An Application of Warm Compress in Reducing Pain Level at First

Stage of Active Phase

Dwi Handayani, Ika Nur Saputri, Diah Evawanna Anuhgera, Riris Sitorus, Raisha Octavariny, and

Wilda Wahyuni Siregar

Institut Kesehatan Medistra Lubuk Pakam, Sumatera Utara, Indonesia

raisha.oct@gmail.com, wilda09wahyuni@gmail.com

Keywords: Warm Compress, Pain Scale, First Time.

Abstract: During the first stage of normal labor, the intensity of pain level by patients is increasing with different quality

of pain in each patient. Severe pain generally occurs in the active phase of the first stage of labor. Mothers

generally feel increased discomfort, sweating, nausea and vomiting. Warm compresses are expected to reduce

the scale of pain experienced by birth mothers. The population was 30 people and taken using accidental

sampling technique. The results showed that there was an influence of the use of warm compresses on the

change in pain scale when the active phase 1 where p value <0.04 (α ≤ 0.05) .The suggestion for mothers in

order to use the method of warm compresses to reduce the scale of pain when the active phase of labor.

Midwives are expected to be able to intervene in the form of warm compresses to reduce labor pain because

it has been proven to have an effect on reducing the intensity of laborpain.

1 INTRODUCTION

One of the factors that influence the level of labor

pain is the experience of childbirth (Jordan, 2015).

Primigravida mothers do not have birth experience

compared to multigravida mothers. Primigravida

mothers generally feel anxious and afraid to face

childbirth (Afifah, 2015). This condition stimulates

the body to release stress hormones, namely the

catecholamine and adrenaline hormones .This

catecholamine will be released in high concentrations

during labor if the mother cannot eliminate her fear

before giving birth.

Labor pain is characterized by uterine

contractions, actual contractions have occurred in the

30th week of pregnancy called Braxton hicks

contractions due to changes in the hormones estrogen

and progesterone but are irregular, painless and

contraction strength of 5 mmHg, and the strength of

Braxton contractions. These hicks will be his strength

in labor and are regular in nature. Sometimes the

discharge of amniotic fluid that usually breaks before

the opening is complete, but can also come out before

labor. With the expected labor rupture can take place

within 24 hours (Gadysa, 20 14).

During the delivery process there is a decrease in

the head into the pelvic cavity which presses the

pudendal nerve so that is triggers the pain sensation

felt by the mother. In addition labor pain is also

caused by contractions that take place regularly with

intensity that is getting stronger and more frequent.

This condition affects the physical and psychological

nature of the mother (Manurung, 2015).

During the first stage of normal labor, the

intensity of pain felt by the patient increasingly

increases with the quality of pain that is different in

each patient. Severe pain generally occurs in the

active phase of the first stage of labor. Mothers

generally feel increased discomfort, sweating, nausea

and vomiting. The mother will also feel shaking in the

thighs and legs, pressure on the bladder and rectum,

back pain and pale around the mouth (Yanti, 2017).

As a result the uterus becomes increasingly tense

so that blood flow and oxygen into the uterine muscle

decreases because the arteries shrink and narrow

which can cause pain that is inevitable (Bobak, 2016).

One of the most tiring and severe, and most

pregnant women feel pain or pain during labor is the

active phase 1. The use of warm compresses for areas

of tension and pain are considered able to relieve

pain. Warm reduces muscle spasms caused by

ischemia which stimulates neurons that block the

Handayani, D., Saputri, I., Anuhgera, D., Sitorus, R., Octavariny, R. and Siregar, W.

An Application of Warm Compress in Reducing Pain Level at First Stage of Active Phase.

DOI: 10.5220/0009471502250231

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 225-231

ISBN: 978-989-758-460-2

225

transmission of further painful stimuli causing

vasodilation and increased blood flow to the

compressed area (Walsh, 2015).

Pain is an unpleasant sensory and emotional

experience due to actual or potential tissue damage.

Pain is the main reason for someone to seek health

care assistance. Pain occurs with many disease

processes or simultaneously with several diagnostic

or treatment examinations. Pain is disturbing and

makes it difficult for more people than any disease

(Brunner and Suddarth, 2010).

Various attempts have been made to decrease the

labor pain, both pharmacological and non-

pharmacological. Pharmacological pain management

is more effective than non-farmacological. However,

it is more expensive and potentially has adverse

effects. Pharmacological therapy is the use of an

epidural which have the side effect namely reducing

the pressure of blood that can interfere with blood

circulation to the fetus. While

non-pharmacological methods are cheap, simple,

effective, and without adverse effects.

Non-pharmacological methods can increase

satisfaction during labor if the mother

can control her feelings and fears (Judha, 2017).

Non-pharmacological methods include

distraction techniques, biofeedback, self-hypnosis,

reducing pain perception, and cutaneous stimulation

(massage, warm baths, hot or cold compresses,

transcutaneous electrical nerve stimulation) (Potter,

2015). Giving hot compress/ warm on the body area

will give a signal to the hypothalamus through the

spinal cord. When heat-sensitive receptors in the

hypothalamus are stimulated, the effector system

emits a signal that initiates sweating and peripheral

vasodilation. Changes in the size of blood vessels are

regulated by the vasomotor center of the medulla

oblongata from the brain stem, under the influence of

the hypotalamic anterior portion so that vasodilation

occurs. The occurrence of vasodilation causes

discharges / loss of energy / heat through the skin to

increase (Wolf, 2013).

The heat channeled through hot compresses can

relieve pain by removing inflammatory products,

such as bradykinin, histamine, and

prostaglandins which will cause local pain. Heat also

stimulates nerve fibers that close the gate so that the

transmission of pain to the spinal cord and brain can

be inhibited (Price, 2015). The compress with Hot

Tubes can seen in the below Figure 1:

Figure 1: Compress with Hot Tubes.

Warm compresses are to provide warmth to

certain areas by using fluids or devices that cause

warmth to the parts of the body that need them. This

action besides to expedite blood circulation is also to

relieve pain, stimulate intestinal peristaltic,

discharged inflammatory sap to be smooth, and

provide calmness and pleasure to the client. Giving a

compress was done on inflammation of the joints,

muscle spasms, flatulence, and cold (Istichomah,

2014).

The warm compress method can use a variety of

methods such as towels or washcloths dipped in warm

water and placed on the body parts (towels covered

with plastic around the compress area so that heat

does not spread out), using hot bags or bladders, hot

showers, sunbathing in the sun, use a warm blanket, a

hot pillow.

The use of warm compresses for areas of

tension and pain are considered capable of relieving

pain. It greatly reduces muscle spasm caused by

ischemia which stimulates neurons that block the

transmission of further painful stimuli causing

vasodilation and increased blood flow to the

compressed area (Walsh, 2015). Mechanisms of pain

control in childbirth can seen in the below of Figure

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

226

Figure 2: Mechanisms of pain control in childbirth.

Survey conducted by researchers on November

2018 at the Galang Health Center in Deli Serdang

Regency, 153 maternal mothers were obtained during

the month of August-October 2018. The average

number of maternity patients was 51 people and the

average number of women giving birth was

primiparous mothers with a total of 35 people. Based

on observations 5 mothers who will give birth can be

seen that the Galang health center does not do a warm

compress on mothers who are going to give birth to

reduce labor pain but only to relax deep breathing.

Therefore, researchers are interested in conducting a

study entitled the use of warm compresses to change

the pain scale when the Active Phase I phase. The

flow of paint management can seen in the Figure 3.

2 RESEARCH METHOD

This research was conducted by using a pre-

experimental ( One group pre and post test design )

that is a study that used a group of subjects,

measurements were carried out before and after

treatment that analyzed the effect of using a warm

compress on changes in pain scale at the active phase.

The location of the study was conducted at the Galang

Health Center, Deli Serdang Regency. Sa MPEL on

research amounted to 3 0 people. The time of the

study will be in October 2018 - April 2019.

Labor Pain

Warm Compress

· Widen blood vessels

(vasodilation).

· Give additional nutrients

and oxygen to cells and get

rid of body wastes.

· Increase blood supply to

areas of the body.

· Speed healing.

· Can be soothing.

Pain scale

changes occur

Figure 3: Flow of paint management.

Sample criteria in this study were divided into two

namely inclusion criteria and exclusion criteria. The

inclusion criteria in this study are willing to be a

research respondent and sign the information concent

given, the mother is active during the first phase,

opening 4 to 9, she does not get drugs that have anti-

pain effects, mothers in normal or physiological labor

without laborinduction. The exclusion criteria in this

study are mothers who have or have wounds in the

back area, mothers in pathological deliveries, mothers

receive pharmacological therapy to reduce pain.

Data collection methods use primary data and

secondary data, where primary data is obtained from

the first source, both from individuals or individuals

such as interviews or the results of questionnaires that

are commonly used by researchers and researcher’s

observations. Secondary data is often referred to as

the method of using document material, because in

this case the researcher does not directly retrieve the

data himself but examines and utilizes the data or

documents produced by other parties. Secondary data

were obtained from the Galang Health Center

Data analysis for bivariate calculations in this

study used paired sampling test with a degree of

confidence of 95%. A variable is said to be related or

influential when the value of p ≤ α (= 0.05). This

proof is carried out to prove the hypothesis of the

effect of the use of warm compresses on the change

An Application of Warm Compress in Reducing Pain Level at First Stage of Active Phase

227

in pain scale in the active phase. The hypothesis in

this study is, there are differences in the scale of pain

before and after a warm compress is performed on the

active phase of maternity mothers in the first stage.

The flow of the research starts from gathering the

population, then looking for samples that fit the

research criteria. Next do a pain scale measurement

before a warm compress, using a vase and then do a

warm compress on the patient. After that, measure the

patient's pain scale again after the intervention. Then,

the data analysis in accordance with the data that has

been obtained.

Determination of the bourbanis pain scale score is

done by measuring the distance between the end of

the line on the painless line to the point indicated by

the patient, (Gillian A., Hawker, Mian, et al, 2011).

The research flow can seen in the Figure 4:

POPULATION

SAMPLE=30

WARM

COMPRES

PRE TEST POST TEST

DATA ANALYS

Figure 4: Research flow.

Examination of a procedure n pain with pain scale

bourbanis are as follows:

1. Explain to the patient the purpose of the

measurement

2. Explain to the patient that the patient is showing

pain based on the number listed according to the

level of pain felt by the patient.

3. Encourage patients to choose or move the

numbers on the bourbanis pain scale according to

the intention of the pain bags felt.

4. Giving hot compresses on the area of the patient's

body.

5. Advise the patient to choosing/ moving the

direction of the arrow on the pain scale bourbanis

according to the intensity of pain that feels right.

6. Record and then interpret the meaning of pain

stated by sufferers by comparing the pain scale

before and after treatment

There are several pain scales that can be used. In

general, this scale was divided into categorical scales

(no pain, mild illness, moderate pain, and severe

pain). Or use of a scale that is described as a

horizontal or vertical line whose edges are given a

value of "0" indicating no pain and "10" indicating

severe pain.

In this research, the most subjective characteristic

of pain is the severity or intensity of the pain. Clients

are often asked to describe pain as mild, moderate or

severe. However, the meaning of these terms is

different for nurses and clients. From time to time this

type of information is also difficult to ascertain.

Figure 5 explain about pain scale according to

bourbanis. The pain scale calculation according to

bourbanis was used. Where the pain scale is is divided

into five categories: no pain (value 0), mild pain

(value 1-3), moderate pain (value 4-6), controlled

severe pain (value 7-9) and severe pain uncontrolled

(value 10).

No Pain Mild Pain

Moderate Paint

Controlled

Severed Pain

Uncontrolled

Severed Pain

Figure 5: Pain Scale According to Bourbanis.

3 RESULT AND DISCUSSION

Before, warm compresses were performed for women

who experienced mild pain of 3 people (10%),

moderate pain in 15 people (50%), severe pain in 12

people (40%). From the observations made, the

respondent's pain response before giving a warm

compress ranged from 4-6. Most respondents

complained of severe pain with an average scale of 7

as shown in Table 1. Pain is influenced by various

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

228

factors. These factors include age, sex, culture,

meaning of pain, location and severity of pain,

attention, anxiety, fatigue, previous experience and

family and social support. Some of these factors have

been found on the observation sheet such as age, sex,

ethnicity and administration of pain-reducing drugs.

Table 1: Distribution of Frekuensi Pain Scale before Warm

Compress.

Variable

n = 3 0

Mild Pain

Moderate pain

Severe pain

controlled

Uncontrolled Severe

Pain

After warm compresses were performed for

women who experienced mild pain as many as 15

people (50%), moderate pain 13 people (50%), severe

pain controlled 2 people (6.7%). The results showed

the majority of the pain scale on respondents after the

intervention was mild pain by 15 people (50%),

moderate pain by 13 people (43.3%) and the minority

of pain intensity was controlled by 2 people (6.7%)

Of the 30 respondents the mean pain scale

measurement for respondents after the intervention

was 3.633, with a standard deviation (SD) of 1.79046

. Measurement of pain is lowest 1 and highest 7. From

the estimated interval results it can be concluded that

95% CI is believed to be the average measurement

after the intervention is 2.97 to 4.3.Frequency

distribution of pain scale after warm compress can

seen in the Table 2.

Table 2: Frequency Distribution of Pain Scale after Warm

Compress.

Variable

n = 3 0

Mild Pain

Moderate pain

Severe pain controlled

Uncontrolled Severe

Pain

43.3

6.7

The following is a difference in pain scale data

before and after a hot compress, which can be seen

that there are significant changes before and after the

intervention can seen in the Figure 6:

Figure 6: Pain Scale Before and after Intervention.

Table 3 explain than the results of the analysis of

the average scale of pain when the active phase 1

before being given a warm compress of 5.8000 with

a standard deviation of 1.54026 and an error standard

of 0.28121 where the pain scale is known at least 3

with a maximum pain scale of 8 . The Average pain

scale when one of the active phase after given a warm

compress of 3.6333 with a standard deviation of

1.79046 and 0.32689 in which an unknown error

standard pain scale at least 1 the pain scale maximum

of 7 . Based on a mathematical calculation of the

difference in decrease in the average scale of pain

when the active phase 1 before and after the

intervention is 2.1667. By using the statistical test

Paired Samples T Test obtained p value = 0.04 (α

<0.05 ). This study found that there was an influence

of the use of warm compresses on the scale change of

pain when the active phase 1 was in primipara in

Galang Health Center, Deli Serdang Regency.

This is consistent with the theory that warm

compresses are factors that influence the reduction in

labor pain. Warm compresses can make the body feel

relaxed because of the warmth of the water which

helps blood vessels to widen so that blood flow is

smooth. The results of this study are supported by the

interview method when observing maternity pain in

maternal, this observation method uses a tool in the

form of a VAS (Visual Analouge Scale) pain level

questionnaire, a rubber bottle for compressing warm

water with a temperature of 37º-41ºC and a towel

towelpengalas to be placed on the lower back of the

mother.

Before

After

An Application of Warm Compress in Reducing Pain Level at First Stage of Active Phase

229

Table 4: Differences in pain scale stage 1 before and

after warm compresses are given.

Pain

Scale

The

mean

Elementary

school

P value

Before the

intervention

After the

intervention

5,8000

3,6333

1.54026

1.79046

0.04

A similar opinion regarding the results of this

study was demonstrated by Arsitya (2015) in her

study entitled the effect of giving warm compresses

to the reduction of labor pain in BPS

KusniSrimarwartiDlingoBantul Yogyakarta in 2015.

In the study showed a significant effect of warm

compresses on labor pain the first method used

method in this research is to use the method of

observation and interviews.

Most of the mothers in the party experienced a

sense of comfort after being given a warm compress.

Warm compresses applied to the mother's lower back

in the area where the fetal head presses on the spine

of the head will reduce pain, warmth will increase

circulation to the area so as to improve tissue pressure

caused by pressure. This warm compress has proven

to be effective in reducing labor pain and helping to

reduce pain during labor. Overall based on what we

have observed, all respondents on average said that

the labor pain they felt was reduced even though the

responses they gave differed.

The above findings are in line with the results of

Yani's (2015) Effect of Giving Warm Water

Compresses on the Feeling of Comfort in Childbirth

Process Active Phase, which shows that giving warm

water compresses that are given on the lower back of

the woman for 20 minutes in the area where the fetal

head presses the spine will reduce labor pain, the

active phase Increases circulation to the area so that

tissue tissue repair is caused by pressure. Heat can be

channeled through conduction (hot water bottles,

electric heating pads, lamps, warm dry and moist

compresses) or conversion (Ultrasonography,

diathermy).

Based on the result of researchers was concluded

that using warm compresses can decrease the pain

when one of the active phase. Warm compresses are

useful for increasing local skin temperature, blood

circulation and stimulating blood vessels, reducing

muscle spasms and increasing pain threshold,

relieving pain sensation, stimulating intestinal

peristalsis, removing inflammation of the sap and

providing calm and comfort to the mother inpartu.

Based on the researchers' assumptions, warm

compresses are very useful in reducing labor pain

because warm compresses can increase local skin

temperature, improve blood circulation, reduce

muscle spasms, eliminate pain sensations, provide

calm and comfort to the mother inpartu so that pain

can reduce labor pain.

4 CONCLUSIONS

There is an influence of the use of warm compresses

to changes the pain scale of the active phase 1 style in

Galang Health Center, Deli Serdang Regency where

the p value <0.04 (α ≤ 0.05) .

5 SUGGESTIONS

Women can use this method of warm compresses to

reduce the scale of pain when the active phase of

labor. The results of this study are expected to be

input for public health center and can improve

services in managing labor pain, by providing

knowledge about the management of labor pain with

warm compresses. Midwives are expected to be able

to intervene in the form of warm compresses to

reduce labor pain because it has been proven to have

an effect on reducing the intensity of labor pain. Next

researcher with a wider area and the respondents are

more so the results are more effective, but it is also

necessary to develop research with other factors that

influence the reduction of pain in the birth mothers of

the first stage phase active.

ACKNOWLEDGEMENTS

To the Chancellor of the Medical Institute of the

Lubuk Pakam Medistra who has given permission to

carry out research, the Chairperson of the

MEDISTRA Foundation Lubuk Pakam who has

provided financial assistance in conducting research,

the Head of primary health care who has provided

data information to researchers and allowed

researchers to collect research data obtained from the

primary helath care.

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

230

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