The Effect of Effleurage Massage on the Intensity of Primigravida

Stage I Labor Pain Latent Phase

Desideria Yosepha, Ginting

Rosita Ginting, Layari Tarigan, Raynald Ignasius Ginting, Sri Maharani

Faculty of Midwifery, and Faculty of Nursing and Physiotheraphy, Institut Kesehatan Medistra Lubuk Pakam, Deli

Serdang, Sumatera Utara, Indonesia, Jl. Sudirman No. 38 Lubuk Pakam

Keywords: Stage I Latent Phase, Labor Pain, Effleurage Massage

Abstract: Effleurage Massage is a touch or gentle, slow, long and unbroken stroke using the tips of the fingers. This

massage effleurage aims to make the mother feel comfortable and relaxed, close the gate of pain and increase

endorphin hormone production. A research has been conducted which aims to find out whether there is the

effect of massage effleurage on the intensity of primigravida labor pain in the first phase of latent phase at

BPM Nurleli Purba, Bandar Khalifah District. This type of research is a quasi-experimental research design

with one group pretest posttest. The population in this study were all primigravida first-stage mothers in the

latent phase, the sample in this study was 10 respondents with accidental sampling technique in accordance

with inclusion criteria. Based on the results of the study it was found that prior to the intervention of the

mother with 70% severe pain and 30% moderate pain, while after the intervention was obtained 40% mild

pain and 60% moderate pain. Based on these results, the P-value 0.004 <0.05 was obtained. This means that

there was an effect of effleurage massage on the intensity of primigravida labor pain in the first stage of latent

phase.

1 INTRODUCTION

One of the goals of Health Development Towards

Healthy Indonesia is Making Pregnancy Safer (MPS)

which means that in every delivery it is expected to

take place safely, mothers and babies are in good

health. Pregnancy and childbirth are a coveted

condition for all Fertile Age Couples, especially for

women. Within a period of nine months a woman

conceives, maintaining the health condition of herself

and her fetus, the time has come for a woman or so-

called prospective mother to prepare for the birth of

her baby (Maryunani, 2017)

Labor is a natural process that every woman will

experience when she will become a mother. In the

labor process itself, the mother must go through

several stages, starting from the stages of opening,

fetal removal, removal of the placenta, and

supervision. Between these stages, the opening stage

is the stage that causes the most pain, even to great

pain (Pratiwi, 2019).

The childbirth experience is a process during

women’s life and the most important consequence of

labour. The separation of woman from the family is a

factor to increase the feelings of isolation and stress

in the mother. During labour the increased anxiety

level in mother enhances the pain perception,

increases the labour duration and secretion of

catecholamine which reduces the blood flow in the

uterus. This decreases the effectiveness of uterine

contractions and increases the labour duration.

Labour duration is one of the effective factors on the

pregnancy consequences and maternal and neonatal

complications. Due to prolongation of the labour

there is risk of fetal or neonatal death, choking,

infection and neural and physical damages in the

infant. In addition, the mother is at risk of postpartum

haemorrhage and infection and psychological distress

due to the anxiety, lack of sleep and fatigue

(Haghighi, 2016).

Labor pain is a problem that has not received

special attention, whereas one of the goals of

intrapartum care itself is to reduce pain in labor, while

providing peace and comfort to the mother. Efforts

made in reducing labor pain itself still prioritize the

pharmacological way, while the non-

pharmacological way is still rarely known and applied

Yosepha, D., Ginting, G., Tarigan, L., Ginting, R. and Maharani, S.

The Effect of Efﬂeurage Massage on the Intensity of Primigravida Stage I Labor Pain Latent Phase.

DOI: 10.5220/0009467601350141

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 135-141

ISBN: 978-989-758-460-2

135

by the community (Arikhman, 2010).

It is undeniable that in labor process will always be

accompanied by pain. Because physiologically all

women will experience pai n during labor during the

labor process. but each individual will feel the

intensity or level of pain that is different

(Puspita,2013).

Fear and anxiety of a prospective mother is very

haunting women. psychologically a mother will be

disturbed when going to face the labor process. it can

also trigger autonomic nerves to become more tense,

and the pain that occurs will be stronger (Pertiwi,

2019)

It is not uncommon to find that every mother is

very worried about the birth process that will be

passed, this alone can triggerperceptions maternal

pain. In addition there are still mothers who are afraid

and cannot stand the process or stages of labor due to

severe pain in the first stage of labor, this sometimes

makes mothers think short and choose the action of

Sectio Cesaria as one of the best solutions. Though

there are many actions or ways that can be done in

reducing labor pain in the first stage, both

farnakologoloically and non-pharmacologically

(Magfuroh,2012).

Severe labor pain and anxiety in the active phase

on labor causes increased levels of catecholamine and

cortisol hormone leading to reduced uterine

contraction strength, uncoordinated contractions, and

eventually prolonged labor duration. The previous

research on 28 American women showed that

massage therapy caused reduction of anxiety,

depression, pain, and postpartum depression.

Massage therapy along with body relaxation leads to

anxiety and stress reduction. Based on the results

from previous studies, it is understood that ice

massage causes significant reduction in labor

duration. With the onset of labor pains, stress

hormones increase, which leads to increased

respiration rhythm rate, heart rate, energy reduction,

and fatigue. Stress increases cortisol hormone

secretion in all vertebrates in response to various

stresses. In addition, cortisol, as the most important

stress -induced hormone, is a significant modulator of

anxiety disordersThe studies have shown that ice

massage significantly reduces duration of the first

phase of labor and probably leads to labor pain

reduction. The underlying reason is that

catecholamine and cortisol hormones, secreting in

response to labor pain and anxiety, cause disruption

in progress of cervical dilation, lower the contraction

of smooth muscles of the uterine wall, and

subsequently prolong labor durationSince

prolongation of labor duration can entail risks to both

mother and fetus, so the objective of nursing and

midwifery personnel in the delivery room is using

suitable methods to shorten labor duration as far as

possible. Therefore, this research is conducted with

the purpose of investigating the effect of massage

therapy on reduction of labor duration and cortisol

hormone level (Hosseini, 2013).

At the time of uterine contractions, occur also

stretching the lower uterine segment and cervix.

Stretching the muscles pelvic or stretching tissue

pelvic floor around the birth canal, too is a source of

pain the other. This pain sensation will generally be

felt very heavy especially by the mother who just

went through childbirth first (Sari, 2015).

A mother's lack of knowledge about pregnancy

and childbirth will also affect the pain and anxiety

experienced during labor. then there are so many

factors that influence it starting from the experience,

knowledge, and also the mother's trust in the birth

attendant. this will all affect the psychological mother

(Juniartati, 2018).

At the first stage where a moher feels prolonged

pain, starting from the opening 0-10 cm. Murray said

that labor pain occurred for 2,700 mothers giving

birth, 15% said they experienced mild pain, 35% said

moderate pain, 30% had severe pain and 20% gave

birth with severe pain (Kristina & Fransiska,2016).

Although pain that occurs during pregnancy until

delivery is a natural thing, but this must also be

overcome, because labor pain is also very decisive for

the mother and the delivery process for the baby, and

the increase in labor itself (Khomsah, 2017).

Giving a massage can increase levels of

dopamine, a neurohormone produced by the

hypothalamus. Fine motor activities such as painting

or playing musical instruments are influenced by

dopamine which affects intuition, inspiration,

excitement, and enthusiasm. insufficient levels

of

dopamine

are likely to cause awkwardness, difficult

to focus, and easily distrube, Keckes (2014).

Massage is an ancient method that women had

received relaxation through it for thousands of years

but in modern labour rooms no accurate evaluation

has been conducted. Massage is an old technique that

is widely used in childbirth and can decrease the

childbirth pain by reducing the adrenaline and

noradrenaline secretion and increasing the

endorphins and oxytocin release thus reducing the

childbirth duration by increasing the uterine

contractions. In earlier studies on the effect of

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

136

massage on labour duration, inconsistent results have

been reported. The complications caused by

prolonged labour in mother and fetus are enormous

and the massage for shortening of duration of labour

is simple, affordable, safe and more acceptable for

pregnant women (Haghighi, 2016).

Research results show that giving massage can

provide positive results. For example, a 15 minute

sitting massage will stimulate the sympathetic

nervous system to increase levels of epinephrine

(adrenaline). this action can increase one's awareness.

Conversely, slower, deeper, and more rhythmic

massage can reduce epinephrine levels, produce a

feeling of relaxation, and can lead to restful sleep

Kecskes (2014).

Accuracy and Trigger Point Therapy (can

suppress soft muscle tissue that relieves pain and

dysfunction) are other examples of massage

techniques that provide a number of important

benefits. These techniques produce endorphins (a

compound known to reduce pain and create a feeling

of euphoria. Endorphins come into play after 15

minutes of massage and their effects can last up to 48

hours in the form of comfort Kecskes (2014).

In choosing a method to reduce pain during labor,

the mother can also be assisted by a midwife.

Midwives can build trust in the mother, so that the

mother can make her more comfortable and relaxed

in labor. Pain control during childbirth plays an

important role during labor because it contributes to

the physical well-being of both mother and fetus.

Different techniques both regional and nonregional to

provide labor analgesia. Non regional methods may

be divided into pharmacological and

nonpharmacological methods. Pharmacological

agents include inhalational agents (nitrous oxide,

Inhalation of halogenated agents) and systemic

analgesics as morphine, diamorphin, fentanyle,

meperidine (pethidine) .A according to non-

pharmacological techniques includes transcutaneous

electrical nerve stimulation (TENS), Relaxation

and/or breathing techniques, Temperature

modulation: hot or cold packs, water immersion,

hypnosis, massage, Acupuncture, and Aromatherapy.

One of the non- pharmaceutical methods for labor

pain reduction is effleurage. Effleurage is one type of

massage which include light or deep stroke by using

a flat surface of hand or forearm over back and/ or

abdominal areas of laboring women. Outcome of

effleurage are reducing pain, relieving stress and

anxiety, relaxation, comfort and decrease the labor

duration of mothers in labor (Zaghloul, 2018).

Reduction of labor pain can be done by using massage

effleurage. This technique is quite simple and easy to

do as a relief for pain in the first stage of labor during

active mothers. This massage is quite easy to do by

health workers such as midwives by giving gentle,

long and unbroken strokes Maryunani (2017).

Other factors that may affect the perception of

labor pain include age, socioeconomic, parity of baby

size, its presentation as well as knowledge and

understanding of childbirth. Lack of knowledge and

understanding result to high anxiety and lead to pain.

However, various methods are performed to reduce

labor pain, both pharmacologically and

nonpharmacologically. The use of pharmacological

methods has better effectiveness, compared with

nonpharmacological methods, but the use of

pharmacological methods often causes side effects

and sometimes does not have the expected effect.

While nonpharmacological methods, in addition to

reducing pain in labor, have non-invasive effects,

simple, effective, and without harmful effects. One of

nonpharmacological techniques that can reduce labor

pain include acupressure and effleurage (Khomsah,

2017).

Based on the results of research conducted by

Kurniasih (2017) states that mothers with severe pain

before massage as much as 61.8% while after

interventions / actions of maternal massage with

severe pain as much as 33.3%. And based on the

results of research also conducted Rossalina (2017)

states the results obtained from 30 respondents that

the respondent's pain scale before performing

massage effleurage measures are mostly moderate

pain as many as 22 people (73.3%), severe pain as

many as 7 people (23.3 %) and only 1 person (3.3%)

had mild pain whereas after the massage effleurage

action was seen there had been a decrease in pain

level, most of which were moderate pain by 20 people

(66.7%), respondents with mild pain increased to 8

people (26.7%) and only 2 people (6.7%) who had

severepain. Based on preliminary studies conducted

at BPM Nurleli Purba, Bandar Khalifah Subdistrict,

Serdang Bedagai District in January to March, as

many as 16 women gave birth, stating that every

mother had severe pain during the first stage of labor,

and they did not know about therapy or massage that

could done to reduce the pain, for example massage

effluerage. Basically this massage can also be done

by a midwife or husband or other labor companions.

Add to this the midwife's ignorance that treats these

patients about the pain reduction effluerage massage

method.

The Effect of Efﬂeurage Massage on the Intensity of Primigravida Stage I Labor Pain Latent Phase

137

Based on the background above, the authors are

interested in conducting research on the effect of

massage effluerage on the intensity of primigravida

labor pain in the first phase of latent phase at BPM

Nurleli Purba, Bandar Khalifah District, Serdang

Bedagai Regency in 2019.

2 RESEARCH METHODS

This type of research is a quasi experiment with cross

sectional design in which the design of this study

researchers used a control group that is the group not

treated and the experimental group is the group that

was treated

2.1 Population and Sample

The population in this study were all women giving

birth in May to June at BPN Nurleli Purba,Bandar

Khalifah District, Serdang Bedagai District.

Sampling technique with accidental sampling, which

was accidental or collision sampling according to

inclusion criteria, with a sample of 20 people.

2.2 Data Collection Technique

Data collection techniques in this study was used

observation sheets that were given intervention and

not given intervention.

2.3 Data Analyisis

This study was used Univariate Analysis aims to

explain or describe each research variable, as well as

using Bivariate Analysis with the Normality Test

using the Shapiro Wilk Test and then the data was not

normally distributed, then the Bivariate Test was

carried out with the Wilcoxon Test.

Figure 1: effleurage message technic

Figure 2. implementation of effleurage massage

In the Figure 1 we can see how to do effleurage

massage. There are two tipes of effleurage massage,

the firt tipe with one hand and making round shape,

and the second tipe with two hand and making

butterfly shape.

And in the Figure 2 we can see that this research use

tipes of effleurage massage which is two hand and

making butterfly shape.

3 RESEARCH RESULTS

3.1 Univariate Analysis

The results of the analysis of the mean intensity of

labor pain in the first stage of the Latent phase with

control group is 5.10 with a standard deviation (SD)

of 0.73. With information experiencing moderate

pain (3-5) as many as 7 people (70%) with a scale

distribution of 4 as many as 2 people, scale 5 as many

as 5 people, while severe pain (6-7) as many as 3

people (30%) with a scale distribution 6 as many as 3

people.

This research was strengthened by the results of

research conducted by Kurniasih (2017), that the

results stated that before intervention or massage

effleurage there were 61.8% stated severe pain, while

after the massage effleurage results that experienced

severe pain dropped to 33.3%. This research was

proven by the results of the bivariate test with a P-

value of 0.017 <0.05.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

138

According to the author's assumption, pain that

occurs in labor due to contractions arising from the

jani in the womb looking for a way out through the

cervix, causing contractions and causes strong pain.

This indicates that labor has begun with other signs of

labor such as cervical lenders mixed with blood.

Besides labor pain was also influenced by several

factors, namely, age, anxiety, mother's knowledge.

Table 1. Mean Intensity of First Stage of Labor Pain Latent

Phase With Control Group at BPM Nurleli Purba, Bandar

Khalifah District, Serdang Bedagai Regency

We can see in Table 1 that the results of the analysis

of the mean intensity of labor pain in the first stage of

the Latent phase with control group is 5.10 with a

standard deviation (SD) of 0.73. With information

experiencing moderate pain (3-5) as many as 7 people

(70%) with a scale distribution of 4 as many as 2

people, scale 5 as many as 5 people, while severe pain

(6-7) as many as 3 people (30%) with a scale

distribution 6 as many as 3 people.

This research was strengthened by the results of

research conducted by Kurniasih (2017), that the

results stated that before intervention or massage

effleurage there were 61.8% stated severe pain, while

after the massage effleurage results that experienced

severe pain dropped to 33.3%. This research was

proven by the results of the bivariate test with a P-

value of 0.017 <0.05. According to the author's

assumption, pain that occurs in labor due to

contractions arising from the jani in the womb

looking for a way out through the cervix, causing

contractions and causes strong pain. This indicates

that labor has begun with other signs of labor such as

cervical lenders mixed with blood. Besides labor pain

was also influenced by several factors, namely, age,

anxiety, mother's knowledge.

Table 2. Mean Intensity of Labor Pain in First Stage Latent

Phase With The Experimental Group at BPM Nurleli Purba,

Bandar Khalifah District, Serdang Bedagai Regency

Intensity N % Mean SD

Moderate Pain 4 40

3,10 1,19

Moderate Pain 6 60

Total 10 100

We can see in Table 2 that the results of the

analysis of the mean intensity of labor pain in the first

stage of the Latent phase with experimental group is

3.10 with a standard deviation (SD) of 1.19. With the

distribution of mild pain (1-2) as many as 4 people

(40%) with a scale distribution of 2 as many as 4

people, while moderate pain (3-5) as many as 6

people (60%) with scale 3 distribution of 3 people,

scale 4 of 1 person and scale 5 of 2 people.

This research is also supported by the results of

research conducted by Rossalina (2017). Data

analysis using paired t-test. The pretest pain scale was

moderate pain of 22 people (73.3%) with an average

of 5.50 while the posttest was moderate pain by 20

people (66.7%) with an average of 4.60. And the

results obtained P-value of 0.001(p<0.05).

According to the researchers' assumptions, by doing

massage effleurage when the mother experiences

contractions, the center of the mother's concentration

of pain will be disrupted and make the mother no

longer focus on pain, so the mother will feel

comfortable and relaxed, this will increase the

mother's endorphin hormone and close the pain gate

mother.

3.2 Bivariate Analysis

3.2.1 Normality Test

Before doing a bivariate test, the data obtained

from the study must be tested for normality. The

results of the normality test will determine what

bivariate analysis should be used. If the results were

significant from the normality test> 0.05 then the data

was normally distributed and continued with the

paired sample t test. However, if the distribution of

data was not normally distributed or the results were

significant <0.05, a Wilcoxon test must be performed.

Table 3. Normality Test Results

Variable N Shapiro-Wilk

Df Sig

Control group 10 10 0,036

Experiment

group

10 10 0,028

The Table 3 explains the results of the normality

test using Shapiro-Wilk because the number of

respondents in this study was less than 50 people

Dahlan (2012). The normality test results obtained in

the control group is 0.036 and in the experiment

Intensity N % Mean SD

Moderate Pain 7 70

5,10 0,73

Severe Pain 3 30

Total 10 100

The Effect of Efﬂeurage Massage on the Intensity of Primigravida Stage I Labor Pain Latent Phase

139

group is 0.028. This shows that the data was not

normally distributed, because the value obtained was

smaller than the p-value (0.05). Then this data was

tested with the Wilcoxon test.

3.2.2 Bivariate Test

Table 4. Effects of Massage Effleurage on the

Intensity of First Stage First Labor Pain in BPM

Nurleli Purba

Variable N Mean p-value

Control group 10 5,10

0,004

Experiment

group

10 3,10

The Table 4 shows the average value of labor pain

intensity with the Wilcoxon test analysis with a value

of α = 0.05 which was obtained the significance value

of 0.004 (p-value <0.05). Statistically there was a

significant effect of massage effleurage performed on

the intensity of labor pain in the first stage of the

latent phase before and after intervention or

treatment. According to the authors' assumption

massage effleurage has an influence on the decrease

in the intensity of labor in the first stage of the latent

phase, because this massage will provide comfort to

the mother, so that maternal anxiety will be reduced

due to increased labor pain due to increased

production of endhorpin hormone so that labor pain

was reduced.

4 CONCLUSIONS AND

SUGGESTIONS

4.1 Conclusions

1. Pain intensity the people of control group for 10

respondents, namely moderate pain (3-5) as many as

7 people (70%) and severe pain (6-7) as many as 3

people (30%), with an average value of 5,10

2. Pain intensity massage effleurage or experiment

group to 10 respondents, namely mild pain (1-2) by 4

people (40%) and moderate pain (3-5) by 6 people

(60%), with an average value of 3,10.

3. From the results of the research with the Wilcoxon

test with α = 0.05, the significance value was 0.004

(p-value <0.05), meaning there was an effect of

massage effleurage on the intensity of labor pain in

the first stage of latent phase.

4.2 Suggestion

1. For Health Services

The results o f this study can be used as an

intervention in midwifery care in pain management in

labor.

2. For further researchers

The results of this study can be used as additional

information or references in developing further

research, by using multigravida respondents with pain

intensity that was different from this study using

primigravidian respondents.

3. For Public

The results of this study can be used as a source of

information for the community that in reducing or

overcoming labor pain can be done with simple

techniques such as massage effleurage, and can be

done by husband or family.

4. For Husband

The results of this study can be used as a method that

can be done by the husband in reducing the pain of

childbirth labor.

5. For Institution

The results of this study can be a theoretical source of

information about the effect of massage effleurage on

labor pain intensity.

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