Effects of Progressive Muscle Relaxation Technique on Decrease Pain

Intensity in Woman During the Latent Phase Delivery

Siti Saidah Nasution

, Erniyati

and Reni Asmara Ariga

Departement of Maternity and Pediatric Nursing, Faculty of Nursing, Universitas Sumatera Utara, Prof. Maas Street

Kampus USU, Medan, Indonesia

Keywords: Progresive muscle relaxation, pain intesity, laten phase delivery.

Abstract: The woman's fear during delivery is a shadow of pain. One of the nonpharmacological methods that use to

decrease intensity pain during delivery is a progressive muscle relaxation technique. Intervention is done

with deep breathing combine exercises when the muscles are relaxed. The study is a quasi-experiment one

group pretest-posttest design. The study aimed to analyze the effect of progressive muscle relaxation

technique on decrease pain intensity for vaginal delivery woman during the latent phase. The sample of

study consist of 30 vaginal delivery women in Universitas Sumatera Utara Hospital and maternity clinic in

Medan with accidental sampling technique. The data were collected by using questionnaires, such as

demographic questionnaire and Numeric Rating Scale (NRS). The study was analyzed by using the paired

sample t-test. The Result of study showed that the intervention could decrease pain intensity for vaginal

delivery woman at the latent phase. That was significance p <0.05. The study suggested that the progressive

muscle relaxation could be applied as an intervention for pain management in labour without use the drugs

during delivery.

1 INTRODUCTION

The labor is a reproductive stage that will be

undergo by the woman. Vaginal delivery or normal

delivery is a process of fetal outflow occurring in a

term pregnancy (37-42 month), delivery with vertex

presentation and there is not complication that

happen to mother and the baby fetus (Rosdahl and

Kowalski, 2014). One of the factors that cause

anxiety or fear in labor is a shadow of pain

(Rondung, 2016). The pain in labor is due to the

process of opening and thinning the cervix and the

fetus down into the birth canal (Nasution, 2018).

Pain occurs in the first stage of labor is not constant

and intermitten, the pain is discomfort at 0–3

opening. the pain is stabbinf at 4–7 opening. (Bobak,

2004) said that pain in labor is caused by uterine

contractions that can increase sympathetic nervous

system activity, changes the blood pressure, changes

heart rate, changes respiration and changes skin

color. If it is not overcome it will increase tension,

fear and stress (Bobak, 2004). If the pain felt by the

woman at the time is not overcome so the labor will

be prolonged. Several studies have shown that in the

experience labor of primitive societies that obtained

for longer labor and pain, the experience labor of

advance societies that obtained 7-14% no pain in

labor and a majority 90% the labor was

accompanied by pain (Prihardjo, 2002).

The pain in labor can be controlled through

pharmacological and nonpharmacological methods.

Common nonpharmocological methods used to

reduce labor pain suct as relaxation and breathing

technique (Bobak, 2004). Jacobson (1938 in Conrad

& Roth, 2007) said that the progressive relaxation in

the muscle relaxation techniques does not require

imagination persistence or suggestion [5] [6]. This

technique is based on the belief that the body

responds to anxiety that stimulates thoughts and the

events of muscle tension is identified the tense of

muscles and then reduce the tension so obtain to feel

relaxation again. The relaxation conditions is one of

the non-pharmacological methods that can be taught

to individuals to reduce pain. Based on this

progressive muscle relaxation action is expected to

reduce physical stress and emotional stress in the

Nasution, S., Erniyati, . and Ariga, R.

Effects of Progressive Muscle Relaxation Technique on Decrease Pain Intensity in Woman During the Latent Phase Delivery.

DOI: 10.5220/0010072704490453

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

449-453

ISBN: 978-989-758-449-7

449

women in labor so that it can decrease the intensity

of labor pain. The pain in labor can be decreased by

deep breathing relaxation, followed by slow breath

(maximum inspiratory arrest) and exhale slowly can

reduce physical stress and emotional stress decrease

the intensity of pain and decrease anxiety (Smeltzer

and Bare, 2002) The result conducted by (Yuliati,

2011) that obtained respiratory relaxation method to

22 woman who in latent phase labor at Medan. The

result showed that the was decrease pain intensity.

The average intensity of pain 6,27 before breathing

relaxation and The average intensity of pain 4,77

after breathing relaxation after the relaxation

breathing (Yulianti, 2011). The technique can reduce

the sensation of pain and control the intensity of the

woman's reaction to pain.

2 METHOD

The type of quantitative research is using quasi

experimental method with the pretest-posttest

design. This research was conducted in two stages,

the subjects were observed by measuring the

intensity of pain before intervention and obtained

leaflets with explanation and done of progressive

muscle relaxation technique then observed again by

measuring the intensity of pain after intervention.

Data was analyzed with frequency distribution and

presentation, paired test of t-test with significance

level 5% (α = 0,05).

3 RESULT

Table 1: Influence of Intervention on Pain Intensity Before

and After Intervention

Variabel Mean Std. Deviasi

value

Pretest

Posttest

6,03

5,23

0,615

1,547

0.007

Table 1 shows that the decrease of pain intesity

is obtained from before and after the effect of

progressive muscle relaxation technique using paired

sample t-test (parametric) test. The result of

wilcoxon test is p = 0.007. The meaning that there is

a significant difference.

The characteristics of respondents of woman

who undergo vaginal delivery are as follows:

Table 2: Frequency Distribution of Woman during Latent

Phase Delivery Characteristic (n = 30)

Variable n %

Age

Risk (<20 and 35)

Years

No Risk (20-35)

Years

Obstetric History

Primi (1)

2-3

> 3

Education

Low (Elementary –

Junior High School)

Midle (Senior High

School)

High (university)

Work

Housewife

Government

Employee

Action of pain

Cying

Screaming

Swapping

Praying

Education Of pain

Yes

Total 30 100

Based on the table 2 shows that most pregnant

women who undergo vaginal delivery latent phase

are in the age range of 20-23 years 19 people as

much as 63%, the majority of Islamic religion 21

people as much as 70%, the majority of high school

education 19 people 63%, the majority of housework

stairs 13 people as much as 44%, parity 2-3 18

people as much as 60%, the majority of actions

when the pain cries 26 people as much as 88%, the

majority of counseling pain management is never 28

people as much as 93%.

Table 3: Intensity of pain before and after intervention

Progressive Muscle Relaxation Technique (n=30)

Pain Intersity

before after

N % N %

0 = No pain

1-3 = mild

4-6 = moderate

7-9 = severe

10 = most severe

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

450

Total 30

Based on table 3 shows that the intensity of pain

were felt by the woman before the intervention was

given as many as 24 woman (80%) were in the

range of moderate pain 6 woman (20%) severe pain.

After painful inntensity as much as 27 women (90%)

were in the range of mild pain and 3 woman (10%)

moderate pain. Based on the assessment using

numbers before the majority pain intervention there

were 6 values of 19 (63%) and after the majority

pain intervention there was a value of 4 as many as

16 (53%).

4 DISCUSSION

The results generally show that progressive muscle

relaxation techniques effectively descrease pain

intensity to woman in the latent phase labor.

Intervention is done by training the woman do the

progressive muscle relaxation so that mothers who

are undergoing labor can relax. According to Herod

(2010) that the progressive muscle relaxation

technique is a deep muscle relaxation technique that

it does not require imagination, persistence, or

suggestion (Herodoes, 2010). Progressive muscle

relaxation techniques focus on a muscle activity by

identifying the tense muscles and then decreasing

the tension by performing relaxation techniques to

get relaxed feelings. Progressive muscle relaxation

technique is a relaxation therapy obtained to clients

by tensing certain muscles and relaxation.

Progressive relaxation is one of the ways in the

relaxation techniques which combine deep breathing

exercises, muscle contraction series and relaxation

series (Kustanti, 2008).

The labor is one part of the life cycle of a woman

to be lived (Sumarah, 2010). It is a stressor for

women due to the changes that occur in her life. The

pain is a normal reaction to the changes that occur

and will make a person feel unhappy or

uncomfortable. This is due to allegations of danger

or threatening frustration, endangering the security,

balance the life of an individual or social group.

Often the pain accompanies pregnancy and peaks

during labor (Litfiah, 2008).

The pain in labor is painful uterine

contractions that can lead to increased sympathetic

nervous system activity, changes in blood pressure,

heart rate, respiration, skin colour and if it not

overcome, it will increase fear, tension and stress

(Bobak, 2003). It explains that the physiology

mechanism of the labor pain in are as follows: The

pain of the first stage is mainly caused by the

stimulus delivered through the nerves in the cervix

and uterus (Anik, 2010). This pain is a visceral pain

that comes from uterine and anaxic contractions.

The intensity of the pain relates to the forces of

contraction and pressure that was generated. Strong

uterine contractions are a source of pain when the

first stage.

The feelings of pain and fear of woman in labor

are varied and influenced by many factors, including

differences in social, cultural, religious, maternal

preparedness in the face of labor, experiences,

family mentoring, and environment. The physical

state of woman may be a factor affecting anxiety in

labor I (Pieter & Lubis, 2010). Pregnancies that

occur at <20 years and> 35 years of age will cause

problems (Anggaraini, 2013). This is in line with

studies that say that low knowledge can lead to an

easy person experiencing anxiety and fear.

Ignorance of a thing is considered a stress that can

cause anxiety. This is due to the lack of information

obtained. The consequences that can occur when the

woman cannot know the process of latent phase

stage labor, the woman will feel anxious and

increase the pain. If the woman has knowledge about

it, so the woman will be more confident in the

delivery (Helbig, Kaasen & Haugen, 2013;

Musbikin, 2006).

Perception and expression of labor pain are

influenced by individual culture. Culture influences

the attitude of the woman in labor (Pilliteri, 2003).

According to it said that culture affects the health

status of women from pregnancy to childbirth

(Nasution, 2015). It is important for the maternity

nurse to know the beliefs, values, practices of the

woman's culture in prescribing and expressing labor

pain (Nasution, 2015). Stress or fear turns

physiologically can cause uterine contractions to be

felt more pain and pain are felt. The woman feel

stress in labor then automatically release the

katekolamin hormones and Adrenaline hormones.

This catecholamine will be released in high

concentrations during labor if the expectant woman

cannot eliminate fear and anxiety before labor

(Nasution, 2018). As a result of the body's response,

the uterus becomes increasingly tense so that the

flow of blood and oxygen into the muscle of the

uterine muscle is reduced as the arteries narrow and

narrow as a result is the pain that cannot be tolerated

(Fatimah, 2017). Relaxing body condition during

Effects of Progressive Muscle Relaxation Technique on Decrease Pain Intensity in Woman During the Latent Phase Delivery

451

labor is very important, if the woman is relaxed then

all layers of muscle in the womb will work in

harmony together as it should so that labor will run

smoothly, easily and comfortably. When the woman

is used to relaxation exercises, the birth canal will be

more easily opened. Conversely, when the woman is

in a state of tension, the fetal head pressure will not

make the cervix open and the only feeling is the pain

and the mother also increases panic and stress.

Relaxation is one way to overcome anxiety or

stress by relaxing muscles and nerves. Relaxation

can improve general health by facilitating the body's

metabolic processes, decreasing aggressiveness and

bad behaviors from stress impacts, improving self-

esteem and self-esteem, mindset becomes more

mature, facilitating self-control, reducing overall

stress, and improving welfare. This relaxation

response that causes the first stage of labor woman

has decreased the anxiety level score so as to

facilitate the delivery process (Detiana, 2010). The

progressive muscle relaxation technique is a

relaxation therapy given to the client by tensing

certain muscles and then relaxed. Progressive

relaxation is the relaxation techniques that combine

deep breathing exercises, muscle contraction series

and relaxation series (Conrad & Roth, 2007),

(Herodes, 2010).

This is in line with studies that suggest that the

effect of progressive muscle relaxation on

dysmenorrhea decreases. To relieve dysmenorrhoea

pain by tightening and relaxing the muscles at one

time from head to toe in a row to obtain a feeling of

physical relaxation (Akbar, Putria & Afriyanti,

2012). Controlled relaxation and breathing can

improve their ability to cope with anxiety and

increase the sense of being able to control which

causes stress and pain. Relaxation also makes the

blood circulation of the uterus, placenta and fetus

become smoothly so that the needs of oxygen and

food of the baby is enaught. Smooth blood

circulation will also make the muscles associated

with the womb and fetus as pelvic, back, and

abdominal muscles become weak and sagging.

Medium when labor, relaxation makes the

contraction process safe, natural, and smooth (Pieter

and Lubis, 2010), (Rohani, 2011)

It has been demonstrated by studies suggesting

that there is an effect of progressive muscle

relaxation on decreasing anxiety levels in

preoperative patients (Lestari and Yuswiyanti,

2015). In preoperative patients with anxiety result in

some muscles will experience tension so as to

activate the sympathetic nerves. Relaxation has a

calming sensation effect on the limbs, lightness and

feel of warmth that spread throughout the body. The

changes that occur during or after relaxation affect

the autonomic nervous work. This emotional

response and the soothing effect generated by this

relaxation transform the sympathetic dominant

physiology into the dominant parasympathetic

system (Conrad and Roth, 2007). In these

circumstances, hypersecretion of catecholamines and

cortisol is lowered and increases the

parasympathetic hormone as well as

neurotransmitters such as DHEA

(Dehydroepinandrosteron) and dopamine or

endorphins. This regulation of the parasympathetic

system has finally created a calming effect (Helbig,

2013).

5 CONCLUSIONS

Implementation of the intervention was performed in

women in latent phase labor without complications.

The study showed that there was a significant

decrease in pain intensity between before and after

progressive muscle relaxation technique with a p

value <0.05 (p = 0.000).

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic of

Indonesia. The support is under the research grant

TALENTA of Year 2018.

REFERENCES

Akbar, I., Putria, E., Afriyanti, E., 2012. Effect of

Progressive Muscle Relaxation on Decreased

Dysmenorrhea in A 2012 Student. Ners Jurnal

Keperawatan. E-JOURNAL UNAIR.

Anggarani, Deri Rizki. (2013). Completely Peeled About

Pregnancy

. PT Agro Media Pustaka. Jakarta

Anik, M 2010 Pain in Technical Delivery and Handling.

CV. Trans Ifo Media. Jakarta

Bobak, L., 2004.

Maternity Nursing. EGC. Jakarta

Conrad, A., Roth, T., 2007. Muscle Relaxation for

Anxiety Disorder: It Works But How? The Journal of

Anxiety Disorder. ELSEVIER

Detiana, P., 2010. Safe and Comfortable Pregnancy Above

30 Years of Age. Media Pressindo. Yogyakarta

Fatmawati., Wulan I., 2017 Differences in the Anxiety of

Maternity Primigravida at the First Time Given with

Not Given Lavender Aromatherapy Journal of Issues

in Midwifery. UB

Helbig A., Kaasen A., Malt F., Haugen G., 2013. Does

Antenatal Maternal Psychological Distress Affect

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

452

Placental Circulation in the Third trimester?PloS ONE.

PLOS

Herodes, 2010. Relaxation Progressve Mucles for

Insomnia among ederly.

http://herodessolution.blogspot.com/2010/11/teknik-

relaksasi-progresif-terhadap.html, [Accessed on

February 20, 2017]

Jacobson, E., 1938. Progressive Relaxation: A

Physiological and Clinical Investigation of Muscular

States and Their Significance in Psychogy and

Medical Practice. The University of Chicago Press:

Chicago, IL.

Kustanti, E., Widodo, A., 2008. Effect of Relaxation

Technique on Changing Mental Status of

Schizophrenic Clients in Surakarta Mental Hospital.

http://etd.eprins.ums.ac.id /6424/1/J210050060.pdf.

[Accessed on February 20, 2017]

Lestari, K.,Yuswiyanti, A., 2015. Effect of Progressive

Muscle Relaxation Techniques on Decreasing Anxiety

Levels in Preoperative Patients in Wijaya Kusuma

Room Dr. Dr. R. Soeprapto Cepu. Jurnal

Keperawatan Maternitas. PPNI JAWA TENGAH

Liftiah. 2008. Abnormal Psychology. Widya Karya.

Semarang

Musbikin, I. (2006). Preparation for Facing Childbirth

from Pregnancy Planning to Educating Children.

Mitra Pustaka. Yogyakarta

Musbikin, I., 2006.

Preparation for Facing Childbirth

from Pregnancy Planning to Educating Children.

Mitra Pustaka.Yogyakarta

Nasution. S., Badaruddin, Dasatjipta, G., Lubis, Z., 2015.

The effectiveness of the intervention of “ Sehat

Umakna Sehat Anakna “ towards improving the

behaviour, knowledge and attitude of pregnant mother

towards maternal and neonatal care in Mandailing

Natal Sumatera Utara. International Journal of

Nursing and Midwifery. ACADEMIC JOURNAL

Nasution. S., Badaruddin, Dasatjipta, G., Lubis, Z., 2015.

Effectiveness of the Health Awareness Community

Team Intervention in Improving the Maternal and

Neonatal Health Status in Mandailing Natal (Madina)

Sumatera Utara Indonesia. International Journal of

Medical Science and Public Health. SCOPEMED

Nasution. S 2018 Asuhan keperawatan pada Ibu Hamil

Resiko Tinggi : HIV-AIDS dengan Melibatkan

Masayarakat (Medan: USU Press) p 57

Pieter, Z., Lubis, N., 2010. Psychology for Midwifery.

Kencana. Jakarta.

Pilliteri, A 2003 Maternal and Child Health Nursing:

Care of the Chilbearing Family. Lippincott.

Philadelphia

Prawirohardjo, S., 2002. Gynecology. Yayasan Bina

Pustaka. Jakarta. 2

Edition.

Rohani, dkk., 2011. Midwifery care during labor.

Salemba Medika. Jakarta.

Rondung, E., Thomten. J., Sundin, O., 2016.

Psychological Persepectives on fear of Childbirth.

Journal of Anxiety Disorders. ELSEVIER

Rosdahl, B., Kowalski, T., 2014. Basic Nursing Textbook.

EGC. Jakarta. 10

Edition

Setyoadi, Kushariyadi, 2010. Treatment of Nursing

Modalities in Psychogeriatric Clients. Salemba

Medika. Jakarta.

Smeltzer Bare. 2002. Medical Surgical Nursing. EGC.

Jakarta. 2

Edition

Sumarah, 2010. Childbirth & Pregnancy Care. EGC.

Jakarta.

Yuliati, T., 2011. Effectiveness of Respiratory Relaxation

Method on Active Phase I First Stage Pain in Medan.

http://repository.usu.ac.id/ [Accessed on February 20,

2017]

Effects of Progressive Muscle Relaxation Technique on Decrease Pain Intensity in Woman During the Latent Phase Delivery

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