PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MS. MAISNAM PRITAM CHANU
1ST YEAR M.Sc NURSING
OBSTETRIC AND GYNAECOLOGICAL NURSING
YEAR 2012 – 2014
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI
BANGALORE – 560 072
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
MS. MAISNAM PRITAM CHANU
NAME OF THE CANDIDATE
AND
ADDRESS.
1st year m.sc. nursing
Padmashree College of Nursing,
Gurukrupa Layout, Nagarbhavi,
Bangalore- 560072
2.
NAME OF THE INSTITUTION Padmashree college of nursing,
Bangalore- 560 072.
3.
COURSE OF THE STUDY
AND SUBJECT
1st year M.Sc. (Nursing),
Obstetric and Gynaecological Nursing.
4.
DATE OF ADMISSION TO
THE COURSE
25/07/2012
“To Assess The Knowledge And
Attitude Of Primigravidae Mothers
Regarding Prenatal Attachment In
Selected Maternity Hospital,
Bangalore”.
TITLE OF THE STUDY
5.
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
The attachment between the pregnant woman and the fetus during pregnancy had
been described as the first important relation to the baby and has strongly been
associated with the following mother-child relation after the birth. The attachment to
the fetus and later to the baby is developing successively. It starts in early pregnancy
and increases during the pregnancy to the most intensive during the last trimester.1
Appropriate antenatal care is one of the pillars of Safe Motherhood Initiatives, a
worldwide effort launched by the World Health Organization (WHO) and other
collaborating agencies in 1987 aimed to reduce the number of deaths associated with
pregnancy and childbirth2. It highlights the care of antenatal mothers as an important
element in maternal healthcare as appropriate care will lead to successful pregnancy
outcome and healthy babies. All pregnant ladies are recommended to go for their first
antenatal check-up in the first trimester to identify and manage any medical
complication as well as to screen them for any risk factors that may affect the progress
and outcome of their pregnancy. According to the Perinatal Care Manual recently
edited by the Ministry of Health Malaysia, primigravida women are advised to go for a
total of ten visits during their pregnancy and for multigravida women, the total
recommended antenatal visit is seven sessions3
Bonding with a baby during pregnancy refers to a process through which a pregnant
woman experiences feelings and emotions for her foetus, interacts with her foetus
and develops a maternal identity (i.e. begins to identify herself as a mother) during
pregnancy. The bond between a woman and her foetus is often conceptualised by
health professionals in terms of maternal-foetal attachment or prenatal attachment.4
2
Some of the ways how to bonds with the baby during pregnancy:
Talk to your baby. Say good morning and goodnight and speak to your baby in a
soothing voice throughout the day. Babies can recognize their mother’s voice from
approximately week twenty-eight and respond to it.
Baby and mom time: Set time aside to spend with your baby. Focus solely on
your baby for about ten minutes each time. Speak to your baby, read nursery rhymes,
sing softly, rock in a rocking chair or dance slowly with your hands on your abdomen.
Babies are calmed by music and by your voice, and speaking or singing to your baby
will help them know your voice at birth.
Baby massage: Stroke and gently massage your belly to introduce your baby to
your touch and the world outside the womb.
Pay attention to baby’s movements: Be aware of the times of day your baby is
most active and focus on baby then. Early morning or evening may be the best time
for you to practice this, so that you can focus on baby at the start of each day or at the
end when your home is quiet and there are fewer distractions, and when you are most
relaxed5.
Benefits of prenatal attachment:
The extent to which a woman bonds with her foetus during pregnancy is an
important determinant of the extent to which she bonds with her newborn baby after
childbirth.
Women who bond more during pregnancy, also develop a greater bond with their
baby during infancy. The bond between a mother and her newborn in turn influences
the baby's future growth and development. A strong bond between a mother and her
baby is associated with better development outcomes later in life.6
Other benefits of prenatal attachment includes high APGAR scores; Early bond of
trust and love; Alertness, confidence and peacefulness; Enhanced visual, auditory, and
motor development; higher intelligence and creativity; Good head and general
movement control; superior learning capacity and I.Q.7
3
The development of a formal theory of prenatal attachment took a circuitous
route, beginning largely with nurses. Rubin, a nurse specializing in maternity care
doing doctoral work at the University of Chicago, perhaps laid the foundation for a
theoretical construct of attachment that begins before birth as she explored women’s
attainment of the maternal role, concluding the immediate bond between postpartum
mother and neonate was a consequence of prenatal processes8,9. She identified four
specific tasks the women she observed navigated before childbirth: (a) Seeking safe
passage for self and baby, (b) ensuring that the baby is accepted by significant others,
(c) “binding-in” and (d) giving of herself. These tasks formed a framework for her
conceptualization of the psychological experience of pregnancy and, although she did
not use the term “attachment,” Ruben states: “By the end of the second trimester, the
pregnant woman becomes so aware of the child within her and attaches so much value
to him that she possesses something very dear, very important to her, something that
gives her considerable pleasure and pride”10.
A perinatal epidemiologist in Australia was interviewing primagravidas (first
pregnancies) at various time points throughout the three trimesters of pregnancy,
finding they were able to imagine their babies in an increasingly human way over the
passage of time11.
The introduction of ultrasound during pregnancy inspired her to examine the
impact on maternal bonding of a visual image of the fetus12. Lumley’s findings
suggested this early view of the fetus enhanced a mother’s ability to differentiate it as
a “little person.” Her next project was one of the first empirical longitudinal studies of
prenatal attachment. Through the use of simple tape-recorded interviews at 5 time
points before and after childbirth, she attempted to capture first-time parents’ attitudes
of their fetus. She conceptualized attachment as being an “established relationship
with the fetus in imagination,” a point at which mothers thought of their babies as a
“real person”. Lumley reported this phenomenon in 30% of her subjects in the first
trimester, 63% in the second trimester and, by 36 weeks gestation, in 92%. She
interpreted delayed attachment as being related to unpleasant symptoms of pregnancy
and lack of interest or support on the part of husbands13.
4
6.2 NEED OF THE STUDY:
Speckhard (1997) suggests that attachment begins long before birth, that it starts
when women begin to form a mental image of their baby and feel the desire to nurture
and protect it. Attachment to the fetus begins as early as 10 weeks gestation (Caccia et
al., 1991), and increases rapidly beginning at approximately 16 weeks gestation
(Grace, 1989). It is well established that maternal-fetal attachment increases
significantly through pregnancy (Armstrong, 2002;Caccia et al., 1991; Condon, 1985;
Damato, 2000; Grace, 1989; Lindgren, 2001), and with quickening (Bloom, 1995;
Damato, 2000; Heidrich & Cranley,1989). Additionally, Reading, Cox, Sledmere, and
Campbell (1984) found that positive feelings toward the fetus are significantly related
to fetal movement and gestational age.
Rubin (1975) argues that quickening and hormonal changes early in the second
trimester result in both the most rapid increase in attachment during pregnancy and in
the highest overall level of attachment during pregnancy. Rubin (1975) outlines the
stages of binding in or prenatal emotional attachment; during the first trimester, there
is little attachment toward the fetus, rather, the woman is becoming accustomed to and
accepting of the state of pregnancy. In the second trimester, quickening and hormonal
changes act to make the woman more comfortable with the pregnancy state and
focused on providing a good home for the fetus while in utero. During this time, the
bond between mother and fetus grows rapidly. In the final trimester, the bond between
the mother and fetus persists, but the woman grows tired of the state of pregnancy.14
Muller in her study (1992) concluded that maternal-fetal attachment was
progressive and may take the whole gestation period to fully develop. The pregnant
woman’s experiences of her fetus are gleaned from either the visceral sensations of
fetal movement or from the use of technical apparatus to visualise the fetus or hear its
heart-beat. She must use her imagination to conceptualise her fetus - she is in the
process of falling in love but needs the physical reality of the baby in her arms to
secure this process.15
5
Research using questionnaires designed to assess maternal-fetal attachment has
identified many factors which influence the extent to which a woman bonds with, or
feels attachment to her fetus during pregnancy.
Socioeconomic and health status and health seeking behaviours is a factor that
influence the prenatal attachment. Like other poor maternal health outcomes (e.g.
premature birth, delivering a low birth weight infant), failure to bond with the foetus
during pregnancy is thought to be more common amongst women from
poor social and economic conditions.
Women from ethnic minorities are more likely than Caucasian women to have
low socioeconomic and health status and thus it would be expected that they would
also experience lower levels of prenatal attachment. However scientists have not yet
produced strong evidence to determine whether or not race or ethnicity is associated
with greater or lesser maternal-foetal bonding.
Evidence suggests that age does not influence the extent to which a woman bonds
with her fetus during pregnancy.
Evidence suggests that women who have less maternal experience (those that
have experienced fewer previous pregnancies) experience higher levels of prenatal
attachment than women with more maternal experience.
Social and relationship support during pregnancy influences maternal-foetal
bonding. Studies have reported higher levels of maternal attachment in women with a
positive and satisfying relationship with the father-to-be; Attachment to a significant
other characterized by high levels of trust; and High levels of emotional closeness and
intimacy in family relations.
6
As a woman's pregnancy progresses, she becomes more aware of her fetus, and
the fetus starts to grow and move. It would therefore be expected that a woman would
become more attached to her fetus as her pregnancy progresses and her awareness of
the fetus increased. A number of studies have reported that women develop a greater
bond with their fetus as the pregnancy progresses. Some studies have also found that
women experience higher levels of maternal-fetal attachment after they become aware
of fetal movements.
Mood disorders such as depression are highly prevalent during pregnancy and
evidence suggests that that these conditions may affect as many women during
pregnancy as they affect after childbirth (i.e. in the period when women
experience postnatal depression). Evidence from scientific studies suggests that
women who experience depression or other mood disorders (e.g. anxiety) during
pregnancy, do not bond with their fetus as much as women who do not experience
mood disorders.
Some women have a higher risk for poor pregnancy outcomes than other women,
for example women who have previously had a miscarriage or those who are pregnant
with twins or triplets. Studies have examined whether or not there are differences in
the extent to which a mother bonds with her fetus in high vs low risk pregnancies.
They have looked at bonding in Pregnant women who have previously had a
miscarriage; Pregnancies where the foetus has been diagnosed with a non-life
threatening, congenital abnormality; Pregnancies which were conceived through in
vitro fertilisation; and Multiple pregnancies - pregnancies in which the woman is
carrying more than one foetus (e.g. twins or triplets). None of the studies have found
differences in the extent of maternal-foetal bonding between women with high risk
pregnancies and those with normal pregnancies.
Substance abuse during pregnancy is associated with poor maternal and infant
outcomes (including an increased risk of low birth weight and impaired childhood
development). Women who abuse substances during pregnancy may therefore find it
7
more difficult to accomplish many of the tasks which are vital to bonding with their
infants. These tasks include things like feeling love or compassion for the foetus or
acting in the interests of the foetus and to ensure its safety. No studies have directly
compared maternal foetal bonding in substance abusing and non-substance abusing
women. There are studies which have examined maternal-foetal bonding in different
groups of substance users. These studies reported that substance users struggle to feel
attachment with their foetus and experience guilt, uncertainty and concern throughout
their pregnancies.
Ultrasound technology enables women to view their foetus growing in their
womb. It has been argued that ultrasound is likely to allow a woman to bond with the
foetus earlier in the pregnancy than she otherwise would (e.g. women may otherwise
only begin to feel attachment once they feel the foetus moving).
One study which examined the difference between having an ultrasound and not
having an ultrasound reported greater maternal-foetal attachment amongst women who
had ultrasound.The type of ultrasound (eg two, three and four dimensional ultrasound)
does not affect the extent to which a woman bonds with her foetus.
Research has found that 76% of men bonded with the foetus before an ultrasound.
A number of studies have examined the use of a variety of tests for foetal
abnormalities, and whether or not the use of these tests is associated with greater or
lesser bonding between a woman and her foetus.
One study examined differences in maternal-foetal bonding between women
using maternal serum screening(testing the pregnant woman's blood for signs of birth
defects in her foetus), women using amniocentesis (testing the pregnant woman's
amniotic fluid for signs of birth defects in her foetus) and a group of women who used
neither of these tests. It reported that women who used maternal serum screening were
less attached to their foetuses than women who used amniocentesis or those who used
neither test.4
8
Mother is the responsible person for the well being of the fetus and its outcome.
Whenever the brain is stimulated, new neuronal connection are being made. The more
connections, the more neurons are integrated. This in turn determines intelligence,
social, and emotional skills of the child. Health professional can both assess and
encourage women’s affective relationship with their fetus.
During the maternity posting of the investigator’s degree programme, while
collecting history in the antenatal OPD, most of the women were unaware and had
inadequate knowledge regarding prenatal attachment and its benefits. This enhances
the investigator to do this study to assess the knowledge and attitude of primigravidae
mothers regarding prenatal attachment.
6.3. STATEMENT OF THE PROBLEM:
“A study to assess the knowledge and attitude of primigravidae mothers
regarding prenatal attachment in selected Maternity Hospital, Bangalore.”
6.4.OBJECTIVES:
1. To assess the knowledge of primigravidae mothers regarding prenatal
attachment.
2. To assess the level attitude of primigravidae mothers regarding the prenatal
attachment.
3. To correlate the knowledge and attitude of primigravidae mothers regarding
the prenatal attachment.
4. To associate the knowledge and attitude of primigravidae regarding prenatal
attachment with their selected demographic variables.
6.5OPERATIONAL DEFINITIONS:
1. Assess: It refers to finding the level of knowledge and attitude among
primigravidae mothers regarding prenatal attachment.
9
2. Knowledge: It refers to the awareness and understanding of primigravidae
mothers on benefits related to prenatal attachment.
3. Attitudes: It refers to opinion, values or feelings expressed by primigravidae
mothers towards prenatal attachment.
4. Primigravidae mother: It refers the mothers who are pregnant for the first
time between the period of 20th to 38th weeks of gestation who are attending
antenatal OPD.
5. Prenatal attachment: It refers to the attachment between the mother and fetus
which includes increasing fetal awareness, maternal massaging, talking to the
fetus, enjoying fetal movement, gaining high APGAR score, early bond of
trust and love, alertness, confidence and peacefulness, enhanced visual,
auditory, and motor development, higher intelligence and creativity, good head
and general movement control, superior learning capacity and I.Q.
6.6. ASSUMPTION:
1. The primigravidae mothers may have inadequate knowledge regarding prenatal
attachment.
2. The primigravidae mothers attitude may vary regarding prenatal attachment
depending on the gestational age.
6.7. HYPOTHESIS:
H1: There will be significant correlation between knowledge and attitude among
primigravidae mothers regarding prenatal attachment.
H2:
There will be significant association of knowledge and attitude among
primigravidae mothers regarding prenatal attachment with their selected demographic
variables.
10
6.8. REVIEW OF LITERATURE:
Review of literature is a key step in research process. Review of literature refers to an
extensive, exhaustive and systematic examination of publications relevant to the
research project. One of the most satisfying aspects of the literature review is the
contribution it makes to the new knowledge.16
The literature review is sectioned under the following headings:
1. Literature related to prenatal attachment
2. Literature related to knowledge and attitude regarding prenatal attachment.
1) Literature related to prenatal attachment
A descriptive study was conducted at antenatal outpatient department at Sri
Ranachandra Hospital Chennai. Sample size was 50 primigravid under convenience
sampling technique. Findings was maternal fatal attachment was 56.50 with standard
deviation was 7.56 and there was no association found between maternal fetal
attachment and demographic variable.7
A longitudinal descriptive study was conducted to examine the relationships
among Maternal Fetal Attachment (MFA), health practices during pregnancy, and
neonatal outcomes in a sample of low-income, predominantly African-American
women and their neonates. The result suggested that MFA was associated with health
practices during pregnancy and adverse neonatal outcomes and also support the
importance of examining MFA in our efforts to better understand the etiology of
health disparities in neonatal outcome.17
A current study examined whether maternal prenatal attachment is associated with the
mother-infant relationship. One hundred pregnant women and their infants at 12
weeks participated in the study. At about 12 weeks postpartum, mothers and their
infants were observed and videotaped during an en face interaction. The results
revealed that maternal prenatal attachment towards the unborn baby is a good
11
predictor of the early mother-infant relationship. This study demonstrated that
maternal prenatal attachment during the third trimester of pregnancy is associated with
the postnatal maternal involvement, and can serve as an important diagnostic aid in
identifying those women for whom the mother-child interaction is likely to be suboptimal.18
According to a Journal article, Prenatal attachment is a construct not only
intriguing for nurse researchers, but also the object of attention from the lay public and
popular media. Promoting prenatal attachment is assumed to have benefits particularly
for children. Pregnant women are admonished that development of a successful
mother-child relationship begins before birth and is their responsibility. The prenatal
attachment research literature was reviewed to determine if the last statement could be
supported. The current state of this body of literature is presented in this article along
with a critique of the research studies and suggestions for future research.19
A comparative study on maternal fetal attachment of primgravidas and
multigravidas women with past history of fetal or neonatal death which haven’t had
living child was done. One hundred and twenty literate Iranian pregnant volunteer
women with the ages of 20-40 years were selected during their 3rd trimester of
planned current pregnancy. Forty samples didn’t have living child, had past history of
fetal or neonatal death and 80 samples were primigravidas. The result shows that a
statistically significant difference was found in 5 subscales of the Maternal fetal
attachment scale between the primigravidas and multigravidas women with past
history of fetal or neonatal death.20
A qualitative study used nine semi-structured interviews and one focus group was
conducted with women who were pregnant or who had recently given birth. The
research aimed to explore the influences on women's engagement with healthy
practices during pregnancy, particularly the effect of maternal-fetal attachment. The
result in this research found that as women became more bonded to the fetus they
became more reassured of its wellbeing, and were less anxious about strictly adhering
12
to healthy diets or abstaining from alcohol. The research concluded that if health
advice emphasises the wellbeing of the fetus in efforts to improve maternal health
behaviour during pregnancy, women may not see its relevance if their embodied
experience and diagnostic tests indicate that the fetus is healthy.21
A comparative study was conducted between primigravid and muligravid women
with the objective to compare prenatal personal (demographic and other descriptive
elements,
including
self-esteem)
and
psychosocial
variables
(maternal-fetal
attachment, marital satisfaction) and to describe perceived pregnancy experiences for
both primigravid and multigravid women. Both quantitative and qualitative data were
collected using a descriptive mixed-methods design. Participants included 50 pregnant
primigravid and 50 multigravid married women recruited during the last trimester of a
healthy, uncomplicated pregnancy. The study reveals that multigravid women had
significantly lower levels of maternal-fetal attachment and marital satisfaction than did
primigravid women during their third trimester of pregnancy.22
A cross sectional study was conducted in Temuco, La Araucanía Region, Chile
with the objective to estimate the prevalence of poorer prenatal attachment and its
association with psycho-affective factors in pregnant women during the third
trimester. 244 pregnant women were participated. The result showed that the
prevalence of poorer prenatal attachment was 24.3% (95% confidence interval 19–
30%), and this was found to be associated with discontent with the pregnancy,
unwanted pregnancy, higher levels of perceived stress, depression and low family
support. The study concluded that detectable psychosocial factors means that early
diagnosis and timely intervention during prenatal care are an essential challenge for
midwives in their work; any progress that can be made during pregnancy will favour
the development of the bonding experience after birth, and thus the balanced
development of the child.23
A journal article published in the past 7 years (2000-2007) were critically reviewed
and synthesized the original research. The study aimed that examined variables
13
thought to increase, decrease, or cause no change in level of maternal-fetal attachment.
Keyword searches included maternal-fetal attachment, parental attachment, and
prenatal attachment. The study shows that factors associated with higher levels of
maternal-fetal attachment included family support, greater psychological well-being,
and having an ultrasound performed. The review concluded that further research is
essential to identify factors influencing maternal-fetal attachment.24
2) Literature related to knowledge and attitude regarding prenatal attachment
An analytical study was conducted aims to review current knowledge concerning
the development of prenatal attachment, the impact of demographic and pregnancy
variables, and the implications for care and well-being of the foetus. The studies
suggested that the level of prenatal attachment typically increases throughout the
course of pregnancy. It is likely that higher levels of social support are associated with
increased levels of prenatal attachment but more research is needed into the
association with this and other psychological variables; more research is needed into
the relationship between prenatal attachment and how women care for themselves and
their developing baby in terms of health related behaviours.25
A prospective study was conducted to examine the relationship between maternal
nutrition and birth size. The study was done in 797 rural Indian women). Energy and
protein intakes were not associated with birth size, but higher fat intake at wk 18 was
associated with neonatal length, birth weight and triceps skinfold thickness when
adjusted for sex, parity and gestation. The study reveals that birth size was strongly
associated with the consumption of milk at wk 18 and of green leafy vegetables and
fruits at wk 28 of gestation even after adjustment for potentially confounding
variables.26
A study was conducted to examine the degree to which women engage in
attachment behaviors toward their unborn children. Cranley's Maternal-Fetal
Attachment Scale (MFAS) was modified to Japanese version (MFAS-J2), which
14
consists of 20 items with .87 reliability. MFAS-J2 was administered to both normal
and high-risk pregnant women (n = 275) during gestation. The result reveals that (1)
Maternal-fetal attachment increased significantly from 5 to 40 weeks of gestation.
Especially feeling fetal movement had positive effect on maternal-fetal attachment. (2)
Women who reported negative perception or ambivalent feeling about their pregnancy
showed low attachment score. And women whose husband reported negative feeling
about their pregnancy responded lower in the scale. (3) Some negative relationships
were observed between maternal-fetal attachment score and the histories of abortion
and sterility. (4) Maternal-fetal attachment showed no significant correlations to
factors of threatened abortion, premature labor, and IUGR. (5) Maternal-fetal
attachment showed negative correlations to State-Trait anxiety during early
pregnancies.27
A comprehensive study was conducted at West Virginia University with the
primary aim to evaluate the relationships among family relationships, maternal/fetal
attachment, and maternal health practices. As a result the women ranged from ages 18
to 36, predominately white, and low income. The majority were married or living
together and completed high school. The result showed that family relationships,
maternal/fetal attachment, and health practices in pregnancy were all positively
correlated. The study identified that using a sample of 30, multiple regression
procedures did not identify significant predictors of maternal health practices or
maternal/fetal attachment.28
15
7.MATERIALS AND METHODS
7.1 SOURCE OF DATA COLLECTION
The data will be collected from primigravidae mothers between 20th
to 38th week of gestation attending antenatal OPD.
7.2 METHOD OF DATA COLLECTION
i.
RESEARCH DESIGN
Non-experimental descriptive design.
ii.
RESEARCH VARIABLE
1) Study variable: Knowledge and attitude of primigravidae mothers.
2) Extraneous variable: It includes information about age, education, type of
work, religion, family type, income, family support, gestational age, previous
source of information
iii.
SETTING: Study will be conducted at selected Maternity Hospital Bangalore.
iv.
POPULATION: All Primigravidae mothers between 20th to 38th weeks of
gestation attending antenatal OPD.
v.
SAMPLE: Primigravidae mothers who fulfill the inclusion criteria and the
sample size will be 60.
vi.
CRITERIA FOR SAMPLE COLLECTION:-
Inclusion criteria:
The study includes

Primigravidae mothers between 20th to 38th weeks of gestation attending
antenatal OPD.
16

Primigravidae mothers who are willing to participate in the study.

Primigravidae mothers who can read and write kannada or English.
Exclusion criteria:
The study excludes

High risk primigravidae mothers

Multigravidae mothers.
Vii. SAMPLING TECHNIQUE
Non probability Convenience Sampling technique
Viii. TOOL FOR DATA COLLECTION
The tool consists of the following sections.
Section A: Demographic data of primigravidae mothers such as age, education, type
of work, religion, family type, income, family support, gestational age,
previous source of information.
Section B: A self administered structured questionnaire to assess the knowledge of
primigravidae mothers regarding prenatal attachment.
Section C: 3 point Likert scale to assess the level of attitude of primigravidae mothers
regarding prenatal attachment.
ix. METHODS OF DATA COLLECTION
After obtaining permission from concerned authority and informed consent
from the samples, the researcher will collect the data from the sample:
Phase І: The investigator will collect the data pertaining to the demographic variables.
Phase П: Assess the knowledge with the help of self administered questionnaires and
attitude with 3 Likert scale.
17
Phase III: Based on the study, the investigator will prepare an informational pamphlet
on prenatal attachment, its advantages and strategies to improve it.
x. PLAN FOR DATA ANALYSIS:
The data collected will be analyzed by using descriptive and inferential statistics.
Descriptive statistics: Frequency, mean, percentage distribution and standard
deviation will be used to describe the demographic variables of primigravidae
mothers.
Inferential statistics:

Paired ‘t’ test will be used to compare the knowledge level of attitude.

Chi-square test will be used to associate knowledge and attitude of primigravidae
mothers with the selected demographic variables.
xi. PROJECTED OUTCOME:
The investigators will come to know the existed knowledge and attitude regarding
the prenatal attachment of primigravidae mothers at the end of the study. Investigator
will prepare pamphlet about benefits and strategies to increase prenatal attachment to
improve the knowledge and attitude of primigravidae mothers.
7.3 Does the study require any investigations or interventions to the patients or
other human beings or animals?
Yes, the study requires a minimum investigation on knowledge and attitude of
primigravidae mothers on prenatal attachment because the investigator is planning
only for descriptive study and no active manipulation is involved in the study.
18
7.4 Has ethical clearance obtained from your institution?
Yes, the permission will be obtained from the consent authorities of the selected
setting. The investigator will take informed consent from the sample.
19
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among low risk and high risk pregnant women. World applied sciences journal 2012;
18: 462-471.
2. World Bank. Safe Motherhood- a review. The Safe Motherhood Initiatives.1987 2005 World Bank Report. New York: Family Care International; 2007.
3. Ministry of Health Malaysia. Family Health Development Division. Perinatal care
manual: antenatal care. (2nd ed). Ministry of Health Malaysia: Putrajaya; 2010.
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http://www.virtualmedicalcentre.com/healthandlifestyle/bonding-with-your-babyduring-pregnancy/232#c4
5. Available at:
http://www.playtexmommyville.ca/mommyville/prenatal/preparation/bonding_with_y
our_baby.aspx
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http://www.virtualmedicalcentre.com/healthandlifestyle/bonding-with-your-babyduring-pregnancy/232#c4
7. S.Rajeswari, vijayalakshmi Ethiraj. Maternal-fetal attachment among primigravida,
Nightingale Nursing Times. A window for Health in Action, May 12; 8:.24-26
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1967a;16(3):237–245.
9. Rubin R. Attainment of the maternal role: Part II. Models and referrants. Nursing
Research. 1967b;16(4):342–346.
20
10. Rubin R. Maternal tasks in pregnancy. Maternal Child Nursing Journal. 1975;4:143–
153.
11. Lumley JM. The development of maternal-foetal bonding in first pregnancy. Third
International Congress, Psychosomatic Medicine in Obsetrics and Gynaecology;1972.
12. Lumley JM. Through a glass darkly: Ultrasound and prenatal bonding. Birth. 1980;
17:214–217.
13. Lumley JM. Attitudes to the fetus among primigravidae. Australian Pediatric Journal.
1982; 18:106–109.
14. Available at:
https://docs.google.com/viewer?a=v&q=cache:4kdbk61ooloj:library.usask.ca/theses/a
vailable/etd-08232004170804/unrestricted/turriffjonassonthesis.pdf+matenal+fetal+attachment,prenatal+em
otional+attachment&hl=en&gl=in&pid=bl&srcid=adgeesi7kuhwdoshwvbxwzjphwng
hhbn8g1rwsh0x9gyv_oe947flfllfshgyhb68obc4prfofelumwzaprd26au090fadsawbc8q1
oxfmmvhbgx0mfe0dawxgtehgwvhhbelyilooda&sig=ahietbq23ncdkcogov2pcar0guux
pgq1aa
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9. Signature of the candidate
:
10. Remarks of the guide
:The study is researchable and
appropriate. It has implication in
clinical nursing practice.
11. Name and Designation of
11.1 The Guide
:Ms. Subhashini. G.
Associate Professor.
11.2 Signature
:
11.3 Co-guide
:Mrs. Dhanalakshmi
Assistant Professor.
11.4 Signature
:
11.5 Head of the Department
:Ms. Subhashini. G.
Associate Professor.
11.6 Signature
:
11.7 Remarks of the Principal
: This study is relevant, feasible and
appropriate for the specialty
chosen.
11.8 Signature
:
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