ISSN 2354-7642 (Print), ISSN 2503-1856 (Online)

Jurnal Ners dan Kebidanan Indonesia JURNAL NERS DAN KEBIDANAN INDONESIA
Indonesian Journal of Nursing and Midwifery INDONESIAN JOURNAL OF NURSING
Tersedia online pada:
http://ejournal.almaata.ac.id/index.php/JNKI
AND MIDWIFERY

Abdominal lifting, effleurage, and deep back massages effective in reducing pain during
active phase of first stage labor
Arantika Meidya Pratiwi1*, Isti Chana Zuliyati1, Fatimatasari Fatimatasari1

1
Departement of Midwifery, University Alma Ata Yogyakarta , Jalan Brawijaya 99, Tamantirto, Yogyakarta
*Corresponding author : [email protected]

ABSTRAK
Latar Belakang : Walaupun persalinan merupakan proses alamiah, seringkali nyeri yang
dialami saat persalinan membuat wanita merasa takut, cemas dan khawatir, sehingga
mempengaruhi proses persalinan itu sendiri yang berakibat timbulnya prolonged labour
dan neonatal asphyxia. Dimana persalinan lama merupakan komplikasi penyebab kematian
ibu yang terbanyak nomor 5 di Indonesia. Nyeri persalinan dapat mempengaruhi kondisi
ibu berupa kelelahan, rasa takut, khawatir dan dapat menimbulkan stress. Stress dapat
menyebabkan melemahnya kontraksi uterus dan berakhir pada persalinan yang lama.
Tujuan : Penelitian ini bertujuan untuk menganalisa efektifitas teknik abdominal lifting,
effleurage dan deep back massage dalam mengatasi nyeri saat persalinan kala 1 fase aktif
Metode : Penelitian ini menggunakan metode one-group pretest-posttest dengan total
sampel sebanyak 30 ibu bersalin. Ada 3 kelompok yang diberi perlakuan, setiap kelompok
diberikan satu Teknik massase. Perubahan nyeri diukur dengan skala nyeri numerik.
Pengujian variabel menggunakan uji Wilcoxon dan effect size untuk melihat efisiensi
masing-masing perlakuan. Perbandingan masing-masing uji intervensi yang dilakukan
menggunakan Kruskall Wallis.
Hasil : ada perbedaan bermakna skor nyeri sebelum dan sesudah pemberian massage
abdominal lifting dengan nilai p = 0.005 (<0,05). ada perbedaan bermakna skor nyeri
sebelum dan sesudah pemberian massage effleurage dengan nilai p = 0,011 (p<0,05). ada
perbedaan bermakna skor nyeri sebelum dan sesudah pemberian Deep Back Masaage
dengan nilai p = 0,004 (p<0,005). Hasil penghitungan size effect untuk teknik Abdominal
Lifting menunjukkan efek sedang dengan nilai d=0.67. Sedangkan untuk teknik effleurage
dan deep back massage menunjukkan dampak yang kuat dengan nilai d >2,00. tidak ada
perbedaan bermakna skor nyeri sesudah pemberian perlakuan antara ketiga kelompok
dengan nilai p = 0,080 (p >0,05).
Kesimpulan : abdominal lifting, effleurage, dan deep back massage berkontribusi dan
efektif untuk menurunkan nyeri persalinan Kala I fase Aktif. Deep back massage adalah
Teknik yang paling efektif (diantara ketiga Teknik) untuk menurunkan nyeri persalinan
Kala I aktif. Tidak ada perbedaan yang bermakna antara ketiga Teknik massage dalam
menurunkan nyeri persalinan.

KATA KUNCI : abdominal lifting; effleurage; deep back massage; nyeri; persalinan

ABSTRACT
Background : Although childbirth is a natural process, the time of childbirth makes women
feel afraid, anxious and anxious, thus affecting the labor process which results in prolonged
labor and neonatal asphyxia. Where prolonged labor is a complication of the cause of
maternal death which is the fifth largest in Indonesia. Labor pain can affect the condition
of the mother in the form of victims, fear, worry and can cause stress. Stress can cause
the uterine contractions to weaken and lead to prolonged labor.

Abdominal lifting, effleurage, and deep back massages effective in reducing pain during active phase of first stage labor 175
 Objectives : This study was to analyze the effectiveness of abdominal lifting, effleurage and
deep back massage techniques in reducing pain during active phase of first stage labor.
Methods : This study used one-group pretest-posttest design method with a total
sample of 30 Participants mother in labor. There were 3 groups that were given
treatment, each group was given one massage technique. Change in pain was measured
by a numerical pain scale. Testing variables using the Wilcoxon test and effect size to
see the efficiency of each treatment. comparison of each intervention test performed
using Kruskall Wallis.
Results : There is a significant difference in pain scores before and after giving
abdominal lifting massage with a value of p = 0.005 (<0.05). There was a significant
difference in pain scores before and after giving effleurage massage with a value of p = 0.011
(p <0.05). There is a significant difference in pain scores before and after giving Deep
Back Masaage with a value of p = 0.004 (p <0.005). The result of calculating the effect
size for the Abdominal Lifting technique shows a average effect with a value of d=0.67.
Meanwhile, the effleurage and deep back massage techniques showed a strong impact
with a d value > 0.8.There was no significant difference in pain scores after treatment
between the three groups with a value of p = 0.080 (p> 0.05).
Conclusions : abdominal lifting, effleurage, and deep back massage are contribute
and effective to reducing the pain during active phase of first stage labor. Deep back
massage is the most effective technique (between the three techniques) to reducing the
pain during active phase of first stage labor. There was no significant difference
between the three massage techniques in reducing labor pain.
KEYWORD : abdominal lifting; effleurage; deep back massage; pain, labor

Article Info :
Article submitted on August 10, 2021
Article revised on September 27, 2021
Article received on October 01, 2021
DOI: http://dx.doi.org/10.21927/jnki.2021.9(3).175-182

INTRODUCTION death in the fifth largest number in Indonesia (6).

Childbirth is a very spectacular condition in a Labor pain can affect the mother’s condition in
woman’s life. Many anthropological studies show the form of fatigue, fear, worry and can cause
that the process of pregnancy and childbirth is very stress. Stress can cause uterine contractions to
important in the life cycle of women (1). Most (90%) weaken and result in prolonged labor (7). Bonica
of labor accompanied by pain (2). Labor pain begins in her study of 2,700 mothers giving birth in 121
to arise in the first stage due to the stretching of obstetric centers from 36 countries found that
the uterus and the occurrence of effacement and only 15% of deliveries took place without pain or
cervical dilation (3). The pain will get stronger with mild pain, 35% of deliveries with moderate pain,
increasing frequency, intensity, and duration of 30% of deliveries with severe pain and 20% of
uterine contractions. The peak of pain begins to deliveries with very severe pain (8). A previous
occur during the active phase of labor (4). study conducted at a public health center in the
Although childbirth is a natural process, city of Yogyakarta on 57 mothers during the active
often the pain experienced during childbirth phase of labor, found that 42.1% of mothers
makes women feel afraid, anxious and worried, experienced severe pain, 57.9% moderate pain,
thus affecting the labor process itself which results and none of the mothers experienced mild pain
in prolonged labor and neonatal asphyxia (5). (9). That shows that labor pain is still a problem
Long labor is a complication that causes maternal for most mothers in labor today.

176 Arantika Meidya Pratiwi, Isti Chana Zuliyanti, Fatimatasari . JNKI, Vol. 9, Issue 3, 2021, 175-182
 There are two methods that can be used to The design was chosen to know the difference
reduce labor pain, namely pharmacological (using in pain before and after giving massase. Thirty
drugs) and non-pharmacological (traditional). participants were selected in the study using
Pharmacological methods have been shown to be purposive sampling in independent practice
more effective at reducing labor pain, but they are midwives, Bantul Regency. The inclusion criteria
more expensive and have the potential for adverse of the participants were the mother is in active
side effects to both the mother and the fetus (7). The phase of first stage labor, not under analgesic
advantages of non-pharmacological methods in effect, and not in complicating labor. The sample
reducing labor pain are that the mother can control exclusion criteria were grandemultipara mothers.
her own feelings and strengths so as to increase Scale of labor pain was measured using the
satisfaction during childbirth, the methods are Numeric Rating Scale. The scale consists of
usually simple, effective, without adverse effects numbers 1 to 10. The pain scale is measured
and relatively cheaper (10). before and after massase.
Non-pharmacological (traditional) methods Data collection was carried out in October-
vary widely that can be applied to help reduce November 2020. Data collection was carried out
pain, including massage / massage. The principle in three independent midwife practices. Each
of this method is to reduce maternal tension so independent midwife practices was taken 10
that the mother feels comfortable and relaxed in mothers and given 1 massage technique. The
facing childbirth. This method can also increase intervention was carried out by a midwife on duty
stamina to deal with pain and does not cause who had been given prior guidance. To avoid bias,
respiratory depression in the baby being born (10). one technique is only performed by one midwife,
There are several types of massage that can be so it is hoped that there will be no difference in
done to reduce pain during childbirth, including the massage methods used. This study used a
the effleurage massage method, abdominal lifting, one-group pretest-posttest design, in which the
and deep back massage. Previous research has mother’s pain level was measured before the
proven that these three techniques can reduce intervention. Then given an intervention in the
labor pain. So far, most of the studies that have form of one type of massage for + 15 minutes.
been done comparing the three techniques After the intervention, the mother again measured
with the counterpressure technique and almost the level of pain.
all of them state that counter pressure is more Univariate analysis was used to determine
effective. Researchers are interested in seeing the frequency of each variable. For the bivariate
how the effectiveness comparison between the test analysis, we used Wilcoxon test with a 95%
three techniques is said to be no more effective confidence interval because the data were not
than counterpressure. This study is expected normally distributed. The level of effectiveness
to provide a real picture of the effectiveness of of each treatment is calculated by the effect
effleurage massage, abdominal lifting, and deep size formula from Cohen. To determine the
back massage in reducing labor pain so that it can comparison of each intervention test, the Kruskal-
prevent women from prolonging labor, which is a Wallis test was used. The data analysis used
contributor to maternal mortality rate in Indonesia. SPSS Statistics 20. The study was ethically
approved by the Alma Ata Ethics Committee,
MATERIALS AND METHODS Alma Ata University, Indonesia, with approval
This study uses a pre-experimental research number No. 093/A/SM/PSIB/AA/IX/2020. All of
design with one-group pretest-posttest design. the respondents in this study were given formally

Abdominal lifting, effleurage, and deep back massages effective in reducing pain during active phase of first stage labor 177
informed consent. The respondents had the right the respondents were housewives and the most
to refuse to participate without penalty if they recent education of the majority of respondents
want to do so. was Senior High School (SMA).

RESULTS AND DISCUSSION The effectiveness of Abdominal Lifting,

Characteristic of Respondents Effleurage, and Deep back Massage
Based on Table 3, the results of the Wilcoxon
Table 1. Frequency Distribution of Respondent
Characteristics
paired nonparametric difference test show the value
of p = 0.005, p = 0.011, p = 0.004 (p <0.05), which
Characteristic F %
AGE means that there are significant differences in pain
17-25 9 30 scores before and after giving the Abdominal Lifting
26-35 17 56,7
Effleurage massage, and deep back Massage. The
36-45 4 13,3
Total 30 100 result of calculating the effect size for the Abdominal
PARITY Lifting technique shows a moderate effect with a
primipara 7 23,3
value of d=0.67. Meanwhile, the effleurage and
multipara 23 76,7
Total 30 100 deep back massage techniques showed a strong
OCCUPATION impact with a d value > 0.8.
Housewife 19 63,4
Teacher 1 3,3 Table 3. Differences in pain scores before and after
Worker 4 13,3 getting Abdominal Lifting, Effleurage, and Deep Back
Employe 3 10 Massage
Enterpreneur 3 10
Abdominal Lifting N Mean SD p-value d
Total 30 100
Before Massage 10 7.4 0.92 0.005 0.67
EDUCATION
After Massage 10 5 0.89
Junior 8 26,7
Effleurage
Senior 16 53,3
Before Massage 10 8.1 0.3 0.011 2.1
College 6 20
After Massage 10 6.5 1.03
Total 30 100
Deep Back Masaage
Before Massage 10 8.5 1.1 0.004 2.4
Based on Table 1, it is known that the After Massage 10 5.8 1.14
majority of respondents are in the range of early
adulthood or age between 26-35 years and had Based on the unpaired Kruskal Wallis
given birth more than once (multiparous). Most of nonparametric difference test which was carried

Table 2. Frequency Distribution of Pain Scores Before and After Abdominal

Lifting, Effleurage, and Deep Back Massage Treatment

Abdominal Lifting Efleurage Deep Back Massage

Pain Score
Pre (%) Post (%) Pre (%) Post (%) Pre (%) Post (%)
1 0 0 0 0 0 0
2 0 0 0 0 0 0
3 0 10 0 0 0 0
4 0 10 0 0 0 0
5 10 50 0 20 0 60
6 0 30 0 30 0 10
7 30 0 0 30 20 20
8 60 0 90 20 30 10
9 0 0 10 0 30 0
10 0 0 0 0 20 0
Total 100 100 100 100 100 100

178 Arantika Meidya Pratiwi, Isti Chana Zuliyanti, Fatimatasari . JNKI, Vol. 9, Issue 3, 2021, 175-182
out according to the results of Table 4, it shows of nerve cells in the spinal cord, brain stem and
that the value of p = 0.080> 0.05, which means cerebral cortex have the ability to regulate pain
there is no significant difference in pain scores impulses through an inhibitory mechanism (Gate
after treatment between the three groups. Control Theory). According to the Gate Control
theory, pain sensations are transmitted along
Table 4. Differences in pain scores for Abdominal
Lifting, Effleurage, and Deep Back Massage
sensory nerves leading to the brain and only a
Techniques certain number of sensations or messages can
Mean Pre Mean be transmitted through these nerve pathways at
N p-value
Test Post Test the same time (12).
Abdominal Lifting 10 7.4 5 0.080
Effleurage 10 8.1 6.2 The results of statistical tests showed that
Deep Back 10 8.5 5.8 there are significant differences in pain scores
Masaage
before and after giving the Abdominal Lifting of
the Latent Stage I labor, with p value = 0.005
DISCUSSION
(<0.05). Abdominal lifting is effective in reducing
Labor pain is a physiological condition that
labor pain during the 1st active phase with d
is felt by almost all mothers who give birth. Labor
value = 0,67. The results of this study are in line
pain began to appear since the first stage of the
with the results of Malawat’s research which
latent phase. As the intensity and frequency of
examined the effect of the Abdominal Lifting
uterine contractions increase, the pain you feel
method on the Intensity of Pain in the Phase
will get stronger, the peak of pain occurs in the
I Inpartum Active Phase I of Dr. The results of
active phase where there is a complete opening
this study indicate that there is an effect of the
up to 10 cm (4). One of the non-pharmacological
abdominal lifting method on reducing the intensity
methods to reduce pain is massage. Massage
of pain in the active phase I part of the mother (p
Massage is a method that provides relief to many
value 0.0001) (13). Anita’s Systematic Review
women during the first stages of labor. It is a
research related to techniques for reducing labor
manipulation performed on soft tissue that aims
pain also states that abdominal lifting can be a
to address physical, functional or sometimes
way to reduce labor pain (14). The abdominal
psychological problems (11).
lifting technique is done by giving the opposite
During the first stage of labour, painful
stroke towards the top of the stomach without
sensations are produced by dilatation of the
pressing inward. This can stimulate large nerve
cervix and lower uterine segment and uterine
fibers to increase the mechanism of activity of the
distension. The intensity of pain in the first stage
substantia gelatinosa which results in the closing
of labor due to involuntary uterine contractions is
of the mechanism door so that T cell activity is
felt from the waist and radiates to the abdominal
inhibited and causes the transmission of stimuli
wall with varying quality of pain (12). The pain
to be inhibited and pain will not be transmitted to
impulses of the first stage of labor are transmitted
the cerebral cortex (15).
through the lower thoracic spinal nerves (T10-12)
The results of statistical tests showed
and the upper lumbar spinal nerves (L1). The
that there are significant differences in pain
afferent fibers of these nerves originate from the
scores before and after giving the effleurage of
uterine body and cervix. Sensory impulses from
the Latent Stage 1st labor, with p value = 0,011
the uterus are transmitted through synapses in
(<0.05). Table 3 shows that effleurage is effective
the posterior horn of the spinal cord, thoracic
in reducing labor pain during the 1st active phase
segments 10, 11, 12 and lumbar 1. Certain groups
with d value = 2,1. The results of this study are

Abdominal lifting, effleurage, and deep back massages effective in reducing pain during active phase of first stage labor 179
in accordance with previous research, namely T-test with p value: 0.000 and alpha: 0.05, so the
research by Paseno M, et al which states that p value <alpha 0.05 (18). Idyawati’s research also
there is a difference between the intensity of the obtained similar results where it was found that
first stage labor pain before and after effleurage there was an effect of the deep back massage
action with the statistical test results p value = method on reducing the intensity of labor pain
0,000 with t count = 9,000 (t table = 1,833) (16). during the active phase of labor. The results
The results of this study were also supported by of the independent t-test concluded that there
the results of research conducted by Santy and was a significant difference after the massage
Ramly that effleurage massage had an effect on method was carried out in the intervention
labor pain with a p value of 0.001 (p <0.05) where group, namely the value of P = 0.001 (19).
the group that received effleurage massage Deep back massage is done by pressing on the
experienced a decrease in labor pain compared sacrum using the palms of the hands and the
to the group that did not get effleurage massage mother’s position in lying on her side. Deep back
(17). Effleurage technique is the act of rubbing massage can reduce the tension of the sacroiliac
the abdomen slowly in rhythm with breathing joint from the occiput posterior position of the
during contractions, used so that the mother fetus by applying pressure to the sacrum. The
does not focus her attention on contractions. This technique is performed in a reclining position
pain reduction occurs because the effleurage to provide a relaxing condition for the mother,
massage can stimulate tactile fibers in the skin so thereby increasing circulation in the genital area
that pain signals can be inhibited. When the touch and improving cervical elasticity (20). From the
is made with circular motions of both hands such calculation of effect size, it shows that deep back
as butterfly movements in the abdomen with soft massage is most effective to reduce pain labor
and light strokes slowly, it will increase abdominal than effleurage and abdominal lifting.
relaxation and reduce muscle tension so as to Based on the unpaired nonparametric
provide comfort to the mother and reduce pain difference test performed by Kruskal Wallis
intensity (16). From the calculation of effect size, according to the results of Table 4, it shows that
it shows that the effleurage technique (d value = the value of p = 0.080> 0.05, which means there
2.1) is more effective in reducing pain than the is no significant difference in pain scores after
abdominal lifting technique (d value = 0.67), but treatment between the three groups, namely
is not more effective than the deep back massage the abdominal lifting, effleurage, and deep back
technique (d value = 2,4). groups. massage.
There are significant differences in pain Based on the results of the study, the
scores before and after giving the deep back three massage techniques studied were proven
massage of the Latent Stage 1st labor, with p effective in reducing labor pain. Basically,
value = 0,004 (<0.05). Based on the results of massage can improve the circulatory system
statistical tests, it was found that deep back that can deliver acids and foodstuffs to the
massage was effective in reducing labor pain cells more optimally and the remains of unused
during the first active phase with d value = 2,4. substances will be repaired. So there will be a
The results of this study are in line with the results better exchange process, increased cell activity
of research by Oktarina et al, which states that will reduce local pain (21). Giving massage helps
there are differences in the intensity of labor relaxation and reduce pain by increasing blood
pain before and after being given deep back flow to the affected areas, stimulating skin touch
massage. The results of data analysis using the receptors so as to relax muscles, change skin

180 Arantika Meidya Pratiwi, Isti Chana Zuliyanti, Fatimatasari . JNKI, Vol. 9, Issue 3, 2021, 175-182
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