeks (w) | 39.6±1.8 | 40.1±1.7 | 1.590 | 0.114 |
| Average pregnancy times (times) | 3.2±0.4 | 3.3±0.5 | 1.230 | 0.221 |
| Average parity (times) | 1.8±0.7 | 1.7±0.6 | 0.854 | 0.395 |
| Operation time (min) | 39.1±10.1 | 42.3±9.2 | 1.844 | 0.068 |
| Intraoperative blood loss (mL) | 462.1±71.2 | 475.3±78.7 | 0.979 | 0.329 |
Comparison of sleep quality between the two groups
Compared with the control group, the QS scores of the research group were significantly lower (all P<0.001) (Table 2).
Table 2.
Comparison of sleep quality between the two groups (score, (x̅ ± sd))
| Group | Research group | Control group | t | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| Daytime function | 1.81±0.22 | 2.34±0.12 | 16.653 | 0.000 |
| Subjective sleep quality | 2.26±0.34 | 2.74±0.51 | 6.166 | 0.000 |
| Hypnotic time | 1.42±0.31 | 2.49±0.53 | 13.722 | 0.000 |
| Sleep obstacle | 1.43±0.21 | 2.21±0.42 | 13.079 | 0.000 |
| Time to fall asleep | 1.96±0.24 | 2.54±0.42 | 9.441 | 0.000 |
| Sleep efficiency | 1.12±0.37 | 2.23±0.52 | 13.695 | 0.000 |
| Sleep time | 1.41±0.36 | 2.34±0.41 | 13.421 | 0.000 |
Comparison of anxiety and VAS between the two groups
Before nursing, there was no significant difference in terms of anxiety and VAS between the two groups (P>0.05). Compared with before nursing, the anxiety and VAS of the two groups were significantly decreased after nursing (P<0.001). In addition, the anxiety and VAS of the research group were significantly lower after nursing than those of the control group (P<0.001) (Table 3 and Figure 1).
Table 3.
Comparison of anxiety and VAS between the two groups (score, (x̅ ± sd))
| Group | Control group | Research group | t | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| Anxiety | ||||
| Before nursing | 42.21±2.69 | 41.73±2.74 | 0.984 | 0.327 |
| After nursing | 39.32±3.67 | 35.12±3.31 | 6.692 | 0.000 |
| VAS | ||||
| Before nursing | 7.27±3.21 | 7.15±3.14 | 0.210 | 0.834 |
| After nursing | 2.42±1.05 | 1.31±1.12 | 5.693 | 0.000 |
Note: VAS: visual analog scale.
Figure 1.
Comparison of anxiety and VAS between the two groups. A: Anxiety score; B: VAS score. Compared with the group before care, ***P<0.001; compared with the control group, ###P<0.001. VAS: visual analog scale.
Comparison of pregnancy outcomes between the two groups
There was no significant difference regarding pregnancy outcomes between the two groups (P>0.05) (Table 4).
Table 4.
Comparison of pregnancy outcomes between the two groups (case (%))
| Group | Control group | Research group | χ2 | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| Normal newborns | 58 (93.55) | 59 (95.16) | 0.000 | 1.000 |
| Low birth weight infants | 4 (6.45) | 3 (4.84) | 0.000 | 1.000 |
| Fetal malformations | 0 (0.00) | 0 (0.00) | 0.000 | 1.000 |
| Stillbirths | 0 (0.01) | 0 (0.00) | 0.000 | 1.000 |
Comparison of oxidative stress between the two groups
Before nursing, there was no significant difference regarding the levels of MDA, ROS, and SOD between the two groups (P>0.05). Compared with before nursing, the levels of MDA and ROS were significantly downregulated, while the level of SOD was significantly upregulated in both groups after nursing (all P<0.001). Additionally, compared with the control group, the levels of MDA and ROS were significantly lower, while SOD level was significantly higher in the research group after nursing (all P<0.001) (Table 5 and Figure 2).
Table 5.
Comparison of oxidative stress reaction between the two groups (x̅ ± sd)
| Group | Control group | Research group | T | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| SOD (U/mL) | ||||
| Before nursing | 118.61±22.52 | 120.36±22.34 | 0.434 | 0.665 |
| After nursing | 174.36±24.42 | 214.53±26.18 | 8.835 | 0.000 |
| MDA (nmol/mL) | ||||
| Before nursing | 4057.31±513.84 | 4082.38±479.25 | 0.281 | 0.779 |
| After nursing | 2395.12±183.15 | 1274.54±104.12 | 66.219 | 0.000 |
| ROS (U/L) | ||||
| Before nursing | 8.47±2.83 | 8.44±2.81 | 0.059 | 0.953 |
| After nursing | 6.14±2.02 | 3.34±1.52 | 8.721 | 0.000 |
Note: SOD: superoxide dismutase; MDA: malondialdehyde; ROS: reactive oxygen species.
Figure 2.
Comparison of oxidative stress response between the two groups. A: SOD; B: MDA; C: ROS. Compared with the group before care, ***P<0.001; compared with the control group, ###P<0.001. SOD: superoxide dismutase; MDA: malondialdehyde; ROS: reactive oxygen species.
Comparison of satisfaction between the two groups
Compared with the control group, the nursing satisfaction was significantly higher in the research group (P<0.05) (Table 6).
Table 6.
Comparison of satisfaction between the two groups (case (%))
| Group | Control group | Research group | χ2 | P |
|---|---|---|---|---|
| Case | 62 | 62 | ||
| Dissatisfied | 8 (12.90) | 2 (3.23) | 3.921 | 0.141 |
| Satisfied | 12 (19.35) | 13 (20.97) | ||
| Strongly satisfied | 42 (67.74) | 47 (75.81) | ||
| Satisfaction | 87.10% | 96.77% | 3.916 | 0.048 |
Discussion
It has been reported that more and more women choose cesarean delivery nowadays, mainly due to their low pain tolerance during labor [14]. Additionally, growing number of parturients prefer labor analgesia to effectively reduce the pain during natural delivery. However, parturients who are not able to give birth via natural delivery still need to be transferred to cesarean section. Therefore, the painless nursing approach in the operating room plays an important role in the process of delivery [15]. Currently, labor analgesia is the major choice for intraoperative analgesia, of which the rationale is to block low back nerves that contribute to the pain when parturients are conscious. This strategy could extensively minimize maternal pain without affecting normal activity [16,17]. However, once this analgesia fails, combined spinal and epidural anesthesia is still required to ensure a successful cesarean section. At this point, effective and painless nursing for the parturients is important to improve their cooperation and ensure a successful surgery.
During laboring, when nurses introduce previous cases of successful childbirth to the parturients, it can eliminate their stress, improve their compliance, and ensure smooth progress of the delivery [18]. This study investigates the application of painless nursing in the operating room in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia and the impact on maternal satisfaction and compliance. We have demonstrated that the research group shows higher satisfaction and compliance compared with the control group. Our data also showed that compared with routine nursing, the painless nursing approach in the operating room can significantly increase parturients’ satisfaction and compliance to a greater extent as well as more ideal clinical effects. Childbirth is often accompanied by obvious stress responses. This study applies the intervention via painless nursing in the operating room, leading to more ideal and satisfactory outcome [19,20]. The results revealed that compared with the control group, the levels of stress response indicators are significantly lower in the research group. Thus, our data suggest that during cesarean delivery, painless nursing in the operating room plays an important role in reducing maternal stress responses, maintaining the stability of various vital signs, and improve the safety of delivery [21]. Before delivery, nurses proactively communicate with parturients for prenatal education, which can improve their knowledge in terms of childbirth, relieve their negative mood, and ultimately improve the pregnancy outcomes [22,23]. we have also demonstrated that compared with the control group, the anxiety and VAS scores of the research group are significantly lower. In addition, compared with routine nursing, a painless nursing method in the operating room is more effective in the improvement of negative emotions of the parturients and the reduction of the pain degrees, which has revealed a high feasibility and should be propagated and applied in clinical practice [24]. It has been reported that most parturients have sleep disorders after childbirth, which affects their quality of life [25,26]. Nurses in this study give a high degree of care to the parturients after childbirth and answer their questions to make them feel more care, which helps eliminate their sleep disorders [27,28]. The data of our research demonstrate that compared with the control group, the research group has lower QS scores, indicating a better sleep quality. Our results also show that compared with routine nursing, painless nursing intervention in the operating room can prolong sleep interval to a greater extent and ensure a good sleep efficiency. It’s been also shown that most parturients have significantly upregulated levels of oxidative stress indicators during delivery [29]. This study shows that compared with the control group, the levels of MDA and ROS are significantly downregulated while SOD level is notably upregulated in the research group, which suggests that the application of painless nursing in the operating room can effectively reduce the oxidative stress level of cesarean delivery parturients due to the failure of natural childbirth via labor analgesia.
Our study has excluded women with major organ damage, contraindications to anesthesia, and non-term pregnant women, while has included participants who are in line with our inclusion criteria. Therefore, the clinical data are comparable. This study has explored the nursing effect of two approaches, routine nursing and operating room painless nursing, which is more comparable, in favor of the exploration of nursing effect, and can provide more informative insights for clinical nursing. Nevertheless, this study has some caveats. For example, the number of study samples is small, the research period is short, and the satisfaction evaluation is done via a self-rating scale, because of which the conclusion may be biased and the accuracy is compromised. Therefore, further researches with more samples should be conducted to improve the accuracy of the data, provide patients with better care approaches, improve the quality of life, and alleviate negative moods.
In summary, the application of painless nursing in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia can effectively improve the sleep quality and negative moods of the parturients, reduce the degree of pain and stress response, and contribute to a high satisfaction and compliance. Therefore, in the clinical nursing of cesarean delivery parturients, this painless nursing strategy in the operating room is worthy of wide propagation and clinical application.
Disclosure of conflict of interest
None.
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