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Pregnancy and behaviours associated with it. A pilot study based on age and level of education of the women
Zweite Stufe. Der Studierende hat eine fixierte Berufseinstellung und stabilere Interesse; bei ihm treten es Neigungen zutage, aber er interessiert sich mehr für die praktischen Seiten des Lehrstoffes; das formierte Ziel gibt allgemeine Orientierung für Lehr- und Betriebstätigkeit, es zeigen sich bei ihm das Selbstgefühl und die Selbständigkeit; es wird das Verantwortungsgefühl formiert. Dritte Stufe. Der Studierende hat eine feste Berufseinstellung, standfeste Interesse und Neigung zu diesem Beruf; er nteressiert sich besonders sowohl für praktische, als auch für theoretische Seite des Lehrstoffes; es geschieht Selbstbehauptung der Persönlichkeit durch die berufliche Arbeit [3, 12]. Vierte Stufe. Leidenschaftliche Begeisterung für den Beruf; die Person und die Sache werden einheitlich; Orientierung formiert sich beim Vorhandensein von grossen Fähigkeiten zum gewählten Beruf; Neigungen und Berufung sind deutlich ausgedrückt; es zzeigt sich hohe berufliche Meisterschaft und Vorhandensein der beruflichen Ideale; es gibt feste Überzeugung in persönlichen und gesellschaftlichen Wichtigkeit des eigenen Berufes. Erkenntnistätigkeit, die den Zufluss der neuen Information vom Beruf und von seinen Forderungen an eine Person gewährleistet, ist effektiver bei voller beruflichen Orientierung (Vorherrschen der direkten Auswahlmotiven). Beim Vorherrschen der Nebenmotiven ist die neue Information über die Forderungen, die vom spezifischen Inhalt der Tätigkeit gehen, für die Veränderung
des ursprünglichen Persönlichkeitssinnes zur Auswahl des Berufes nicht immer ausreichend, deshalb kann sie zur Moti-venverschiebung nicht führen und folglich den Übergang des Widerspruchs vom äußerlichen Niveau zum inneren nicht gewährleisten [4, 41]. Organisation einer aktiven Kraftprobe in der Tätigkeitssphäre, auf die wir Studenten orientieren, ist die wichtigste Bedingung zur Erhöhung des Niveaus ihrer beruflichen Orientierung. Realisierung dieser Bedingung setzt solche Organisation der Tätigkeit voraus, bei der vor den jungen Leuten die solche Aufgaben gestellt werden, die die Tätigkeitsspezifik und ihre schöpferische Seiten zeigen. Es ist zu berücksichtigen, daß im Grunde der Veränderung des Motivationsverhältnisses zur Tätigkeit die Veränderung von entsprechenden Bedürfnissen, Interessen und Neigungen liegt [5, 23]. Als psychologische Mechanismen der beruflichen Orientierung bei einem Person können also die komplizierte Mehrebenenstrukture von Motiven, Werten, Persönlichkeitssinnen und Fähigkeiten auftreten, die die professionell wichtigen Eigenschaften bestimmen. In Zusammenhang mit den oben beschriebenen Triebkräften der beruflichen Orientierung ist zur Entwicklung der letzteren eine solche Organisation der Studententätigkeit notwendig, die den Widerspruch zwischen den Forderungen der bevorzugten Tätigkeit und ihren Persönlichkeitssinn für eine Person aktualisieren würde. Die Möglichkeiten von verschiedener Arten der Tätigkeit sind in dieser Hinsicht ungleichwertig.
Referenz:
1. Halapina L. N. Sozialisierung eines Lehrers. - Kuzbass, 1995.
2. Lekerova G. J. Features of Motives’ Manifestation of Professional Development and Personal Characteristics of Future Teachers.//Life Science Journal. - 2014. - 11 (l s).
3. Lekerova G.J. Features of the organization and conduct of professional orientation to, 3 teaching profession in the field of education.//The Psychology of learning Moscow. - 2007. - № 9. - Р. 100-109.
4. Lekerova G.J. Psychological and pedagogical bases of active teaching metods.//Life Science Journal. - 2014. - 11 (bs).
5. Lekerova G. J. Forming of steady motivation and orientation of entrants in the system of high professional schools in Kazakhstan.//European scientific journal. - 2015. - vol. 11, no. 1. - Р. 116-119.
Tollkuci Ela Bujar, PhD candidate, Centre of Albano-logical Studies Institute of Cultural Anthropology and Study of Art,
Department of Ethnology E-mail: tollkuci@yahoo.it
Marjola Rahim Lagji, Msc student, Mediterranean University of Albania, Faculty of Law and Political Science E-mail: marjola.lagji@hotmail.com
Pregnancy and behaviours associated with it. A pilot study based on age and level of education of the women
Abstract: This study arises from the will to know the aspects related to births in Albania, focusing mainly on three stages: pregnancy, birth and postpartum. The random sample of this pilot study consisted of 50 women. Among the
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most important results of the study we can identify: the use of folic acid begins mainly during the early pregnancy process; the number of ultrasounds scans remains high for women of any age or level of education; natural births are more common to any group of age or level of education and monitoring of breastfeeding is generally adequate. Exception is for the group of women with middle class degree which demonstrated lower results to this variable. Keywords: pregnancy, birth, postpartum, folic acid, breastfeeding.
Introduction
Today, it is accepted by the great part of researchers and doctors that, a mother gets gradually shaped by a cumulative work that begins many months before the actual child birth [13]. According to ISTISAN 2012 [5], the road to the birth is a unique opportunity for health promotion, but in lot of cases consists in spontaneous information research, by women, like a spontaneous tendency to reduce various vulnerabilities. Every new mother develops in her mind a completely different mental set than she didn’t had before, and will enter a large area of unknown experiences for women who are not mothers [13]. During the pregnancy, the woman is expected to be attentive about her diet in order to ensure the health and proper development of the child [9]. The body of the newborn is a symbol of the ability of the mother to feed and to be concerned for his health [6]. For example, according to the survey ISTISAN 1996 [4], fifty percent ofwomen who smoke, stop smoking during pregnancy but also those who continue to do it, reduce the average in half of the number of cigarettes. An extraordinary combination between medical priorities and psycho-social aspects is today the case of pregnancy in women with diabetes. A woman with the first type of diabetes (dependent from insulin) and second type of diabetes (independent from insulin), that desires or even is in the situation to be pregnant, will be accompanied by questions like: can I get pregnant? Will my child inherit diabetes? Is my child’s life at risk during childbirth? Is my life at risk during childbirth? Will the diabetes get worse during pregnancy? [1]. To achieve pregnancy a diabetic woman should reach standards [12] and also follow a pregnant program that often requires a very high level of motivation, both in the physical and psychological point of view. It is advisable about these patients to follow a pregnancy management plan in cooperation with members of a working group. There is a worsening of metabolic control to these women especially in comparison with the first moment when they just become part of the educational program [10]. The main reasons for the deterioration is the unstable self-control, the difficulty to keep alive the intensive behaviour oriented to self-management and lack of social support. These aspects increase the social responsibility of the operators to control all the stressful factors that this young mother have to face [7]. It also becomes necessary the implementation of a pre-conception counselling mainly for women who schedule a pregnancy within a year.
Pregnancy
The future mother ought to adhere to a natural regimen of physical exercises for 15 to 30 minutes per day [8]. At the moment the mother discovers that she is pregnant, she should set up a meeting with a good doctor to examine the overall state of her health. Most important is the estimation
of the number of red beads which play an important role in the transmission of oxygen to the brain of the mother and child. During the period before the conception, that is one to two months before pregnancy and throughout the first trimester of pregnancy, it is recommended for all women to schedule their pregnancy and to take folic acid (series of vitamin B). According to scientific evidence, folic acid is associated with a reduction of risk for several birth deformities. The results of the pilot study on folic acid, conducted by ISS Union 2010 [11], highlighted that it was used from 22.1 % of Italian women and 6.4 % of foreign women. Among Italian women the use of folic acid in the period before conception was significantly higher for women that are employed, married, at the first experience of pregnancy and in more mature age. The lowest use of folic acid among women with more than one pregnancy, was interpreted as an aspect related to the fact that, although it is recommended during pregnancy, it is not accompanied by appropriate information on the necessity and the correct way of his acquisition. Regarding to the courses of accompaniment during pregnancy, there is a vast scientific literature that assesses the impact of various indicators on well-being. ISS has conducted two observational studies on birth path in the years 1995-1996 and 2002 [11]. Both studies showed a significant correlation between participation in the preparatory birth courses and reduction of risk for inappropriate practices. For this reason it is recommended that: “Pregnant women, should be given the opportunity to participate in the birth accompaniment courses, organized in order to allow interaction between participants and instructors of the courses. Women should seek and receive information on pregnancy, birth, breastfeeding, childcare and parenting" [11]. According to ISTISAN 2012 [5], the topics that are mostly covered during the preparatory courses provide with general information (for example the work with the body, relaxation techniques, recommendations on the limit of no more than three ultrasound scans, etc.), contractions during the birth, childbirth and breastfeeding.
How to realize a “perfect” childbirth
Referring to the literature and the numerous studies performed on aspects that related to the specific moments of contracting till the time of birth, we can noticed a set of guidelines and recommendations that are useful to the welfare of the young mother and child as well as to the specific work of doctors, obstetrics, nurses and all the staff involved into the process. The mother has to be in the position in which gravity can work for her and her child [8]. The woman must be conscious when she faces a strong coercion as well as when it comes the time for an appropriate rest
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Pregnancy and behaviours associated with it. A pilot study based on age and level of education of the women
during childbirth. It is better to use a birth stool for a more comfortable birth and likely to have an open position. The Use of baths with warm water is a technique that is becoming common in the practices of public and private hospitals all around the world. Warm water is a natural stimulant of endorphins which plays an essential role for the relaxation of muscle tension especially for women during the contractions. In conclusion to these recommendations, the last but not the least, when the head of the child comes out, the lights must be switched off or at least must be lowered. A bright light burns the cells of the eyes in an irrecoverably way causing to the infant the loss of 40 % of the ability to see [8]. The most significant indicator of excessive medicalisation of births is the worldwide increasing proportion of birth operations. Especially in Italy (38 %) this percentage is the highest in Europe the more if this is compared to Netherlands and Slovenia where this value varies between 14 % to 15 %. The caesarean is a very important surgical practice to save lives in cases of pregnancies at risk (the appropriate cases of this operation estimated up to 15 %), but it is inappropriate in pregnancies without complications. Based on the results of the study of ISTISAN 2012 [5], for the Italian champion the caesarean section is more common among older women, mothers who give birth for the first time and residents in the southern region compared to the northern region. Such issues are of interest and must be analysed around the world but also in the territory and for birth practices in Albania. This is not only for the consequences and costs associated to the caesarean section, but for all the psychological consequences of the operation itself, the lack of immediate contact with the baby and the consequences of the difficulties to recover of the mother in the after intervention period.
Important instruments of actions with infants
Immediately after the process of birth, as the child is quickly washed and the mother is cleared from all the bloodshed, they should be allowed to relax together as “skin to skin" [8]. This does not only provides an emotional security, but also provides the opportunity for the child to learn the basic rhythms of the universe in a new context. Regarding the manner of feeding the child, the mother’s milk is the best for a child. National and international institutions, such as WHO, UNICEF and the European Union [2] have agreed on the recommendation that follows: “exclusive" provision of breastfeeding up to 6 months of life; continuation of breastfeeding up to two years or more based on the wishes of the mother and child. Interventions that promote the breastfeeding to the child refer to the hospital caring, the transmission of accurate information, support during breast-feeding, attention through popular hospital practices that favour the breastfeeding such as observation during breastfeeding, skin to skin contact, the connection to the breast within two hours from the birth or even earlier, within the first half an hour, in order to favour the assuming of the colostrum [5]. According to the research of ISTISAN 2012 [5], 64.8 % of the women in Italy have stated that they have breastfed
for more than the first three months of life and 23.7 % for less than the tree months of life. Among those who have not breastfed after the birth, 45.9 % have done it because of health problems related to the child and 10.5 % of them because of a personal choice.
Materials and Methods
This pilot study was based on a sample of 50 women. The study was conducted in two main cities of Albania: Tirana and Saranda. The places where the submission of the questionnaire was conducted, were near the playgrounds, nurseries, kindergartens and various premises where the mothers of young children gathered together. The age of the participant varied from 18 to 45 years old. The period that has passed from the moment where the participants became mothers ranged from one month to less than two years.
The measuring instrument used in this study was a questionnaire composed of four sections:
A. Part I — Items about the Pregnancy period;
B. Part II — Items about the Birth period;
C. Part III — Items about the Postpartum period;
D. Part IV — Items about Socio-demographic characteristics.
Study hypothesis
For the purpose of this study we raised four experimental hypothesis:
H1 = the use of folic acid before the gestation phase increases with the growing of the age and the level of education of women.
H2 = the number of ultrasound scans during the pregnancy decreases with the growing of age and women’s education.
H3 = the level of education and the age of mothers relates with the preference for natural births instead of the caesarean section.
H4 = by the increase of level of education and the reduction of maternal age, there is a growing number of observations during breastfeeding of the infant.
Results
From the data analysis it was found that 48 % of the mothers interviewed had a high school education. This number is followed by mothers with higher level of education, which constituted of 40 % of the respondents (2 % of them had a post-university degree and 38 % of them had a University degree). 12 % of the mothers had a middle class degree of education, which is the lowest level analysed in this study. Regarding to the age groups of the subj ects who participated in this pilot study, we calculated that 36 % were from 26 to 30 years old. Another 34 % consisted on the age group of18 to 25 years old (4 % of them were in the age of18 to 20 years old and 30 % of them in the age of 21 to 25 years old). Also 16 % are in the age of 31 to 35 years old and 14 % in the age of 36 to 45 years old (only 2 % of these belongs to the age group of 40 to 45 years old). In table. 1 there are reflected the interest responses of the mothers that meet the needs of our study. Responses are accompanied by higher sample percentages starting by every level of the measurement scale that was used.
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Table 1. - Table of summary for the responses of the mothers
No Question Answer The highest %
1 Who has followed you during the pregnancy? Gynaecologist 94 %
2 How many ultrasound scans did had during the pregnancy? Up to four 78 %
3 Who counselled you during the pregnancy? Only the doctor 74 %
4 Have you been part of a preparatory course during the pregnancy? No 94 %
5 Would you like telling any of your friends to follow the preparatory courses? Yes 56 %
6 Did you take the vitamin b Yes 90 %
7 How was your baby-birth? Natural birth at the hospital 66 %
8 Which would have been the type of birth you would have wanted to have? Natural birth at the hospital 74 %
9 Did you have an immediate contact with your baby (skin to skin) after the birth? Yes 66 %
10 How did you thought to feed the baby before the birth? Absolutely breastfeeding 100 %
11 Who are the reasons of not breastfeeding? Because of a baby problem 33 %
12 During your staying in the hospital, did anyone observed you while breastfeeding? Yes 86 %
Table 2. - The relationships between the level of education and four types of characteristic behaviours for each of the aspects of the pregnancy
Education Level
Post-University University High school Middle school
Folic Acid During/ 100 % 68.4 % 79.2 % 66.7 %
Before Pregnancy 00 % 15.8 % 12.8 % 33.3 %
Ultrasound scans 4-5, < 5 100 % 60 % 70.8 % 66.7 %
Up to 3 00 % 40 % 20.2 % 33.3 %
Type of birth Natural 100 % 73.7 % 54.2 % 83.3 %
Caesarean Section 00 % 21 % 45.8 % 16.7 %
Observation During Breastfeeding Yes 100 % 100 % 87.5 % 33.3 %
No 00 % 00 % 12.5 % 66.7 %
Table 3. - The relationship between age of participants and four characteristic behaviours in the stages of birth
A ge
18-20 21-25 26-30 31-35 36-40 41-45
Ultrasound scans 4-5, < 5 100 % 86. % 72.2 % 87.5 % 55 % 100 %
Up to 3 00 % 14. % 27.8 % 12.5 % 45 % 00 %
Folic Acid Before/ 100 % 86.7 % 66.7 % 62.5 % 66.7 % 100 %
During Pregnancy 00 % 13.3 % 16.3 % 27.5 % 16.7 % 00 %
Type of birth Natural 50 % 80 % 55.6 % 50 % 83.3 % 00 %
Caesarean Section 50 % 20 % 38.9 % 50 % 16.7 % 100 %
Observation During Breastfeeding Yes 100 % 86.7 % 100 % 50 % 100 % 100 %
No 00 % 13.3 % 00 % 50 % 00 % 00 %
Table 2 arises from existing relationships between the level of education and four types of characteristic behaviours for each of the aspects of the pregnancy: folic acid consumption, number of ultrasound scans, methods of birth, mother’s observation during breastfeeding.
As we can notice from the Table 2, the folic acid is consumed more during the first period of pregnancy for all the
levels of women education. The same can be said about the number of ultrasound scans as there has been no variation in these numbers by the changing of the level of education. The majority of mothers, for all levels of education, has committed more than 5 scans with ultrasound scans. Beyond the educational level, most of the women have conducted a natural birth. There is a low percentage of those women who have performed
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Pregnancy and behaviours associated with it. A pilot study based on age and level of education of the women
a caesarean birth notwithstanding the desire for a natural birth anyway. From the relationship between level of education and observations during breastfeeding, we noted a reduction in the number of observations by the responsible staff for mothers with lower level of education. The differentiation starts from the women with high school education for which the number of observations is on the rate of 87.5 %. The discrimination was highlighted for women with a middle school degree. This may come as a result of the low level of information of this category of mothers with the resulting of a lower demand for observation during breastfeeding. On the other hand, women with a higher level of education may have a broader information about the importance of this process claiming a higher observation from the staff during the breastfeeding. Table 3 shows the relationship between age of participants and four characteristic behaviours in the stages of birth.
We noticed that there is no significant relation between women’s age and the number of ultrasound scans they have committed. This number is high, more than 4 for all ages. Also, there are no differences in the consumption of folic acid starting by the age. Its consumption has been realized for all the woman during the beginning of the pregnancy. What we could pointed out was that the age groups of 21 to 25 years old and 36 to 40 years old have a predominance for natural birth, more than for the age groups of 26 to 30 years old and 31 to 36 years old who have a ration of half and half between natural and caesarean birth. So we have two extremities: the youngest and the oldest mothers. For the youngest mothers we might think that the reason is the encouragement of the doctors to perform a natural birth and for mothers of the age 36 to 40 years old, we can say that the age may be related to the possibility they have had other childbirths, a fact which facilitates the possibility to perform again with a natural birth. In conclusion, the analysis of the tables show that there is a natural correlation between birth and the age groups of mothers from 21 to 25 years and 36 to 40 years old.
Discussion
For the majority of women in this sample the consultations and the monitoring during pregnancy is mainly done by the private gynaecologist. There is a dominant preference for the private gynaecologist (76 %). This reflects about the shake on the credibility of Albanian mothers to the state structures (only 18 % did the consulting in the state structures). This is due to the low monitoring of the public structures. There is a predominance of a very high number of women that have
performed ultrasound scans during pregnancy. 78 % have done more than four ultrasound scans and 52 % have passed the number of five ultrasound scans. In the meantime, 22 % of the mothers respected the quote of no more than three ultrasound scans that is what today is known, referring to the literature, as the most appropriate number of possible ultrasound scans. Many women do not have enough information about the correct number of ultrasound scans. The women referred that the doctors themselves have ensured them on the fact that there is no problem related with the number of ultrasound scans. There is no information of our subjects of the study, about the existence of birth preparatory courses. 98 % of the women stated that they did not attend a preparatory course and only 2 %, which is the percentage that correspond to a single woman, confesses that has followed a preparatory course. Most of the women have expressed a desire for a preparatory course and were willing to recommend it to a friend. In the absence of such courses they suffered the lack of information about the aspects associated with the birth. The consumption of the folic acid is carried out by a good part of women. 74 % of the women have taken the folic acid ones the pregnancy has begun. Only 16 % had information of the necessity to obtain the folic acid before conception. 10 % of women said they had never taken the folic acid. These included even a woman who did not remembered the exact type of vitamin she was said to take and therefore she answered negatively (it was suggested that, to avoid misinterpretation, women were said beforehand that the folic acid is the series of vitamin B). 74 % of women stated that they wanted a natural birth. The results have highlighted that 66 % ofwomen have had a natural birth. 16 % of the women had a caesarean birth because of an emergency. 16 % of the women had an elective caesarean birth. We remain at similar levels to those Europe countries with a lower quote of caesarean intervention. Regardless of the fact that the study was conducted only in 50 subjects, it is still important to evidence a tendency for the women to a natural birth. It is noted that 66 % of new mothers have had an immediate contact, skin to skin, with the newborn. 34 % of the mothers said they did not have an immediate contact to the baby at the birth. These include some of those mothers who have not been aware because of the caesarean birth or by anaesthetics. 100 % of the subjects had wanted to breastfeed the baby even before the real birth. Despite this, 18 % of them could not conducted this desire because of health reasons of the mothers or even of the child.
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