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Effects of antenatal perineal massage on perineal trauma
Effects of antenatal perineal massage on perineal trauma
Several research studies have been undertaken to determine the effects of antenatal perineal massage on perineal trauma (Beckmann & Garrett, 2006). In all these researches, several factors have been identified as relating to perineal outcome and this include age greater than twenty years, nulliparity, length of second stage if greater than one hour epidural anesthesia and some other specific factors like fetal distress (Johanson, 2000).
Body weight, accipitoposterior position and breech presentation are possible other factors that have been identified to cause perineal trauma. In their research, Eason, Labrecque, Wells & Feldman (2001) note that women who practice antenatal perineal massage during each week before birth are likely to have low incidences of perineal trauma, pain and lacerations as compared to those who do not. However, his sample was very small (only 20 participants) and thus was not limited to nulliparous population (Parahoo, 2006).
Perineal trauma following the normal vaginal birth can be associated with both long-term and short-term morbidity in significant levels (Wagner & Marsden, 2006). Antenatal perineal massage has been widely proposed as the best method for decreasing the effects and incidence of perineal trauma. Perineal massage should be started from after 34 weeks of pregnancy (Labrecque et al, 1999). The practice is best recommended during or after a shower because at this time, blood vessels at the perineum are fully dilated thus making the perineum softer and comfortable to massage.
Parahoo, (2006) notes that application of antenatal perineal trauma helps a lot in reducing both the perineal trauma during birth and the associated pain afterwards. Majority of women are keen to give birth without any perineal cuts, tears or stitches as they in most cases cause severe pain and discomforts later on which can impact adversely on their sexual functionalities. Administering perineal massage especially during the last month of pregnancy has been found to be an appropriate way of enabling the perineal tissue to expand with a lot of ease during child birth (Feldman, 2001).
Researches have shown that perineal massage undertaken either by the woman or her partner for at least twice a week reduces heavily the chances of developing perineal trauma and the subsequent perineal pain (Wagner & Marsden, 2006). This becomes clear especially on those women who have never given birth before. Antenatal perineal massage has the potentiality to significantly reduce the chances of perineal trauma and the associated perineal pain (Bodner et al, 2002). This method is generally well accepted by women. It is thus imperative that women all over the world are well informed of the benefits of applying perineal massage and also provided with the relevant information on how to apply it (Wagner & Marsden, 2006).
According to Labrecque et al (1999), appropriate antenatal perineal massage applied from approximately the 35th week of gestation reduces significantly the likelihood of perineal trauma that may need stitching. In addition women who do the massage are less likely to develop cases of perineal pain at three months after the birth.
Definition of terms
Perineum: this is the area of tissue that lies between the vagina and the anus. The perineum muscles connect with the muscles of the pelvic floor. The perineum is very important especially in women to (Labrecque et al, 1999). Tearing or stretching of the perineum during child birth can most likely remove support from the back wall of the vagina thereby making dropping down of the uterus more likely. Having a weak pelvic floor can also result in the incontinence of the bowels and the bladder. Further, trauma to the premium may lead to discomfort and a lot of pain when making love (Johanson, 2000).
Perineal massage: perineal massage is a form of therapy that is administered to prepare the perineum to stretch with a lot of ease during child birth. Perineal tissues need to stretch out during the birth process so as to allow the baby to pass out through the vagina easily (Johanson, 2000). Perineal massage is important in a number of ways:
It increases the elasticity of the perineum muscles. This helps in improving the rate of blood flow to the perineum and its capacity to stretch out more easily and with less pain during birth.
It reduces chances of tears in the perineum and also the chances of needing an episiotomy.
Helps reduce the degree of pain after birth.
Perineal trauma is a common occurrence that affects women during child birth and it is estimated that more than 85 percent of all women who deliver will sustain some degree of the trauma. Perineal trauma morbidity as relates to child birth constitutes a major global health challenge (Gomme, Sheridan & Bewley, 2004).
This potential morbidity which is mostly associated with vaginal birth is a major issue of concern for both women and midwifes. Severe perineal trauma can result in feacal inconsistency, dysparnea as well as perineal pain. In his book, Bodner et al, (2002) suggests that perineal trauma can cause serious psychological problems for women. This can make them fearful of future pregnancies, a thing that can eventually lead to feelings of isolation and loss of social identity.
More psychological effects of the trauma can as well impact adversely on women’s relationships with their partners and the linkages with their newborns (Beckmann & Garrett, 2006). Researches have indicated that perineal trauma contributes a lot to an increase in requests for caesarean sections. The reduction in routine episiotomy means that the majority of this trauma is spontaneous (Beckmann & Garrett, 2006). Considering all these factors, it emerges that any method proven to reduce the likelihood of sustaining the effects of perineal trauma has to be recommended. Preventing the effects of this trauma on women will be of great benefit to a large number of women.
A problem based learning case study, recently undertaken, highlighted a lady who gave birth in a stand alone birthing centre. Mr. Gorski achieved a normal vaginal delivery with an intact perineum. The author undertook an extensive literature search to establish what clinical care could be provided that would enable women to give birth without genital tract trauma. This essay reviews the literature on perineal massage and its effects upon the incidents and morbidity associated with perineal trauma
Researches on major databases on maternity and postnatal care reveal lots of articles on the subjects. The quantity of literature retrieved from these articles is very much relevant. Most of these literature is however very quantitative in nature and as such provide hard objective facts that can be statistically analyzed and interpreted. This research perspective is consistently in line with many of the questions that midwives have to answer in respect of this research topic. Most of the literature developed so far in many countries show that the need to reduce the effects of perineal trauma is an issue of world wide concern that requires concern efforts that transcend political boundaries (Parahoo, 2006).
It is in light of these that several stakeholders worldwide have stepped up advocacy for the use of perineal massage antenatally as a possible way of reducing perineal trauma associated with vaginal birth (Beckmann & Garrett, 2006). It is widely believed that perineal massage can increase the flexibility of the perineal muscle and thus decrease the degree of muscular resistance. This enables the perineum to stretch freely without tearing or developing lacerations. Perineal massage is a more recent and developing concept in the discipline of midwifery and as such as not taken roots deep. This practice is widely advocated by the National Institute for National Excellence (NICE). This institute has developed guidelines for advising women on how to go about it (Bodner et al, 2002).
Various organizations have advocated the use of antenatal perineal massage to decrease the incidents and rate of perineal trauma during vaginal birth to (Labrecque et al, 1999). NICE recommends that oil or any other recommended lubricant should be used to massage the perineal muscles for up to five times a week as from the 34th week of pregnancy. This, according to the institution’s research increases the likelihood of having an intact perineum after delivery especially in nulliparous women (Beckmann & Garrett, 2006).
Beckmann & Garrett carried out a systematic review on the effect of antenatal massage on the incidents of perineal trauma at birth. The purpose of a systematic review is to find answers to a particular issue or problem (Cronin, et al 2008), it is an approach used to summarize, appraise, and communicate the results of otherwise unmanageable quantities of research (Macinnes, 2010).All available research studies on a particular topic are identified, analysed and a conclusion reached. This type of review produces the ‘best available evidence’ on which practice can be based, (Polit & Hungler 1995).
The aim of the systematic review was to assess the effect of antenatal perinatal massage on the incidents of perineal trauma at birth. All published and unpublished randomised and quasi-randomised controlled trails evaluating any described method of antenatal perineal massage were considered for the review. Macinnes, (2010) describes how, a literature review should give an overview of all the current literature surrounding the topic of interest. All pregnant women who were planning a vaginal birth and had undertaken perineal massage for at least the last four weeks of pregnancy using any method of perineal massage or device.
Data collected and analysed by both authors independently who applied the selection criteria to the studies assessing study quality, study authors were contacted directly for additional information. Four trails were included in the study (2497 women) comparing digital perineal massage with control. Antenatal perineal massage was associated with an overall reduction in the incidents of trauma requiring suturing (four trais, 2480 women, and risk ratio 0.19. results also show that women carrying out massage were less likely to have an episiotomy; however these results are only significant for women without previous vaginal birth. Data sources included an Electronic search including the Cochrane Pregnancy and childbirth (2008), Medline, PubMed (1966 to June 2008), and Embase (1980) using their search strategy, researchers were also contacted directly.
No language or study type constraints were imposed allowing a recently published Japanese study to be included, however the Japanese study was the only study to be carried out within the past 10 years, and all other studies are more than ten years old. It is important to pay attention to the publication dates of the literature reviewed, (Parahoo2006), however more recent research of good quality, on the topic was limited. Midwives are seen to be guardians of the perineum and often regard an intact perineum after delivery with pride (Robertson , 2002). Walsh, 2007) describes how midwives use a variety of strategies, techniques and maneuvers before during and after delivery in an attempt to reduce perineal trauma, the optimum outcome for mother and midwife is an intact perineum.
Several empirical researches have shown that antenatal perineal massage can be very helpful in preventing perineal lacerations and episiotomy (Beckmann & Garrett, 2006). In 1999, there was an article in the American Journal of Ob/Gyn by Labrecque in which the effectiveness of perineal massage during pregnancy for preventing perineal trauma at birth was investigated. Women participants in the experimental groups were voluntarily requested to perform about a fifteen minute perineal massage daily from the thirty-fifth week of pregnancy until they delivered. The massage primarily involved introducing one or two fingers at up to about three to four centimeters into the vagina and applying and maintaining pressure — first downward for approximately two minutes and then for further two minutes onto each side of the vaginal entrance. The women were freely given a bottle of sweet almond oil to use as a lubricant in the exercise.
The result of this research study showed that among the women participants without a previous vaginal birth, about 25 percent of them from the perineal massage group and fifteen percent from the control group were delivered vaginally with an intact perineum, with about ten per cent absolute difference. This incidence intact perineum delivery increased with compliance in regular practice of the antenatal perineal massage (Beckmann & Garrett, 2006).
As for the women with a previous vaginal birth, about thirty five per cent and thirty two per cent in the massage and control groups, respectively, made deliveries with an intact perineum, for an absolute difference of about three percent (Beckmann & Garrett, 2006). There were no statistically significant differences between the groups in the frequency of sutured vulvae and vaginal tears, women’s sense of control and satisfaction with the delivery experience. The researchers in this experiment concluded that concluded that perineal massage is a very effective approach to increasing the chances of child delivery with an intact perineum for women with a virgin vaginal delivery, but not for women who have had a previous vaginal birth (Beckmann & Garrett, 2006).
More researches on this subject have indicated that slow and controlled vaginal delivery is the key to an intact perineum and reduced incidence of perineal lacerations and subsequent pain (Beckmann & Garrett, 2006). The baby, who is the primary subject of the midwife’s practice, must not suffer any form of fetal distress and as such, the mother and her partner must listen closely to the midwife or health care provider for advice on when and how to push and when to stop pushing. The other extra advantage of performing antenatal perineal massage may be to allow for the mother to give a normal vaginal birth without developing any episiotomy or laceration (Gomme, Sheridan & Bewley, 2004).
Bibliography
Labrecque M, Eason E, Marcoux S, Lemieux F, Pinault JJ, Feldman P, Laperriere L. (2009), Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol.
Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):76-80.
Johanson R.(2000) Perineal massage for prevention of perineal trauma in childbirth. Lancet.
Eason E, Labrecque M, Wells G, Feldman P. (2001) Preventing perineal trauma during childbirth: a systematic review.
David Vernon, “With Women, Midwives Experiences: from Shiftwork to Continuity of Care Australian College of Midwives, Canberra, 2007 ISBN 9780975167458, p17f
Dobson, V.; B. Sales (2000). “The Science of Infanticide and Mental Illness”. Psychology, Public Policy and Law 6 (4): 1098–1112. doi:10.1037/1076-8971.6.4.1098.
Parahoo,k.(2006) nursing research. principles, process and issues 2nd edition. London, Macmillan press limited
Beckmann & Garrett (2006) Antenatal massage for reducing perineal trauma. Cochrane Database of systematic Reviews, Issue 1
Labrecque et al (1999) Randomised control trail of prevention of perineal trauma by perineal massage during pregnancy
Shipman m.k. et al(1997) Antenatal perineal massage and subsequent perineal outcomes: a randomised control trail
Davidson & Brown (2000) prenatal perineal massage: preventing lacerations during delivery
Bodner_adler et al(2002) perineal massage during pregnancy in primiparous women. Gynecology & Obtetrics
Gomme,C Sheridan, M and Bewley S(2004)antenatal perinatal massage part 1 and part 2 British journal of midwifery
Jackson (2000) the bottom line: care of the perineam must be improved British journal of midwiferyNational Institute for clinical excellence(2008) Intrapartum care-care of healthy women and thier babies during child birth
Albers L & Borders (2007) minimizing Genital tract trauma and related pain following spontaneous vaginal birth. journal of midwifery and womens health
REnfrew (1998) the perineum in child birth. national childbirth trust. londonFraser, D and cooper, M(2003) the midwife. In Fraser, D and cooper Myles textbook for midwives(14th) dition Edinbourough. churchill. Livingstone
Ibrahim A. Alorainy, Fahad B. Albadr, Abdullah H. Abujamea (2006). “Attitude towards MRI safety during pregnancy” ([dead link]). Ann Saudi Med 26 (4): 306–9. PMID 16885635. http://www.saudiannals.net/pdfs/06-201.pdf.
Wagner, Marsden. (2006) Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. Berkeley: University of California Press, 2006. Print.
“With Women, Midwives Experiences: from Shiftwork to Continuity of Care, David Vernon, Australian College of Midwives, Canberra, 2007 ISBN 9780975167458,
Social Psychology, Why is this problematic for social Psychologists
Social Psychology
Author
Institution
Date
A. What is the A-B problem? Why is this problematic for social Psychologists?
Knowing the thought pattern of individuals is of importance not only to social psychologists but also to every person. Social psychology is concerned with the causes and nature of behavior, as well as mental processes in social situations. In essence, social psychologists examine the way in which social influences can goad people into doing things that are not in line with their personalities. By definition, attitude means that we act according to our cognitions when we have the freedom to do so. However, scholars show a weak link between Attitudes (A) and behaviors (B). In most cases, we do not act according to our consciences. The A-B problem refers to the research finding that indicates that people’s actions are not always in line with their attitudes. This raises a problem for social psychologists since it implies that individual behavior is unpredictable.
B. Describe Attrition theory. Review some of the attribution biases we make. Why is the fundamental attribution error so important to consider in Social Psychology.
Attribution refers to the belief or assumption as to why individuals behave in a certain manner. In essence, the attribution process refers to the process by which individuals make inferences pertaining to the traits and motives through observation. The attribution theory, therefore, refers to the processes by which people make conclusions about the factors influencing other people’s behavior (Weiner, 1986). The theory is crucial since attributions allow us to perceive others as either victims of circumstances or purposeful actors. According to the theory, individuals can make internal or external attributions. Internal attributions refer to inferences made that an individual’s behavior results from his personality, character or attitude. External attributions indicate that an individual’s behavior is influenced by the circumstances he is in. The theory outlines that our attributions are significantly influenced by our motivational and emotional drives. We blame victims for their fate while distancing ourselves from the thought of suffering the same fate. We also view ourselves as less predictable and more multifaceted than others, while ascribing less variability to others (Weiner, 1986).
Incorrect attributions come as a result of systematic biases, which include the self-serving bias, the just world hypothesis and the fundamental error. The self-serving bias refers to the tendency of individuals to attribute failures to situational factors and successes to internal factors. The further an event is in the past the higher the likelihood that individuals will blame circumstances for their failures, and congratulate themselves on successes. In self-effacing bias, individuals blame themselves for failure and attribute their success to situational factors and not personal attributes. In the just-world bias, individuals believe in a fair world where what people get is what they deserve. This helps them to understand difficult circumstances. It is noteworthy hat individuals are more generous to themselves than to others. They will blame other people’s failures to internal factors, and their success to situational factors (Weiner, 1986).
The fundamental attribution error, also known as the correspondence bias, refers to the tendency for individuals to attribute other individual’s behavior to internal factors like feelings, personal traits and abilities. In this case, they will assume that there is correspondence between other people’s behavior and their personal attributes. However, they will attribute their own behavior to situational factors. The fundamental attribution error explains that people focus on other people’s behavior rather than the circumstances surrounding their behavior (Weiner, 1986).
C. Describe the Milgram study. Why was it conducted? What did Milgram conclude? Why did the participants behave the way they did? Ethics?The Stanley Milgram study examined the effect of authority on obedience. Milgram concluded that people obey out of a desire to appear co-operative or out of fear, even when the actions are not in line with their desires or better judgment. The study illustrated the reluctance that people have in confronting those who misuse power (Milgram, 1974). Milgram study involved 40 men who were to participate in an experiment as teachers. In this experiment, the participants were to deliver a “shock” to a “student” in case he answered the questions incorrectly. The participants believe that the shocks administered were real, whereas the student was a confederate in that study. Milgram had come up with an intimidating shock generator that had shock levels from 30 volts with 15-volts increment up to 450 volts. In addition, the switches had labels such as slight shock, danger, severe shock and intense shock, with the final two switches carrying an ominous XXX. If the participants faltered in administering the maximum shocks, the experimenter would prod them along using commands such as “you have no other choice but to continue” and “the experiment requires that you continue”.
65% of the participants delivered maximum shocks to the student. 26 participants delivered maximum shocks while the rest stopped prior to administering the maximum shocks. It is noteworthy, that most of the participants were extremely distraught, agitated and angry with the experimenter, but they went ahead to follow the orders to the end. The experiments showed that, on average, all people are good and would only obey under coercion especially when a higher authority was in proximity (Milgram, 1974). Milgram concluded that, ordinary people who have no hostility on their part can carry out terrible destruction in the course of their jobs. In addition, even with the clarity of their work’s destructive nature, few people have the necessary resources to resist authority, even when the orders do not conform to basic standards of morality.
The participants complied due to the physical presence of the authority figure, the fact that Yale (a competitive academic institution) was sponsoring the study and because they assumed that the experimenter was competent. In addition, they assumed that the learner and teacher status was selected randomly, and the shocks had only been said to be painful not dangerous (Milgram, 1974).
D. What is groupthink? Why does it occur? Give real examples
Groupthink refers to a problem that arises when a group makes faulty decisions due to group pressures rather than realities of the situation. Group pressures result in deterioration of moral judgment, mental efficiency and reality testing (Janis, 1982). It mostly happens when groups are cohesive and isolated from conflicting opinions, especially where leaders are directive and open. Group think occurs due to feelings of vulnerability, pressures on group members to conform, and stereotyping members of the out-group. It may also occur when the group believes in its own rightness thereby discrediting information that is against the group’s decision (Janis, 1982).
The most-quoted example of groupthink is the invasion of Iraq, where the Bush administration and the Congress decided to invade Iraq without building a broad-based allies coalition. Other examples include the escalation of the Vietnam war, hostage rescue in Iran and the Bay Pigs invasion.
References
Milgram, S. (1974). Obedience to authority: An experimental view. HarpercollinsWeiner, B. (1986). An attributional theory of motivation and emotion. New York: Springer-Verlag.
Janis, I. (1982). Groupthink: Psychological studies of policy decisions and fiascoes. Boston, MA: Houghton Mifflin.
(Weiner, 1986)
Effects Of Alexander Hamilton And Aaron Burr In Modern Times
Effects Of Alexander Hamilton And Aaron Burr In Modern Times
In the year 1800, there was an election that will forever be remembered in the history of the United States. The election was marred with extreme betrayal and intrigue. During this time, campaign efforts were evident as every candidate tried to ensure that they won the election. On the other hand, Aaron Burr and Alexander Hamilton were involved in a struggle that is known up to date. They have made a huge impact in modern times, as they made the history of the United States be viewed with more attention. They were the ones who made Americans know that their constitution had serious and extreme flaws (Trees, 2004. 34).
The duel that existed between Burr and Hamilton based on politics, is today relevant in the political arena. They are described as having the most famous duel to ever take place in the history of America. Hamilton was a federalist, and Burr did not believe in the intentions of his rival, and thus the reason for the enmity. Their ambition, talent and charisma are what lead them to detest each other. They persisted with their duel, which took place at New Jersey, in what is known as ‘Duel in Weehawken’. The latter took place in the year 1804 and the following day, Hamilton died after being shot by Burr (Ellis, 2000.56). Burr was lucky to escape the punishment that murderers are given. He was acquitted and treason charges were inferred upon him thus went into exile. Many years later, he came back to New York and in the year 1836, lost his life.
In modern times, many politicians often have similar political ambitious, which can sometimes escalate to extreme lengths. Some of the recommendations that Hamilton made concerning the constitution have today been implemented. Furthermore, it is through the efforts of Hamilton that effective monetary policies exist today. Currently, Democrat and Republican politicians are often involved in various disagreements. They mostly have different opinions regarding running the country and policies. For example, the latest health law has been taken to court due to disagreements between the two parties. Republicans believe that President Obama does not seem to favor Americans through his latest law on health. It suggests that the government should not force every American to have medical insurance (Ellis, 2000.59).
Most American politicians have today been influenced by the boldness of Burr and Hamilton. Burr and Hamilton were extremely passionate in what they believed in. Hamilton was known for his religious and moral reservations, and thus did not want to participate in the duel. In modern times, politicians as well as other members of society are well informed and educated concerning dueling (Knott, 2002.89). This is the reason why duels are not common, as its effects are known to be disastrous. Instead, people are provided with a forum such as the media where their views can be addressed and heard. Today, power, which people have, is controlled by various law enforcement agencies. Also, people found guilty of crimes such as murder are punished.
In conclusion, Aaron Burr and Alexander Hamilton have had a significant impact on people lives in the modern society. They have influenced many aspects of life, especially those involved in politics. Indeed, Hamilton will forever be remembered as a man of great honor. On the other hand, Burr is an example of a person that society should not accommodate. The two men have shaped American politics as they offer valuable knowledge concerning politics.
Work Cited
Ellis, Joseph. The Founding Brothers .New York: Alfred A. Knopf, 2000.Print.
Trees, A. The Founding Fathers and the Politics of Character. Princeton: Princeton University Press, 2004.Print.
Knott, S. Alexander Hamilton and the Persistence of Myth. Lawrence: University Press of Kansas, 2002.Print.