الفهرس 
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Abstract
Pregnancy is a unique, exciting and often joyous time in awoman’s life; it is tremendously powerful stage of developmentthat brings a woman to motherhood. Keeping birth normal and thestriving to interfere as little as possible with the natural processcan be defined as a goal for the midwife. The underpinningphilosophy of Lamaze method is a midwife led care on normality and the natural ability of women to experience birthwithminimum or without routine interventions
Lamaze Philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. It prepares women on the ways they can decreases their perception of pain, such as through relaxation techniques ,breathing exercises, distraction by a supportive person and self. Lamaze method is widely practiced method in all over the world .It`s employed during pregnancy and childbirth to help women to respond positively to the pain of labor .It also intended to contribute to the process of labor without drug use .
This study aimed to:
Determine the Effect of third trimester Lamaze preparation on labor pain intensity and pregnancy outcome.
To fulfill the study aim: A quasi experimental research design was used.
Materials and method
Setting:
The study was conducted in a private clinic as well as Walei- El-ahd private hospital. This clinic was particularly chosen because they are already practicing antenatal classes where this research needs adherence and sustainability of the study subjects to antenatal exercises and preparation. The hospital was chosen because women was referred to it during delivery.
Subjects:
A convenience sample of 100 pregnant women, was selected from the previously mentioned setting according to the following inclusion criteria: women had normal course of pregnancy, In the 3th trimester of pregnancy. Multigravida & singleton pregnancy with cephalic presentation. Free from any medical or gynecological problemsand willing to participate in the study. The selected subjects were equally assigned to either the control (50) or the study group (50).
Tools used in this study:
Four tools were used for data collection, Tool (I): Socio-demographic, reproductive and clinical data structured interview schedule , Tool II: Visual analog scale (VAS), Tool III: present behavioral intensity scale (PBI)and Tool IV: Pregnancy outcome assessment checklist.
Collection of data consumed a period of 6 months from beginning of March 2021 until the end of August 2021.
Data of tool I was collected from both groups through an interview schedule, which was conducted individually and in total privacy.
The study subjects were divided into two group 50 study and 50 control
The control group received the routine antenatal care. The researcher interviewed each woman individually forabout 30 minutes during their antenatal visits to collect basic data using (tool I). Then they are observed twice during labor (after 25minutes& after 45 minutes)to assess severity of labor pain using ) tool II, III) and to assess maternal and fetal outcome using (tool IV).
The study group received antenatal Lamaze preparation. Lamaze preparation includes four sessions which was performed at 28wks, 30wks, 32wks, and 34wks of gestation. Each session will take about 20-30 minutes.
The subjects was assessed during first and second stage of labor to assess pain intensity using tool II, III.
Pain intensity and present behavioral manifestations of labor pain was measured before intervention for both groups and was measured after 25 min from the start of the intervention time, followed by another assessment after 45 min, during and after contraction after intervention during the active and transitional phases using tool II (pain intensity) and tool III (present behavioral intensity scale). Each woman was asked to mark her current level of perceived pain along the scale, with the number corresponding to the marked point recorded as the pain score.
The duration of the first , second and third stages of labor were also recorded among the two groups. Furthermore, women were monitored continuously for labor progress, vital signs, and general well-being until their transfer to a postpartum care room.
The main findings of the present study were:
Subject’s general characteristics
No statistically significant differences were found between study and control groups in relation to their socio-demographic characteristics , reproductive history, antenatal care.
Physical examination
It was obvious that both the study and control group were relatively similar in their blood pressure (P= 0.516), On the other hand, Statistically significant difference was observed between the two groups concerning their pulse, respiration and temperature, where P=(0.001, 0.002, 0.012) respectively.
Vaginal examination
It was found that the mean of cervical dilatation among the study and control group was (3.58 ± 0.73, 3.58 ± 0.97) respectively with no statistically significant difference among the two groups in relation to cervical dilatation (P=0.514).
Current birth data
Statistically significant difference was found between the study and control group in relation to uterine contraction in the term of duration and interval where (P= 0.039&0.001) respectively. On the other hand, No statistically significant difference was found between the two groups in relation to number of uterine contraction.
Labor pain profile
A highly statistically significant difference among the study and control groups in relation to sites of labor pain (P=0.001). As regards descriptionof Pain: no statistically significant difference among both groups.
Intensity of labor pain
No statistically significant differences were encountered before intervention in relation to labor pain intensity among the study & control groups. However, highly statistically significant differences were obviously monitored between the two groups in relation to pain intensity after intervention 25 min and 45min of Lamaze practice. This was clearly demonstrated when severe & unbearable labor pain among study group was sharply and significantly declined. Also, there were statistically significant differences between pain intensity scores before with after (25min) or (45min) for study group (P=0.001).
Maternaloutcome
Statistically significant difference was encountered between the both groups in relation to need for assisted birth. On the other hand, There was no statistically significant difference among both groups in relation to Presence of maternal distress, Vital signs, Need for Instrumental delivery, Need of episiotomy.
Duration of labor
A highly statistically significant differences between the control and study groups in relation to duration of labor. It clearly shows that mean duration of stages of normal labor (first, second, third) was shorter among the study group compared to the control group.
Fetal outcome
Fetal outcome was better among study group compared to the control group, where fetal distress was observed among a sizable portion of study group , compared to more than one third of control group. Moreover, mean APGER score after1min & After 5min was higher among study group compared to control group. Fetal complication during labor was present among minority of the study group, compared to around half of the control group. On the other hand, none of the both groups need for cardio-pulmonary resuscitation (CPR). Meanwhile, less than one- quarter of the study group need new natal ICU, compared to one half of the control group.A statistically significant difference was observed among the study and control group in relation to their fetal outcome.
Recommendations:
Based on the findings of the present study, the following arerecommended:
Designing and applying Lamaze childbirth preparation classes as an essential component of standard antenatal care at different affiliated Egyptian public hospitals.
Designing and applying childbirth preparation classes during pregnancy particularly for primigravidas to promote their self-control during labor that lead to a more satisfactory birthing experience.
Designing comprehensive updated booklet of Lamaze childbirth preparation suited and tailored to the culture of the Egyptian women and distributed through private and different affiliated Egyptian antenatal clinics.
Further studies
Investigate the effect of Lamaze childbirth preparation classes on women’s self- efficacy for selecting delivery method (normal or caesarean delivery)
Explore the perceptions and attitudes of healthcare providers toward applying Lamaze childbirth preparation classes.
Designing and implementing antenatal educational training programs into maternity and midwifery nursing undergraduate curriculum.