“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND PRACTICES OF
THE POST PARTUM DIET AMONG THE WOMEN DURING THEIR
PUERPERAL PERIOD IN SELECTED HOSPITALS AT TUMKUR.”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mrs. HARIBALA PALIWAL
OBSTETRICS & GYNAECOLOGICAL NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate
: Mrs. Haribala Paliwal
M.Sc. Nursing, 1st Year
And address
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution
: Akshaya College of Nursing
3. Course of Study
: M.Sc. Nursing 1st year,
And Subject
4. Date of Admission to
Obstetrics & Gynaecological Nursing
:
Course
5. Title of the Topic :
“A descriptive study to assess the knowledge and
practices of post partum diet among the women during
their puerperal period in selected hospitals at Tumkur.”
2
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
The post partum period or puerperium starts about an hour after the delivery of
the placenta and includes the following six weeks. By six weeks after delivery, most of the
changes of pregnancy, labour and delivery have resolved and the body has reverted to the
non pregnant state. A good post partum care and well balanced diet during puerperal can
influence her health for rest of her life. Healthy food choices are encouraged with respect for
ethnic and cultural preferences, while after cesarean birth, women usually receives clear
liquid until bowel sounds are present and then advance to solid.
For each 20 calorie of breast milk produced, the women must consume an additional
30 calories. This results in a dietary increase of 500 to 1000 calories each day for women
who are maintaining body weight. Unfortunately, many women consume less than the
recommended amounts of calcium, magnesium, zinc, vitamins B6, and folate. New mothers
are likely to stop taking prenatal vitamins which result in nutritional deficiency during their
postpartum period and necessitate a restitution of prenatal nutritional supplementation.
Prenatal supplements generally do not include a significant amount of calcium, in addition
during lactation; 250 –350 mg of calcium is transferred daily from the mother to the neonate
through breast feeding. Woman should be apprised of the need for additional
supplementation to meet requirement for this key mineral.
Postpartum nutritional counseling can be tailored to the individual woman based on
risk factors for poor nutrition such as extremes of maternal age, excessive weight gain
during pregnancy, deviation from ideal body weight, multiple gestation, and history of
eating disorders, close interconceptional period and highly restrictive diet due to traditional
and religious practices.1
3
Giving birth to a new life can be very emotional and at the same time very
exhausting. But this is also a phase of life wherein diet and exercise plays a very important
role not only to get you back in shape but also to bring up a healthy baby. Eating a healthy
diet should be your main focus rather than losing weight immediately. Remember it took
about nine months for your body to undergo these enormous changes, so give it almost that
much time to get back into shape. Although most mothers want to lose their pregnancy
weight, extreme dieting and rapid weight loss can be hazardous to your health and to your
baby's if you are breastfeeding. It can take several months for a mother to lose the weight she
gained during pregnancy. This can be accomplished by cutting out high-fat snacks and
concentrating on a diet with plenty of fresh vegetables and fruits, balanced with proteins and
carbohydrates. Exercise also helps burn calories and tone muscles and limbs. Along with
balanced meals, breastfeeding mothers should increase fluids. Many mothers find they
become very thirsty while the baby is nursing. Water, milk, and fruit juices are excellent
choices. In fact, if something is lacking in mom's current diet, mom's body will dip into her
reserves of nutrients to keep breast milk nutrient-dense. However, you are going to need
your body to be healthy for a long time to take care of your growing child, so don't short
change yourself! Be assured that the composition of nutrients in human milk is consistent. A
nutrition shortage for mom is more like to reduce the quantity of milk than the quality of the
milk for baby.2
6.1 NEED FOR THE STUDY
A mother's body has undergone many changes during pregnancy, as well as with
the birth of her baby. She needs to heal and recover from pregnancy and childbirth. In
addition to rest, all mothers need to maintain a healthy diet to promote healing and recovery.
4
The weight gained in pregnancy helps build stores for your recovery and for breastfeeding.
After delivery, all mothers need continued nutrition so that they can be healthy and active
and able to care for their baby.3
The purpose of a balanced diet is to provide you with an adequate intake of
calories, protein, vitamins and minerals without getting too much of any one nutrient. The
key to following a balanced diet is to know your caloric needs and how much to eat from
each food group. . When it comes to losing weight, the authors of "What to Expect When
You Are Expecting" suggest waiting until six weeks after birth before starting a weight loss
diet, and if you are breastfeeding, you shouldn't cut back too much. Following a healthy
postnatal diet that includes a variety of foods from each of the food groups should help
promote a steady weight loss and help you get back to your pre-pregnancy weight.4
A study was Design of an intervention addressing multiple levels of influence on
dietary and activity patterns of low-income, postpartum women. Low-income, multi-ethnic
women are at elevated risk for obesity and chronic diseases, yet influences at different levels
may act as barriers to changing risk behaviors. Following the birth of a child, childrearing
and social isolation can exacerbate these influences. The social ecological framework
integrates behavior-change strategies at different levels, providing a strong theoretical base
for developing interventions in this high-risk population. The primary purpose of this
randomized controlled trial is to test the efficacy of an educational model delivered by
community-based paraprofessionals in improving diet, activity and weight loss among new
mothers over a 12-month postpartum period and a 6-month maintenance period. This model
fosters institutional change to support behavior changes influenced at intrapersonal and
interpersonal levels, through collaboration with federal programs for low-income families:
the Special Supplemental Food Program for Women, Infants and Children (WIC), and the
5
Expanded Food and Nutrition Education Program (EFNEP). Participants are randomized to
the Usual Care, e.g. WIC nutrition and breastfeeding education, or Enhanced EFNEP
intervention arm, consisting of Usual WIC Care plus a sustained, multi-component
intervention including home visits, group classes and monthly telephone counseling. If
shown to be efficacious, this program will be readily sustainable through existing federal
agencies.5
A study was conducted on Diet and lifestyle interventions in postpartum women in
China: study design and rationale of a multicenter randomized controlled trial. A threedimension comprehensive intervention strategy, which incorporates intervention measures
simultaneously to individual postpartum woman, their family members and community
environment, will be utilized to maximize the effectiveness of intervention. Regular visiting
and follow-up was done in both group; nutrition and health related measurements were
assessed both before and after the intervention. Study was the first and largest multicenter
RCT which focus on the effectiveness of diet and lifestyle intervention on reducing the
incidence rate of postpartum diseases and improving health status in postpartum women.
They hypothesize that the intervention will reduce the incidence rates of postpartum
diseases and improve nutrition and health status due to a balanced diet and reasonable
lifestyle in comparison with the control condition. If so, the results of their study will
provide especially important evidence for changes in both the concept and action of
traditional postpartum practice in China.6
A study was conducted on the self-reported perceived factors influencing antenatal
and postnatal diets of a sample of primigravid women. Participants (n=39) were recruited
from general medical practices during the first trimester of pregnancy, with 37 participants
remaining in the study until six months post-partum. Self-reported diet diaries at the first
6
trimester, third trimester and six months post-partum generated information on food
consumption, using estimated portions. In-depth interviews at the same three time points
identified environmental, physical, social and emotional barriers to healthy eating during
pregnancy. Findings from the interviews indicate that the key influences on dietary choices
change over the three time periods. Conclusions relate to the key influencing factors and a
number of recommendations are made for health promotion interventions to ensure women
are informed and able to choose a healthy eating plan during pregnancy and post-partum.7
The study was examined the iron status of Chinese mothers living in Hong Kong up
to six months after childbirth. Findings indicate that postnatal iron status recovery is more
affected by physiological than dietary factors and that blood loss during childbirth plays a
significant role in the development of postpartum anemia.8
Encourage mothers to do as little as possible for 42 days (or as long as she can). That
means avoiding all housework and driving around. Even limit guest visits in number and time
they stay. Keeping visits to fifteen minutes is good. Create a food tree of friends and nearby
family who are willing to bring mom yummy and easy to digest foods every day, and won't
mind doing some laundry or dishes. Ayurveda emphasizes proper diet for this time to ensure
the health of both baby and mom. Foods need to be fresh, not processed, served warmed, very
soupy, and moist in consistency. Dishes should be prepared with digestive spices such as
cumin, caraway, ginger, mustard seed, clove, basil, turmeric, fenugreek, cinnamon, and garlic
(roasted only).it is the best support for post partum healing.9
To maximize the benefit of your breast milk a nursing mother must practice good nutrition. If
you eat too little while breastfeeding, you may not produce as much milk. Thus there is a
need for the study to assess the knowledge and practices regarding post partum diet among
the women during their puerperal period.
7
6.2 REVIEW OF LITERATURE
The literature review involved in identifying and searching for information on a topic
and developing an understanding of the state of knowledge on that topic. The scope of
literature review should be broad enough to allow a reader to become familiar with research
problem and narrow enough to include predominantly relevant sources. Literature review is
considered as a systematic and critical review of the most important scholarly literature on a
particular topic.
The study design was a randomized controlled trial conducted in both urban and rural
area of Hubei between August 2003 and June 2004. A total of 302 women who attended the
antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited.
Women randomized to the education intervention group in both urban and rural area received
two two-hour prenatal education sessions and four postpartum counseling visits. Control
group women received usual health care during pregnancy and postpartum period. Women
were followed up until 42 days postpartum. Outcome measures were nutrition and health
knowledge, dietary behavior, health behavior and health problems during the postpartum
period. Women in the intervention groups exhibited significantly greater improvement in
overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean
products as well as nutrition and health knowledge than those in the control groups.
Significantly more women in the intervention groups give up the traditional behavior taboos.
The incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was
significantly lower in the intervention groups as compared with the control groups. The study
shows that health and nutrition education intervention enable the women take away some of
the unhealthy traditional postpartum practices and decrease the prevalence of postpartum
8
health problems. The intervention has potential for adaptation and development to large-scale
implementation.10
A study was conducted to explore the levels of maternal morbidity during the
puerperium in Hubei province and its relation to diet and behavior practice. 2100 women who
had at least one child under 2 years of age were selected as the subjects by cluster-stratified
sampling in the rural area, sub urban and city of Hubei province and surveyed through
questionnaires. 59.34% of the women reported at least one symptom during the puerperium.
The reported postpartum problems included backaches, arthralgia or leg clonus (35.29%),
breast problems (19.64%), anal intestines diseases (25.72%), anaemia (10.03%), oral cavity
disease (9.28%), etc. The logistic regression analysis showed that the significant factors
related to the reported morbidity in puerperium were doing housework, sleeping time,
brushing teeth, the intake of some kinds of foods(including leafy vegetables, cereals, meat,
eggs and sugar),delivery ways, breast feeding, etc. Health problems in the postpartum period
are extremely common; some factors such as traditional diet and behavior practice during the
puerperium are associated with the maternal morbidity in the puerperium.11
A study was conducted to examine the general food and nutrition-related beliefs
and knowledge of post-partum women in Brisbane and Canberra. Cross-sectional survey was
using self-administered mail or email delivered questionnaire. one hundred and sixty-eight
post-partum women, who gave birth to a live infant in Brisbane or Canberra ,from three
maternity hospitals in Canberra and one in Brisbane and were inter-viewed during a sevenday sampling period at each hospital. Outcome measures were: beliefs, opinions and
intentions relating to food, nutrition and weight; knowledge of requirements of core foods;
and sources of nutrition information. Standard statistical tests were used to assess bivariate
relationships and multivariate analyses were performed using multiple logistic regression.
9
almost all the women (97%) were confident they could feed their families a healthy diet but
their knowledge of core food requirements was inadequate with only 1.9% correctly
answering four food intake questions, 10.5% correctly answering three food intake questions,
67.3% correctly answering two food intake questions and 20.4% correctly answering one
food intake question. The major sources of nutrition information cited by these women were:
reading (44.0%), education (36.9%), family (22.0%, particularly mothers), the media
(13.1%), weight loss diets and organizations (4.8%) and health professionals (4.2%).There is
a need to provide pregnant and post-partum women with information about core foods
requirements for health, so that they can better guide their families to healthful eating
habits.12
A study was conducted to examine the changes in women's eating habits and
attitudes in the 6 months after childbirth, focusing particularly on eating-disorder
psychopathology. A general population sample of 97 primigravid women originally studied
during pregnancy were followed for 6 months postpartum to describe their changes in eating
and weight after childbirth with particular reference to the behaviors and attitudes
characteristic of clinical eating disorders. Assessment was by standardized interview. It was
found that eating disorder symptoms increased markedly in the 3 months postpartum and then
plateaued over the next 6 months. This overall plateauing masked substantial variation in
different domains; in particular, weight concern continued to increase to the 6-month
assessment, although shape concern decreased. Concern about residual weight gain after the
birth of a child was described by many mothers as particularly distressing and seemed to
precipitate a clinical eating disorder in a few cases. Many women would have welcomed
educational advice about how to deal with changes in eating, weight, and shape after
pregnancy. It was concluded, therefore, that overall, there is evidence of an increase in
10
eating-disorder psychopathology in the 6 months after childbirth. It is argued that education
about how to deal with the changes in weight and shape after pregnancy might decrease the
risk of developing frank eating disorder psychopathology.13
A study was conducted to evaluate the effectiveness of a dietary intervention on
increasing vegetable consumption in breast-feeding (BF) and formula feeding (FF)
postpartum mothers to aid in attaining a healthy weight. There was no control group in this
intervention study as this study was involved in the preparatory stage for a larger study. It
was expected that after completion of the program, both groups of mothers would consume
more vegetables attributable in part to an increase in vegetable preference and self-efficacy in
purchasing, preparing and consuming vegetables. Postpartum mothers (N=47) were recruited
for a dietary intervention with focus on increasing vegetable intake to aid in attaining a
healthy weight. The intervention consisted of a pre-evaluation session, nutrition education
program, and a post-evaluation session. BF mothers significantly increased their self-efficacy
in vegetable selection, preparation and consumption (p=0.01) and FF mothers demonstrated a
trend towards increasing self-efficacy (p=0.06). Both groups significantly increased intake of
Total Target Vegetables (BF, p= 0.03; FF, p =0.01), Other Vegetables (BF, p= 0.05; FF,
p=0.05) and All Vegetables (BF, p=0.01; FF, p=0.01), increasing a total of 1.8 servings for
BF and 2.2 servings for FF beyond baseline for all vegetables. It was concluded that a
theory-based dietary intervention is effective in increasing vegetable consumption in
postpartum women.14
A study was conducted to describe associations between body mass index (BMI;
kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period
in a sample of 64 women. As part of a larger study, women were recruited during pregnancy
and followed prospectively to 14 months postpartum. Measures included self-reported pre
11
pregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month
postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms
(STAI). During pregnancy, symptoms of depression or anxiety were not significantly
correlated with concurrent eating attitudes or measures of BMI. However, at 14 months
postpartum, measures of eating attitudes and both depression and anxiety symptoms were
associated. Measures of BMI were associated with depressive and anxiety symptoms at both
4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month
postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of
affective symptoms. Results suggested that overweight women were at risk for elevated
anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum. : During
pregnancy, symptoms of depression or anxiety were not significantly correlated with
concurrent eating attitudes or measures of BMI. However, at 14 months postpartum,
measures of eating attitudes and both depression and anxiety symptoms were associated.
Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14
months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum
depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective
symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4
months and depressive symptoms at both 4 and 14 months postpartum. These results provide
evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and
symptoms of depression and anxiety in the postpartum period those are not present during
pregnancy.15
A controlled trial including ninety-two postpartum primiparas was conducted in three
intervention and three control child health clinics in primary health care in Finland. The
intervention included individual counselling on diet and physical activity during five routine
12
visits to a public health nurse; the controls received the usual care. Postpartum weight
retention may contribute to the development of obesity. It was studied that whether individual
counselling on diet and physical activity from 2 to 10 months postpartum has positive effects
on diet and leisure time physical activity and increases the proportion of primiparas returning
to their pre-pregnancy weight. In total, 50% of the intervention group and 30% of the control
group returned to their pre-pregnancy weight (weight retention ≤ 0 kg) by 10 months
postpartum (p = 0.06). The confounder-adjusted odds ratio for returning to pre-pregnancy
weight was 3.89 (95% CI 1.16–13.04, p = 0.028) for the intervention group compared with
the controls. The mean proportion of high-fibre bread (of total weekly amount of bread)
increased by 16.1% (95% CI 4.3–27.9) by 10 months postpartum in the intervention group
compared with the controls when adjusted for confounders (p = 0.008). No significant
differences were observed in changes in leisure time physical activity between the groups.
The intervention increased the proportion of primiparas returning to pre-pregnancy weight
and the proportion of high-fibre bread in their diet. Larger randomized controlled trials were
needed to show whether counselling can improve dietary and leisure time physical activity
habits in postpartum women and also to confirm the results concerning the effect on reducing
postpartum weight retention.16
A study was conducted to describe the beliefs and practices related to the traditional
postpartum care among women who had given live births in a village in Penang, Malaysia. A
descriptive cross sectional study was conducted among 68 women residents of a village who
had given live births. Besides the baseline demographic data, information was collected on
the postpartum confinement period and the aspects of traditional postpartum care. The data
was analyzed using the SPSS version 18.0. All the 68 eligible women responded. All of them
were aware of and practiced postpartum ‘pantang’. The mean perceived confinement period
13
was 53 days. Most respondents practice the confinement period due to self-belief (86.8%),
others due to convenience (4.4%) and family pressure (4.4%). Most women in this village
were aware of and practiced the common postpartum regimens except for the encouragement
of more food intake and the limitation of contact with others. Older women were more likely
to consume or use traditional herbs (χ² = 9.468, 4, P = 0.050) and to restrict their water intake
(χ² = 18.827, P < 0.001). Most of them claimed that they would repeat the same traditional
postpartum care regimens in their subsequent pregnancies and would advise their children the
importance of doing so despite the presence of complications. This study revealed a high
awareness and practice of traditional postpartum care.17
The study was conducted to investigate the influence of social support on weight, diet,
and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas.
A community-based participatory project, Promoting Healthy Lifestyles among Women, was
conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and
type 2 diabetes. Qualitative analyses of in-depth semi structured interviews with dyads of 10
pregnant and postpartum Latinas, and 10 people who influenced them were conducted.
Husbands and some female relatives were primary sources of emotional, instrumental, and
informational support for weight, diet, and physical activity-related beliefs and behaviors for
Latina participants. Holistic health beliefs and the opinions of others consistently influenced
Latinas' motivation and beliefs about the need to remain healthy and the links between
behavior and health. Absence of mothers, other female relatives, and friends to provide
childcare, companionship for exercise, and advice about food were prominent barriers that
limited women's ability to maintain healthy practices during and after pregnancy. The
findings support evidence that low-income, recently immigrated pregnant and postpartum
14
Latinas could benefit from community-based, family-oriented interventions that provide
social support necessary to promote and sustain healthy lifestyles.18
A study was conducted to identify attitudes about nutrition and their influence on
weight status in low-income mothers in the first year postpartum Nutrition attitudes were
assessed at 1.5, 6, and 12 months postpartum. Body weight was measured at each time point
and height at 1.5 months to calculate body mass index. Nutrition attitudes at each time were
compared with demographic variables and weight status. Subjects were 340 non-Hispanic
white (31.3%), non-Hispanic black (25.1%), and Hispanic (43.7%) new mothers (mean
age=22.4 years) located in central Texas. Criteria for participation included good health at
delivery and low income (≤185% federal poverty guideline). χ2 tests were used to compare
demographic groups to categorical variables. Multivariate analysis of variance was done to
investigate the effect of demographic variables on instrument subscale scores. A repeatedmeasures analysis of variance was used to identify significant changes over time. Obese
women had higher barriers to healthful eating subscale means at 1 year compared with
normal and overweight subjects at 1.5 and 6 months, and had more barriers than overweight
participants at 12 months. Obese individuals also had higher emotional eating subscale scores
than did overweight women at 1.5 months and both normal and overweight subjects at 12
months. Women who were obese at 1 year postpartum were more likely to perceive more
barriers to healthful eating and respond more to emotional cues to eat. Health professionals
could emphasize potential changes and difficulties often faced in postpartum and identify
techniques to overcome these obstacles to healthful eating.19
A cross-sectional retrospective study was conducted in the selected urban,
suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of
2100 women who had given birth to full-term singleton infants in the past two years were
15
selected as the participants. Data regarding postpartum practices and potentially related
factors were collected through questionnaire by trained investigators. During the puerperium,
18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank
milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still
popular among the participants. About half of the women didn't get out of the bed two days
after giving birth. The average time they stayed in bed during this period was 18.0 h. One
third of them didn't have any outdoor activities in that time periods. The educational
background of both women and their spouses, location of their residence, family income,
postnatal visit, nutrition and health care educational courses were found to be the influencing
factors of women's postpartum practices. Traditional postpartum dietary and health
behaviours were still popular among women in Hubei. Identifying the factors associated with
traditional postpartum practices is critical to develop better targeting health education
programs. Updated Information regarding postpartum dietary and health practices should be
disseminated to women.20
A study was conducted on Traditional beliefs and practices in the postpartum
period in Fujian Province, China: a qualitative study. Researcher interviewed family
members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly
developing urban county. They asked about their traditional beliefs and their behaviour
postpartum. They used a framework approach to identify main themes. They categorized
reported behaviour against their probable effects on health, drawing on Western standards
Respondents reported that zuo yuezi was commonly practiced in urban and rural families to
help the mother regain her strength and protect her future health. Zuo yuezi included: dietary
precautions, such as eating more food and avoiding cold food; behavioural precautions, such
as staying inside the home, avoiding housework and limiting visitors; hygiene precautions,
16
such as restricting bathing and dental hygiene; and practices associated with infant feeding,
including supplementary feeding and giving honeysuckle herb to the infant. Respondents
reported that the main reasons for adhering to these practices were respect for tradition, and
following the advice of elders. Categorized against Western medical standards, several zuo
yuezi practices are beneficial, including eating more, eating protein rich food, avoiding
housework, and daily vulval and perineal hygiene. A few are potentially harmful, including
giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants
supplementary feeds, although zuo yuezi emphasizes breast feeding. Zuo yuezi is an
important ritual in Fujian. In medical terms, most practices are beneficial, and could be used
by health staff to promote health in this period. They concluded that further research on
reported potentially harmful practices, such as supplements to breast feeding, is needed.21
A study was conducted to describe factors associated with breastfeeding failure
during the first 6 months post-partum in a sample of Hong Kong Chinese women
participating in a longitudinal study of maternal nutrition. Forty-four Hong Kong Chinese
lactating mothers who intended to breastfeed exclusively for at least 3 months were recruited
and followed for 6 months post-partum. Demographic data were compared with 20 mothers
who intended to use formula feeding. Mothers were followed up at 2 and 6 weeks and 3 and 6
months and details of infant feeding practices were obtained. Information was sought on
breastfeeding management in hospital, reasons for discontinuation of breastfeeding or for
providing supplements to babies and intention to seek, and sources of, lactation support.
Thirty-nine mothers who planned to completed the follow up. Compared with mothers in the
formula-feeding group, breastfeeding mothers were more likely to be professionals or
housewives. Continuation of any breastfeeding (total and partial) was noted in 30 (77%), 22
(57%), 16 (41%) and 12 (31%) mothers at 2 and 6 weeks and 3 and 6 months post-partum,
17
respectively. The majority (97%) of mothers stated that they were given information on the
benefits and management of breastfeeding. However, late initiation of breastfeeding and
providing supplements to babies were common. Perceptions of insufficient milk supply
(44%), breast problems (31%) and being too tired (28%) were the main reasons stated for
stopping breastfeeding or for providing supplements to babies. Midwives from the postnatal
wards and hotlines were the main sources of lactation support. These results highlight
difficulties in sustaining breastfeeding, either exclusive or partial, in Hong Kong Chinese
women. Despite being recruited on the basis of intending to exclusively breastfeed for 3
months, less than half these mothers were still breastfeeding and only approximately onethird were exclusively or predominantly breastfeeding at 3 months. More needs to be done
within the hospital environment to initiate breastfeeding immediately after birth and to avoid
giving unnecessary supplements and more effort is needed to foster a mother’s confidence,
commitment and knowledge of breastfeeding.22
6.3 STATEMENT OF THE PROBLEM
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND PRACTICES OF
THE POST PARTUM DIET AMONG THE WOMEN DURING THEIR
PUERPERAL PERIOD IN SELECTED HOSPITALS AT TUMKUR.”
6.4 OBJECTIVE OF THE STUDY
 To assess the knowledge level regarding post partum diet among the women during
their puerperal period through structured interview questionnaire sheet.
18
 To assess the postpartum dietary practices among the women during their puerperal
period by comparing the food eaten during their last 24 hours with the food groups of
dietary scale.
 To determine the association between the knowledge and practice score of the post
partum diet with their selected demographic variables.
6.5 OPERATIONAL DEFINITION
Descriptive Study
It means a study in which phenomena are described or the relationship between the
knowledge and practice score of post partum diet with selected demographic variable is
examined among the women during their puerperal period.
Assess
It is the organized, systematic and continues process of collecting data from women during
their puerperal period regarding post partum diet.
Knowledge
It refers to familiarity with post partum dietary pattern, which can include information, facts,
descriptions, acquired through experience or education to the women during their puerperal
period.
19
Practices
It means to perform an activity or exercise repeatedly or regularly in order to improve or
maintain the health of the women during puerperal period.
Post Partum Diet
It means the diet which is given to the mother in the period, begins immediately after the
birth of a child and extending for about six weeks.
Women during their puerperal period
A state of a woman that begins immediately after the expulsion of the placenta and continues
up to the time when the uterus returns to normal size, i.e. about 6 weeks.
6.6 ASSUMPTIONS
There will be a less knowledge and practices of the post partum diet among the women
during their puerperal period.
6.7 HYPOTHESIS
H1- The mean knowledge and practice score of post partum diet will be significantly lower
among the women during their puerperal period.
H2- There will be significant association between the knowledge and practice score of post
partum diet among the women during their puerperal period with their selected demographic
variable.
20
6.8 PILOT STUDY
A pilot study will be conducted one week prior to actual data collection on 10 samples to
Check the feasibility of tool.
7. MATERIALS AND METHODS OF STUDY
7.1 SOURCES OF DATA
Hospitalized women during their puerperal period.
Research Design
:
Descriptive study
Setting of the study
:
Selected hospitals of Tumkur city
Population
:
Hospitalized women during their puerperal period.
Sampling technique
:
Non probability convenience sampling
Sample size
:
100 hospitalized women during their puerperal period.
7.2.3 INCLUSION CRITERIA
 Hospitalized women during their puerperal period from selected hospitals at Tumkur.
 Those who can understand English, Hindi and Kannad.
 Women during their puerperal period those who are willing to participate in study.
 Those who are available at the time of study.
7.2.4 EXCLUSION CRITERIA
 Hospitalized women with any other gynaecological problem.
21
 Those who are not able to communicate in English, Kannad and Hindi.
 Those who are not willing to participate.
 Those who are not available at the time of study.
7.2.5 DATA COLLECTION TOOL
After obtaining the permission from the concerned authorities the investigator will introduce
her to the study subjects and explains the purpose of study.
Description of the tool
:
Structured interview and Questionnaire sheet
The tool consists of 2 sections:Tool-1
Part-A : Socio-demographic and obstetric characteristics of the study subjects such as age,
level of education, occupation, type of the family, family income,& obstetrical characteristics
of the study subjects such as their gravidity, parity and history of abortion were included in
that part.
Part-B : Questions related to women’s dietary knowledge and practices during the puerperal
period.
Tool-2
A dietary scale is used to assess dietary practices of the study subjects and to analyze the diet
consumed throughout 24 hours by the puerperal women. The scale contained data related to
food groups.
22
7.2.6 DATA ANALYSIS PLAN
It consists of:Descriptive statistics: Frequency, percentage, standard deviation and mean score will be
used to assess the level of knowledge and practice score of post partum diet in women during
their puerperal period.
Inferential statistics Chi-square test to find the association between knowledge and practices
of post partum diet with their selected general and obstetrical characteristics.
7.2.TIME AND DURATION
Time and duration of the study will be as per research committee.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER
HUMAN OR ANIMAL? IF SO DESCRIBE BIEFLY
No
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTATION in case of above ?
The pilot study and main study will be conducted after the approval of research
committee. Permission will be obtained from the post natal mothers and concerned
authorities. The purpose and details of the study will be explained to the study subjects and
an informed consent will be obtained from them.
Confidentiality and anonymity of the subject will be maintained. A written permission will be
obtained from institutional authority.
23
8. LIST OF REFERENCES:
1) Samar K. Hafez and Sahar M Yakout, Early postpartum dietary practices among a
group of Saudi women. Journal of American Science, 2010; 6(11):990-998. (ISSN:
1545-1003).
2) Bandolier evidence based thinking about health care, healthy post natal care, post
natal
nutrition
and
diet
for
post
natal
illness,
2008.available
at
www.diethealthclub.com.
3) Postpartum Nutrition and Lactation www.drlera.com.
4) Post natal diet, www.livestrong.com.
5) Peterson k e, Sorenson g. pearson m, Hebert j r .gottlieb b r and mccormick m.c.
Design of an intervention addressing multiple levels of influence on dietary and
activity patterns of low-income, postpartum women, December 31st 2001.available at
www.oxfordjournals.org
6) Diet and lifestyle interventions in postpartum women in China: study design and
rationale of a multicenter randomized controlled trial, BMC Public Health 2010,
10:103.available at www.biomedcentral.com/1471-2458/10/103
7) Olga tuffery and sortspec. Factors influencing antenatal and postnatal diets of
primigravid women, The Journal of the Royal Society for the Promotion of Health,
September 2005; vol. 125, 5: pp. 227-231.
8) Chan, S.M., Nelson, E.A.S., Leung, S.S.F., Li, C.Y, Postnatal iron status of Hong
Kong Chinese women in a longitudinal study of maternal nutrition, European Journal
of Clinical Nutrition, ISSN: 0954-3007 , 2001.
9) How to best support post partum healing, Postpartum care, the Ayurveda way Dec,
2003 findarticles.com/p/articles/mi_m0KWZ/is_3_5/ai_112246364.
24
10) Liu Nian, Mao Limei, Sun Xiufa, Liu Liegang, Yao Ping, and Chen Banghua, The
effect of health and nutrition education intervention on women's postpartum beliefs
and practices: a randomized controlled trial, Department of Nutrition and Food
Hygiene, School of Public Health. February 1, 2009.
11) MAO Li-Mei,SUN Xiu-Fa,LIU Lie-Gang,et al, Study on maternal morbidity during
the puerperium and its relation to dietary and behavior practice, Department Of
Nutrition and Food Hygiene, Hubei, China , 2006.
12) Nowak, Madeleine, Harrison, Simone L., and Büttner, Petra G, General nutrition
related knowledge and beliefs of post-partum women, Nutrition and Dietetics, 61 (2).
pp. 82-87. ISSN 1446-6368, 2004.
13) Steinb A and Fairburn CG, Eating habits and attitudes in the postpartum period,
vol58, 1996.
14) Gahl, Kohls Jessica, A Theory-Based, Dietary Intervention Focused on Increasing
Vegetable Consumption in Postpartum Mothers and Infants, MS, University of
Cincinnati, Allied Health Sciences : Nutrition, 2007
15) Carter S. Alice, baker wood Christina and D Kelly , Brownell, Body Mass Index,
Eating Attitudes, and Symptoms of Depression and Anxiety in Pregnancy and the
Postpartum Period , From the Departments of Psychology, University of
Massachusetts Boston (A.S.C.), Boston, MA, and Yale University (C.W.B., K.D.B.)
New Haven, CT.
16) Kinnunen I Tarja, Pasanen Matti, Aittasalo Minna, Fogelholm Mikael, Weiderpass
Elisabete and Luoto Riitta, Reducing postpartum weight retention – a pilot trial in
primary health care, Nutrition Journal 10 sep.2007.
25
17) M. Hishamshah, M. bin Ramzan, A. Rashid, W. Wan Mustaffa, R. Haroon & N.
Badaruddin: Belief and Practices of Traditional Post Partum Care among a Rural
Community in Penang Malaysia”. The Internet Journal of Third World Medicine.
2011 Volume 9 Number 2.
18) Thornton L, Kieffer C Edith, Peña Salabarría Yamir - Young Odoms Angela -, Willis
K Sharla. , Kim Helen and Salinas A Maria. Weight, Diet, and Physical ActivityRelated Beliefs and Practices among Pregnant and Postpartum Latino Women: The
Role of Social Support, and Child Health Journal Volume 10, Number 1, 95-104,
DOI: 10.1007/s10995-005-0025-3.
19) Nuss Henry, Clarke
Kristine, Lehman Klohe Deborah , Graves Freeland
Jeanne .Influence of Nutrition Attitudes and Motivators for Eating on Postpartum
Weight Status in Low-Income New Mothers, 9 November 2006.
20) Liu Nian , Mao Limei, Sun Xiufa, Liu Liegang, Chen Banghua and Ding Qiang ,
Postpartum practices of puerperal women and their influencing factors in three
regions of Hubei, China, Department of Nutrition and Food Hygiene, School of
Public Health, Tongji Medical College, Huazhong University of Science &
Technology, BMC Public Health 7 nov.2006.
21) Raven H Joanna, Chen Qiyan, Tolhurst J Rachel and Garner Paul, Traditional beliefs
and practices in the postpartum period in Fujian Province, China: a qualitative study,
BMC Pregnancy and Childbirth, 21 June 2007.
22) Chan Sm , Nelson Eas, Leung Ssf Li, Cy , Breastfeeding failure in a longitudinal postpartum maternal nutrition study in Hong Kong, Journal of Paediatrics and Child
Health Volume 36, Issue 5, pages 466–471, October 2000.
26
9. Signature of candidate
:
10. Remarks of the guide
:
11. Name and designation of (in block letters)
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide (if any)
:
11.4 Signature
:
11.5 Head of the Department
:
11.6 Signature
:
12. Remarks of the Chairman or Principal
:
12.1 Signature
:
27