KNOWLEDGE OF THE EFFECT OF REGULAR PELVIC FLOOR EXERCISES ON MATERNAL HEALTH AMONG WOMEN OF REPRODUCTIVE AGE

1.1 Introduction

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death. Exercise comprises the daily living activities, interests or hobbies and living demands they must fulfill each day (Taylor et al., 2008). Since maternal health care relies on the entire health system of a country, its outcomes including health-seeking behavior can be traced from the way health systems operate (Parkhurst et al., 2005).

The health system includes the human resources, organization of maternal health services which dwells on the availability of both private and public sectors, and reforms in the health sector (Graham, 2002). Recent studies point to the declining maternal mortality mostly high for countries in the developing and transition world (Okiwelu et al., 2007). However, since it is difficult to measure how much progress is occurring, estimates are usually assumed (Graham et al., 2001).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of technical terms.

1.2 Background of Study

Exercise recommendations have evolved over the last several decades (Borg-Stein et al., 2005). Until the 20th century physical activity during pregnancy had been discouraged primarily because of theoretical concerns of exercise-induced injury and adverse foetal and maternal outcomes (Dempsey, Butler & Williams, 2005). Consequently many saw pregnancy as a state of confinement in which women were not encouraged to engage in recreational physical activity (Dempsey et al., 2005). Women were instructed to limit their involvement in exercise and non-exercisers were told not to initiate exercise when pregnant (Borg-Stein et al., 2005).

World Health Organization (2017) recommends at least 150 min of moderate or 75 min of vigorous aerobic physical activity for individuals aged 65 years and above (or an equivalent combination). Few researches have targeted effects of exercise on old people. Daily movement or activities reduces with advance in age however this does not mean that it is not necessary for old people to do exercise. Pregnant Women care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity (Ayres, 2008).

It is advisable for all pregnant women wishing to pursue exercise in pregnancy to be screened for contra- indications and risk factors, for subsequent recommen- dations to be made on an individual basis. It is useful to classify pregnant women into sedentary, recreational and competitive athlete, as this will help guide the intensity of exercise. All women should be aware of warning symptoms that may develop during physical activity, and advised to stop the exercise and seek medical advice should they occur. Exercise forms only one component of a healthy lifestyle. A nutritious diet, adequate hydration, and abstinence from smoking, alcohol and illicit drugs are crucial in maintaining optimal health during pregnancy (Horak and Osman, 2012).

Lack of exercise on maternal health might result in loss of muscular and cardiovascular fitness, excessive maternal weight gain with a raised risk of GDM, varicose veins, dyspnea, lower back pain and poor psychological adjustment (Royal College of Obstetricians and gynecologists - RCOG, 2006). An initial approach to becoming more physically active could be to encourage women to incorporate unstructured physical activity into daily living, both before and during pregnancy. Giving women an appropriate exercise prescription can encourage them to participate in physical activity (Colberg et al., 2013).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Knowledge of the Effect of Regular Pelvic Floor Exercises on Maternal Health among Women of Reproductive Age.

1.3 Statement of Problems

Investigation revealed that pregnancy and delivery are normal physiological processes. During pregnancy and after pregnancy so many physiological and psychological changes occur and sometime mothers are worried and stress regarding these. But exercise does wonder during pregnancy. It helps prepare the mother for child birth by strengthening the muscles and building endurance, and makes getting her body back in shape once the baby's born much easier. Body releases a hormone called relaxing during pregnancy which loosens the joints in preparation of delivery, so mother need to take care with the choice of exercises and pay attention to technique.

It's important to find exercises that won't injure her or harm the baby. Ideal exercise gets her heart pumping, keeps her supply, manages weight gain and prepares her muscles for the hand work of labour and delivery without causing undue physical stress for her or her baby.

Postnatal period demands a lot a physical and psychological adaptation. While some exercise is very good for a new mother, doing too much too soon can be harmful also. Current medical practice recommends that pregnant women should most assuredly engage in some sort of exercise regimen while pregnant. Exercising during pregnancy is good for the mother. Pregnant women who exercise tend to have reduced risk of obesity, gestational diabetes, and hypertension.

One study was conducted on effect of selected antenatal exercise on the nature and outcome of labour in 39 primipara mothers during antenatal period in a selected hospital. An experimental method was used. The study concluded that antenatal exercise taught were effective in terms of outcome of labour in both mother and baby.

Another study was conducted, to investigate the effect of an exercise programme, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy related low back pain. Randomized method is used. The study concluded that a specific exercise program decreased back pain intensity and increased functional ability during pregnancy.

The researcher from taking knowledge from experts realized that the knowledge regarding antenatal and postnatal exercise is very important for antenatal mothers and their health. So, the need for this study to evaluate Knowledge of the Effect of Regular Pelvic Floor Exercises on Maternal Health Among Women of Reproductive Age.

1.4 Aim and Objectives of Study

The aim of the study is to evaluate the Knowledge of the Effect of Regular Pelvic Floor Exercises on Maternal Health among Women of Reproductive Age. In achieving this aim, the following specific objectives were laid out as follows:

1. To assess the practice level of exercises by women of reproductive age in Benue State in a bid to increase maternal health;
2. To analyze women's views and perception of the effects of pelvic floor exercises on their maternal health in Benue State;
3. To assess the positive and negative effects of pelvic floor exercises on women's maternal health in Benue State; and
4. To investigate the level of women's knowledge on the effect of pelvic floor exercises on maternal health of women of reproductive age in Benue State.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are the women of reproductive age improving maternal health using exercises (pelvic floor exercises) in Benue State?
• What is the level of women's knowledge on the effect of pelvic floor exercises on maternal health among women of reproductive age in Benue State?
• What are women's views and perception of the effects of pelvic floor exercises on their maternal health in Benue State?
• What are the positive and negative effects of pelvic floor exercises on women's maternal health in Benue State?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant level of women's knowledge on the effect of pelvic floor exercises on maternal health among women of reproductive age in Benue State
• H1: There is significant level of women's knowledge on the effect of pelvic floor exercises on maternal health among women of reproductive age in Benue State

Hypothesis Two

• H0: There are no significant effects of pelvic floor exercises on women's maternal health in Benue State
• H1: There are significant effects of pelvic floor exercises on women's maternal health in Benue State

1.7 Significance of Study

The outcome of this study would be significant to women of child-bearing age in Benue State and Nigeria in general in the following ways:

1. The findings of this study would provide information on the care of maternal health of women of reproductive age through regular exercises (pelvic floor exercises in this case).
2. The findings of this study would help policy makers and the health sector to understand problems militating against maternal health among women of child-bearing age in Benue State and provide a way forward via regular exercises.
3. It would provide a basis for further research to other interested researchers. Also, the findings of this study would contribute to existing knowledge on the effect of regular pelvic floor exercises on maternal health of women of reproductive age; knowledge and awareness level.

Finally, this study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

1.8 Scope of Study

The scope of the research is focused on the Knowledge of the Effect of Regular Pelvic Floor Exercises on Maternal Health among Women of Reproductive Age using Benue State as a case study.

This study will cover six Local Government Areas selected from the three Senatorial Zones in Benue State. They include Katsina-Ala, Vandeikya (Zone A); Gboko, Makurdi (Zone B), and Ogbadibo, Otukpo (Zone C). Specifically, only women of reproductive age attending antenatal and postnatal clinic at the General Hospitals in the selected Local Government Areas were involved in the study.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Basic Assumptions

This study was based on the following assumptions:

1. Adequate and regular exercises are necessary to protect and promote the maternal health of women of reproductive health.
2. Place of residence can constitute a strong barrier to practice of exercises and related activities among women of reproductive age.
3. Level of education and knowledge can constitute a strong predictor of exercise practice for maternal health among women of reproductive age.
4. The attitude and perceptions of women of reproductive age in Benue State can affect their practice and proper information on exercise for maternal health.

1.11 Definition of Terms

Maternal Health:

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death.

Pelvic Floor Exercises:

Pelvic floor exercises strengthen the muscles around the bladder, sexual organs, and back passage. Strengthening the pelvic floor muscles can help stop incontinence, treat prolapse, and make sexual activities better. Both men and women can benefit from doing pelvic floor exercises.