DISSERTATION ON ³$678'<72$66(667+(())(&7,9(1(662)$/021'32:'(5 ON LACTATION AMONG POSTNATAL MOTHERS IN µINSTITUTE OF OBSTETRICS AND GYNECOLOGY AND HOSPITAL FOR WOMEN A1'&+,/'5(1¶ CHENNAI.´ M Sc (NURSING) DEGREE EXAMINATION BRANCH ±III OBSTETRICS AND GYNECOLOGICAL NURSING COLLEGE OF NURSING MADRAS MEDICAL COLLEGE, CHENNAI ± 03. A dissertation submitted to THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI ± 600 032. In partial fulfillment of requirements for the degree of MASTER OF SCIENCE IN NURSING APRIL 2016 CERTIFICATE This is to certify that this dissertation titled ³$ VWXG\ WR DVVHVV WKH effectiveness almond powder on lactation among postnatal mothers at the Institute of obstetrics and Gynecology, Government hospital for women and children, Chennai. is a confide work done by Mrs. A. Josephine Carmel Rani , II year M Sc (N)student, College of Nursing, Madras Medical College, Chennai, submitted to The Tamil Nadu Dr. M.G.R. Medical University, Chennai, in partial fulfillment of the university rules and regulations towards the award of the degree of Master of Science in Nursing. Branch ± III Obstetrics and Gynecological Nursing, under our guidance and supervision during academic period from 2014-2016. DR .V .Kumari, M.Sc (N), Ph.D., DR.R.Vimala, M.D., Principal, Dean, College of Nursing, Madras Medical College Madras Medical College, Rajiv Gandhi Govt. General Chennai-03. Hospital, Chennai-03. A study to assess the effectiveness of almond powder on lactation among postnatal mothers in IOG and hospital for women and children, Chennai. Approved by the Dissertation committee on 20 .01.2014 RESEARCH GUIDE Dr. V. Kumari. M.Sc(N), Ph.D., Principal, College of Nursing, Madras Medical College, Chennai-03. CLINICAL SPECIALITY GUIDE Dr .V.Kumari, M.Sc(N), ph.D, Principal, College of Nursing, Madras Medical College, Chennai-03. MEDICAL EXPERT PROF . Dr.Nalina , M.D, D.G.O., Assistant Professor, Government Institute of Obstetrics & Gynecology& Hospital for Women and Children, Chennai-08. A dissertation submitted to THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI ± 600 032. In partial fulfillment of requirements for the degree of MASTER OF SCIENCE IN NURSING APRIL 2016 ACKNOWLEDGEMENT ´Blessed is the man who trusts in the ord and has made the ord his hope and &21),'(1&(} -Jeremiah: 17.7 With a profound sense of gratitude I thank God Almighty for His constant help and blessing showered up on me throughout this study. The essence of all beautiful art is gratitude. Gratitude can never be expressed in words but this is only deep perceptions, which make the words flow from ones inner heart. I wish to express my sincere thanks to Dr. R. Vimala, M. D, Dean, Madras Medical College, Chennai for providing necessary facilities and extending support to conduct this study. Words are beyond expression of humble & guidence Dr.V Kumari, M.Sc.(N)., Ph.D., Principal, College of Nursing, Madras Medical College, Chennai, who made a research of real experience and role modeling in the field of nursing research. My heartfelt gratitude to Mrs. J.S. Elizabeth Kalavathy, M.Sc (N), Class Co- ordinator, College of Nursing Madras Medical College, Chennai, for her support and encouragement for completing the study. I extend my thanks to Dr. Lakshmi, MSc(N),Ph,D(N) Additional Director of Medical Education(Nursing),Directorate of Medical Education, Chennai. who guided and helped me to complete my study. It is great privilege to thank Dr. S Baby Vasumathi. M.D, DGO, Director and Superintendent at the Institute of Obstetrics and Gynecology and Hospital for Women and Children, for granting permission to conduct the study. I express my sense of gratitude to Dr. Nalina, M.D., DGO, Assistant Professor, Institute of Obstetrics and Gynecology, Hospital for Women and Children Egmore, Chennai for her valuable suggestions and guidance to complete this study. I am grateful to Mrs. Jayanthi M. Sc. (N). Lecture, college of nursing, Madras medical college, Chennai constant support and guidance throughout the study. I express my thanks to all the faculty members of the College of Nursing, Madras Medical College, and Chennai for their support and an assistance given by them in all possible manners to complete this study. It is my immense pleasure and privilege to express my gratitude to Mrs. Kangavalli.P. M.Sc (N), Reader in Obstetrics & Gynecological Nursing , Madha College of Nursing, Chennai, for validating this tool. It is my pleasure to express the deep sense of gratitude to Mrs. S. Valarmathy, M.Sc, M.Phil , Research officer, The Tamilnadu DR MGR Medical University, Chennai for the suggestions and guidance in statistical analysis. My special thanks to Sis. Margaret, M.A, M.Phil., English literature for her immense help in editing my study within stipulated time I extend my thanks to Mr. Ravi, B. A., B.L. I.Sc., Librarian, College of Nursing, Madras Medical College, and Chennai for his co-operation and guidance. I extend my thanks to the Dissertation Committee Members for their healthy criticism, supportive suggestions which molded the research. I wish to thank to all the staff Nurses of the institute of Obstetrics and Gynecology, Chennai who have extended their co-operation during the study. I honestly express my sincere thanks to all participants in this study greatly indebted for their patience, co-operation and giving their valuable acceptance to participate. My heartfelt thanks to my classmate and friends who helped and supported me for the successful completion of this study. I thank one and all who directly or indirectly helped in successful completion of this study. Abstract TITLE : A study to assess the effectiveness of almond powder on lactation among postnatal mothers in the Institute of obstetrics and gynecology and hospital for women and children, Chennai. %UHDVWIHHGLQJLVWKHRSWLPDO¿UVWIRRGIRUQHZERUQVLQWHUPVRIKHDOWK outcomes for both mother and child. The amount of milk produced may depends on how often the mother is nursing . It is beneficial to nurse on demand to nurse when the baby wants to nurse rather than a schedule. Galactagogues are substances that increase milk volume by enhancing the rate of milk production and include herbs such as almonds, fenugreek, blessed thistle, and fennel and .medications such as domperidone, metoclopramide. Need for study: A major reason given by mothers for premature cessation of breastfeeding is their perception of insufficient milk supply. Health professionals, have a key role in encouraging the breastfeeding through monitoring from the prenatal to the postpartum, both the pregnant woman, but also the family and community, where everyone can support and encourage breastfeeding. Objectives : x To assess of breast milk inadequacy among postnatal mothers in the control and experimental group. x To assess the breast milk adequacy on lactation among postnatal mothers in experimental and control group after intake of almond powder. x To assess the effectiveness of almond powder on lactation among postnatal mothers by comparing the control and experimental group. x To find out the association between the breast milk adequacy among postnatal mothers with selected variable in the control and experimental group. Key words Postnatal mother, Almond, effectiveness, lactation Methodology: Research approach ± Evaluative approach Research Design - True experimental study design , Sample size - 60 postnatal mothers Sampling technique - Random sampling Study Settings - Postnatal ward at IOG Study Population - Postnatal mothers Tool - modified tool for adequacy of breast milk on lactation. Data collection procedure ± Formal permission was obtained from the Director and Head of the IOG, Chennai. After establishing a good rapport with postnatal mothers, Informed and written consent was obtained. Modified tool for adequacy of breast milk were filled by both experimental and control group. Almonds are .dried , powdered and it was given in the form of 30g powder mixed with the 100ml of milk once a day (Morning 10am) for the consecutive five days. I spent half an hour for every postnatal mother for the intervention. On the 5th day evening breast milk adequacy was evaluated in both the experimental and control group.. Data Analysis : The data were analyzed using descriptive statistic such as Mean .Standard deviation ,Frequency and Percentage and inferential statistic like paired µ7´DQGXQSDLUHG³7´WHVW&KLVTXDUHWHVW Study results : The results revealed that the experimental mothers are having an adequate 86.7% level of breast milk secreation whereas in control group are having 100%. Satisfactory level. Differences between pretest and posttest score was analyzed using proportion with and mean difference. This difference shows the effectiveness of almond powder (p-.000) on increasing the adequacy of breast milk which was statistically significant in the experimental group. Discussion : There is an significant difference in the level of breast milk adequacy on lactation among postnatal mothers. Hence the H1 hypothesis has accepted. Conclusion. The investigator there by concludes that the almond powder has increased adequacy of breast milk secreation among postnatal mothers. Recommendation: A similar study can be conducted by providing almond from the antenatal period to assess the effectiveness on lactation. TABLE OF CONTENT CHAPTER CONTENT PAGENO INTRODUCTION 1 1.1 Need for the study 4 1.2 Statement of the problem 6 1.3 Objectives of the study 6 1.4 Operational definitions 7 1.5 Assumptions 7 1.6 Hypotheses 8 1.7 Delimitations 8 II REVIEW OF LITERATURE