CHAPTER ONE
INTRODUCTION
1.1 Background to Study
Exercise has become a vital part of many women’s lives. Although many women still prefer to engage in exercise during pregnancy, they are concerned about the possible adverse effects.
The concerns about exercising during pregnancy relate to the dual stresses of pregnancy and exercise that might create conflicting physiological demands on the mother-to-be (Wiswell, 1996; Sternfeld, 1997). In contrast to the adaptations that occur during pregnancy, which are intended to nurture and protect the foetus, those that occur during exercise serve to maintain maternal homeostasis. Excessive physical activity during pregnancy may thus create conflicting maternal and foetal needs and may pose potential risks for the outcome of the pregnancy. On the other hand, the adaptations may complement each other and offer potential benefits (Sternfeld, 1997).
The physiological changes that occur during exercise include: redistribution of cardiac output away from the visceral circulation to the exercising muscles and skin, depletion of energy stores and an increase in body temperature (Clapp, 1996). In addition, several other potential risks have been described, including teratogenic effects as a result of exercise-induced hyperthermia, decreased carbohydrate availability for the foetus, redistribution of uterine blood flow with subsequent foetal hypoxia, increaseduterine contractility with a possible increase in the risk for preterm labour, infertility, abortion, congenitalmalformation,cordentanglement,placental separation, premature membrane rupture, growth restriction, foetal trauma, foetal bradycardia, difficultlabour, as well as maternal musculoskeletal injury (Clapp, 1996; Sternfeld, 1997; Stevenson, 1997; Clapp, 2000; Borg-Stein, Dugan & Gruber, 2005).
Exercise recommendations during pregnancy have evolved over the last several decades (Borg-Stein et al., 2005). Until the 20th century physical activity during pregnancy had been discouraged primarily because of theoretical concerns of exercise-induced injury and adverse foetal and maternal outcomes (Dempsey, Butler & Williams, 2005). Consequently many saw pregnancy as a state of confinement in which women were not encouraged to engage in recreational physical activity (Dempsey et al., 2005). Results from animal studies published before the 1970’s clearly supported these concerns, which led to a variety of restrictive regulations regarding exercise(Clapp, 1996; Dempsey et al., 2005). Women were instructed to limit their involvement in exercise and non-exercisers were told not to initiate exercise when pregnant (Borg-Stein et al., 2005). In contrast, research findings published since the 1970’s do not support these concerns (Clapp, 2000; Dempsey et al., 2005). In fact, findings of studies completed since 1985 have demonstrated no adverse maternal or foetal effects in healthy women engaged in mild and moderate exercise activities (Clapp, 1996; Henriksson-Larsen, 1999; Riemann &Kanstrup-Hansen, 2000; Dempsey et al., 2005;), but rather, showed somewhatfavourable effects (Wiswell, 1996; Sternfeld, 1997; Clapp, 2000; Frey, 2002). The influence of the past 30 years of research can clearly be seen in the significant changes of the American College ofObstetriciansandGynaecologists (ACOG) guidelines, published in 2003 (Committee on patient education of the ACOG, 2003). These guidelines recommend moderate exercise, 30 minutes or more per day, on most, if not all days of the week for women with low risk pregnancies.
1.2 Statement of Problem
Pregnancy and delivery are normal physiological processes. During pregnancy and after pregnancy so many physiological and psychological changes occur and sometime mothers are worried and stress regarding these. But exercise does wonder during pregnancy. It helps prepare the mother for child birth by strengthening the muscles and building endurance, and makes getting her body back in shape once the baby’s born much easier. Body releases a hormone called relaxing during pregnancy which loosens the joints in preparation of delivery , so mother need to take care with the choice of exercises and pay attention to technique . It’s important to find exercises that won’t injure her or harm the baby. Ideal exercise gets her heart pumping, keeps her supply, manages weight gain and prepares her muscles for the hand work of labour and delivery without causing undue physical stress for her or her baby.
Postnatal period demands a lot a physical and psychological adaptation. While some exercise is very good for a new mother, doing too much too soon can be harmful also. Current medical practice recommends that pregnant women should most assuredly engage in some sort of exercise regimen while pregnant. Exercising during pregnancy is good for the mother. Pregnant women who exercise tend to have reduced risk of obesity, gestational diabetes, and hypertension.
One study was conducted on effect of selected antenatal exercise on the nature and outcome of labour in 39 primipara mothers during antenatal period in a selected hospital .An experimental method was used. The study concluded that antenatal exercise taught were effective in terms of outcome of labour in both mother and baby.
Another study was conducted, to investigate the effect of an exercise programme, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy related low back pain. Randomized method is used. The study concluded that a specific exercise program decreased back pain intensity and increased functional ability during pregnancy.
The researcher from taking knowledge from experts realized that the knowledge regarding antenatal and postnatal exercise is very important for antenatal mothers and their health. So, the need for this study to evaluate knowledge of the effect of regular pelvic floor exercises on maternal health among women of reproductive age.
1.3 Research Objectives
The general objective of this study is to evaluate the knowledge of the effect of regular pelvic floor exercises on maternal health among women of reproductive age. The following specific objectives were formulated for the study;
1. To investigate the level of women’s knowledge on the effect of pelvic floor exercises on maternal healthof women of reproductive age in Benue State
2. To analyse women’s views and perception of the effects of pelvic floor exerciseson their maternal health in Benue State
3. To assess the positive and negative effects of pelvic floor exercises on women’s maternal health in Benue State
4. To assess the practice level of exercises by women of reproductive age in Benue State in a bid to increase maternal health.
1.4 Research Questions
The following research questions were formed from the objectives of the study.
1. What is the level of women’s knowledge on the effect of pelvic floor exercises on maternal healthamong women of reproductive age in Benue State?
2. What are women’s views and perception of the effects of pelvic floor exerciseson their maternal health in Benue State?
3. What are the positive and negative effects of pelvic floor exercises on women’s maternal health in Benue State?
4. Are the women of reproductive age improving maternal health using exercises (pelvic floor exercises) in Benue State?
1.5 Significance of the Study
The outcome of this study would be significant to women of child-bearing age in Benue State and Nigeria in general in the following ways:
1. The findings of this study would provide information on the care of maternal health of women of reproductive age through regular exercises (pelvic floor exercises in this case).
2. The findings of this study would help policy makers and the health sector to understand problems militating against maternal health among women of child-bearing age in Benue State and provide a way forward via regular exercises.
3. It would provide a basis for further research to other interested researchers. Also, the findings of this study would contribute to existing knowledge on the effect of regular pelvic floor exercises on maternal health of women of reproductive age; knowledge and awareness level.
1.6 Basic Assumptions
This study was based on the following assumptions:
1. Adequate and regular exercises are necessary to protect and promote the maternal health of women of reproductive health.
2. Place of residence can constitute a strong barrier to practice of exercises and related activities among women of reproductive age.
3. Level of education and knowledge can constitute a strong predictor of exercise practice for maternal health among women of reproductive age.
4. The attitude and perceptions of women of reproductive age in Benue State can affect their practice and proper information on exercise for maternal health.
1.7 Scope of Study
The study was focused on the knowledge of the effect of regular pelvic floor exercises on maternal health among women of reproductive age in Nigeria using Benue State as a case study.
1.8 Delimitation and Limitation of the Study
Delimitation
This study was delimited to the knowledge of the effect of regular pelvic floor exercises on maternal health among women of reproductive age (15-49 years) in six Local Government Areas selected from the three Senatorial Zones in Benue State. They include Katsina-Ala, Vandeikya (Zone A); Gboko, Makurdi (Zone B), and Ogbadibo, Otukpo (Zone C). Specifically, only women of reproductive age attending antenatal and postnatal clinic at the General Hospitals in the selected Local Government Areas were involved in the study.
Limitation
Uncooperative attitude of some of the respondents constituted a limitation in this study as some of the women of reproductive age did not return their questionnaire. The researcher only made do with responses of the respondents whose questionnaire were correctly completed and returned.
1.9 Definition of Terms
Maternal Health:Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death.
Pelvic Floor Exercises:Pelvic floor exercises strengthen the muscles around the bladder, sexual organs, and back passage.Strengthening the pelvic floor muscles can help stop incontinence, treat prolapse, and make sexual activities better.Both men and women can benefit from doing pelvic floor exercises.
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