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The Effectiveness of Birth Ball During Pregnancy in Length of Labor

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The Effectiveness of Birth Ball During
Pregnancy in Length of Labor
1st Siti Mutoharoh
Midwife Diploma Study Program
Muhammadiyah Health Sciences
Institute of Gombong
Gombong, Indonesia
Sitimutoharoh23@gmail.com
2nd Kusumastuti
Midwife Diploma Study Program
Muhammadiyah Health Sciences
Institute of Gombong
Gombong, Indonesia
ncuz.kusuma26@gmail.com
3rd Eni Indriyani
Midwife Diploma Study Program
Muhammadiyah Health Sciences
Institute of Gombong
Gombong, Indonesia
eni.indryani29@gmail.com
ABSTRACT--The number of dead in Indonesia in
2015 reached a high rate, were 305 per 100,000 live
births. Maternal deaths that occur in Indonesia are
caused by several factors, including long-standing
or obstructed labour by 5%. Birth ball is a physical
therapy ball that helps with labour and can be used
in various positions. One of the exercises in birth
ball is to sit on the ball by wiggling your pelvis and
is considered to be able to provide comfort and
speed up labour. The sitting position above the
birth ball, is assumed to be similar to squatting
open the pelvis so that it helps accelerate labour.
The research method used was a quasi-
experimental in two groups, namely the treatment
group and the control group with 30 respondents
each. Respondents in this study were
physiologically pregnant women with a gestational
age of more than 34 weeks. The results showed
there were differences in the length of labour
between the treatment group and the control
group. The difference in duration of first stage of
labour between the treatment group and the
control group is shown by the p-value of 0.002 and
RR 1.36. While the difference in the second-stage
length in the treatment group compared with the
control group is indicated by the p-value of 0.020
and RR 1.33. The conclusion of the study is that
there was a significant difference in the length of
labour in the first and second stages between the
treatment group given birth ball exercises and the
control group.
Keywords: birth ball, pregnancy, length of labor
I. INTRODUCTION
The number of dead in Indonesia in 2015 is still
high, namely 305 per 100,000 live births [1]. Maternal
deaths that occur in Indonesia are caused by several
factors, it is evident that old parturition or parturition is
jammed by 5%. Particles that last more than 18 hours
will cause the mother to become infected, dehydrated,
and increase, increasing the risk of death for the mother
[2].
The birth ball is a physical therapy ball that helps
with labor and can be used in various positions. One of
the movements of a birth ball exercise consists of sitting
on the ball by wiggling the pelvis, providing comfort
and accelerating labor [3].
The use of birth ball during pregnancy will
stimulate postural reflexes and maintain the muscles
that support the spine. The sitting position on the ball, is
assumed to be similar to squatting open the pelvis so
that it helps accelerate labor. If the ball is placed on the
bed, then do the exercises in a kneeling position or
bending with weight resting on the ball, moving to push
the pelvis then the baby will change to the correct
position. This activity will be useful in shortening
maternity time [4].
Research conducted by Mirzakhani, et al (2014) [5]
states that there is a significant relationship between the
groups treated with birth ball training during pregnancy
to the duration of labor because it can reduce pain at the
opening, accelerate cervical dilatation and facilitate
labor.
The birth ball exercise has several exercises
movements, including Pelvic Rocking Exercises. The
results of Surtiningsih, et al. (2016) [6] showed that
there were differences in the length of time the first
stage of labor in primiparous mothers who did Pelvic
Rocking Exercises and those who did not do Pelvic
Rocking Exercises with ρ-values of 0,0001 <α (0.05).
The purpose of this study was to identify pregnant
women and find out the effectiveness of birth ball
exercise on labor.
II. METHOD
This research was a quasi-experimental quantitative
research in two groups, namely the treatment group and
the control group with 30 respondents each. Data
analysis using chi-square. Respondents in this study
were physiologically pregnant women with a
gestational age more than 34 weeks. The treatment
group performed birth ball exercises 4 times in 4 weeks.
III. RESULT AND DISCUSSION
1. The characteristic of respondents
Table 1. The distribution of respondent’s characteristic
frequencies
Advances in Health Sciences Research, volume 20
1st International Conference on Community Health (ICCH 2019)
Copyright © 2020 The Authors. Published by Atlantis Press SARL.
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Control
Treatment
Characteristic
No.
%
n
n
Age
1
30.0
9
8
<20 and >35
70.0
22
21
20-35
Educational background
2
0.0
0
6
SD (elementary)
26.7
8
13
SMP (junior high)
73.3
22
11
SMA (senior high)
Job
3
100.
0
30
27
IRT (Housewive)
0.0
0
3
Self employed
4
Paritas
60.0
18
22
multiparous
40.0
12
6
Primapra
0
2
Grande
Based on the table above, the majority of
respondents aged between 20-35 years both in the
treatment group (73.3%) and in the control group
(70%). In fact, the respondent education in the majority
treatment group was junior high (43.3%) and in the
control group, the majority was senior high school
(73.3%). Respondents' occupations were mostly not
working or as housewives (IRT) in both the treatment
group (90%) and the control group (100%). Most
respondents in the control and treatment group were
multiparous, namely 73.3% in the treatment group and
60% in the control group [7] said that labor is
influenced by several predisposing factors, including
parity, age, knowledge and education. Labor is
influenced by several factors, namely age, parity, the
distance of pregnancy, education, and mother's
knowledge [8]. [9] in their results showed a significant
relationship between age and parity with the length of
labor as indicated by the p-value of 0.001.
2. The length of the 1st stage
Table 2. The length of the 1st stage
The length of 1st stage
>6 hours
<=6 hours
CI
pvalue
n
%
N
1.09
-
1.69
0.002
0
100.0
30
Group
Treatment
8
73.3
22
Control
Based on the table above, it can be seen the
difference in the 1st stage in the treatment group
compared to the control group. This is indicated by the
value of p-value 0.002 and RR 1.36.
Childbirth is a process that ends with the release
of the results of the conception [10]. This process
begins with labor contractions, which are
characterized by progressive changes in the cervix
(cervical dilatation) and end with placental birth [11].
Birth ball is a physical therapy ball that can help the
mother who is in the first stage of labor to a position
that is useful to help the progress of labor. This birth
ball exercise can be started from pregnancy [4]. One
of the movements in birth ball training is pelvic
rocking, which is useful for increasing the pelvic area,
pushing the baby's head down due to the force of
gravity, and thus increasing the rate of labour [4].
Surtiningsih, et al (2016) [6] research shows that
Pelvic Rocking Exercises are very effective in
shortening the length of time in the first phase of
active phase with a value of ρ-value of 0,0001. Hassan
Zaky, Nevertity (2016) [12] in his research mentioned
that there were significant differences in the duration
of the first stage of labor in the control group and the
treatment group Birth ball training was given with a p-
value of 0,000
Tussey CM, et al (2015) [9] in the results of their
study showed a significant difference between the
duration of the first stage of labor in the control group
and the treatment group was given birth balls. This
exercise significantly increased the acceleration rate of
stage 1 by 29 minutes compared to the control group.
Shirazi, et al (2019) [13] in the results of their
study showed a significant difference in time 1 in the
group receiving birth ball treatment during pregnancy
with a p-value of 0.003.
Normal childbirth is a labor that begins in time
and without the provision of certain drugs [14].
Mirzakhani, et al (2014) [5] stated in their research
that there were significant differences in the treatment
group that received birth ball training with the type of
labor faced compared to the control group. Most of the
respondents, 92.60% of respondents gave birth by
vaginal birth, and the rest gave birth by sectio caesaria
caused by the first stage of 29.6%.
Hau, et al (2012) [15] in their research showed
that there was a significant difference in the duration
of the first stage of labor in the treatment group
undergoing birth ball training, with a p-value of 0.003.
Research by Gau ML, et al (2011) [3] shows that
birth ball training in the treatment group can shorten
the length of the first stage of labor, reduce analgesic
use, and reduce the incidence of labor by sectio
caesaria.
3. The length of 2nd stage
Tabel 3. The length of the 2nd stage
The length of 2nd stage
primi> 1
hour, and
multi >1/2
hour
primi <= 1
hour and
multi < 1/2
hour
CI
RR
pval
ue
%
n
%
n
Group
1.03-
1.71
1.33
0.02
0
6.7
2
93.3
28
Treatment
30.0
9
70.0
21
Control
Based on the table above, the results of the study
showed that there was a significant difference in the
second stage between the treatment groups with the
Advances in Health Sciences Research, volume 20
286
control group indicated by the p-value of 0.020 and
RR 1.33.
Childbirth is divided into several times, namely
the 1st stage, the 2nd stage, the 3rd stage, and the 4th
stage. The 1st Stage is a phase of cervical dilatation,
the 2nd stage is the fetal outflow phase, while the 3rd is
a placental release phase while the 4th stage is a
surveillance phase [7].
The factors that influence of labor are power,
passage, and passenger. The Power consists of his and
mother's strength straining. The Passage is the birth
canal factor that is the vagina and pelvic cavity, while
the passenger is the baby and placental factor [2]. The
pelvic cavity as the place where the baby comes out
must have a balanced size compared to the baby's head
which is the part of the baby with the largest diameter
[16]. The benefits of birth ball exercise include being
able to increase the area of the pelvic area by 30% and
increasing the elasticity of the muscles around the
pelvis, so that this exercise is expected to be able to
accelerate the rate of labor in the second stage [4].
Tussey CM, et al. (2015) [9] in the results of their
research showed a significant relationship between birth
ball exercises with the length of the 2nd staged by a p-
value of 0.001. The exercise can increase the rate of
speed of the second stage of labor by 11 minutes.
Surtiningsih, et al. (2016) [6] in their research
showed that there were significant differences in the
length of the 2nd stage in the group that received pelvic
rocking treatment with p-value <0.005. The average
length of second stage of labor in the treatment group
was 29 minutes, while in the control group was 48
minutes.
IV. CONCLUSION
The conclusion of this study is that most
respondents aged between 20-35 years old, high school
educated, not working/housewife (IRT) and multi para.
There was a significant difference in the duration of the
first and second stages of labor in the treatment group
with birth ball exercises compared to the control group.
V. ACKNOWLEDGEMENT
Thank you to RISTEKDIKTI for funding this PDP
research grant, Muhammadiyah Health Sciences
institute of Gombong, which has provided moral and
materials support, as well as the Central Health Care of
Buluspesantren 1 and Adimulyo who have collaborated
to be part of this research.
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... A cervical dilatation rate of 1 cm per hour is expected for primiparas, while multiparas may dilate at a rate of more than 1 cm to 2 cm per hour (Nurasiah, 2014). The benefits of providing birth ball exercises include enhancing maternal comfort, shortening the duration of labor, muscle relaxation resulting in the release of endorphins, faster cervical dilatation, wider pelvic area (Aprilia, 2017), and promoting relaxation, which encourages the baby to descend and expedite the delivery process (Mutoharoh et al., 2020). ...
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Objectives: Childbearing is considered as a great event in the lives of many women while the effect of pain on this event is undeniable. Thus, the think of pain and how to overcome it has engaged the minds of women, their family, and health-care providers. The birth ball is one of the non-invasive methods of pain control. Therefore, the present study aimed to evaluate the effect of the birth ball on the pain and self-efficacy of pregnant women during the childbirth process. Materials and Methods: This study was a randomized clinical trial. A total of 178 participants were selected based on the specific selection criteria and randomly allocated to control and intervention groups. The women in the intervention group were asked to join a planned exercise with the birth ball including a 20-minute well-defined exercise three times a week for 6–8 weeks at home whereas those in the control group followed up the routine prenatal cares. The questionnaires were completed by the participants at the four and eight-centimeter cervical dilations. Results: Based on the results, birth ball exercises could significantly improve childbirth self-efficacy and pain so that labour pain was lower in this group of women as compared to the other group (P<0.001 in both cervical dilatations). In addition, the score of selfefficacy was higher in the intervention group compared to the control group (P<0.001). Further, the result of generalized estimating equation model showed that birth ball exercise can decrease the childbirth pain. However, part of this effect may be related to an increase in the patients’ self-efficacy (30%-40%). Conclusions: In general, although birth ball exercise could decrease the childbirth pain, part of this effect was probably associated with an increase in self-efficacy of the patients.
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Background & aim: Considering the fact that cesarean section (c-section) poses greater risks of maternal and neonatal complications, compared to vaginal delivery, scholars seek different strategies to decrease the prevalence of this surgical procedure. Birth ball exercises during pregnancy are among the proposed strategies. Thus, this study aimed to determine the effect of using birth ball during pregnancy on mode of delivery in primiparous women. Methods:This clinical trial was conducted on 54 women, referring to the maternity ward of Omolbanin Hospital. Subjects were randomly assigned to intervention and control groups. The intervention group performed birth ball exercises for 4-6 weeks; on the other hand, the control group only received routine care. Data were collected using questionnaires, forms of examination and observation, and checklists for recording exercise movements on a weekly basis. Chi-square, Fisher’s exact test, and Mann-Whitney U test were performed, using SPSS version 16. Results: Rates of vaginal delivery and c-section in the intervention group were 92.6% and 7.4%, respectively, while the corresponding values in the control group were 66.7% and 33.3%, respectively. Chi-square showed a significant difference between the two groups in terms of mode of delivery (P=0.018). Conclusion: Considering the significance of promoting vaginal delivery among women, performing birth ball exercises is recommended as a useful, non-pharmacological, and inexpensive strategy for reducing c-section rate.
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One strategy for reducing the primary cesarean surgery rate and length of labor is using a peanut-shaped exercise ball for women laboring under epidural analgesia. A randomized, controlled study was conducted to determine whether use of a “peanut ball” decreased length of labor and increased the rate of vaginal birth. Women who used the peanut ball (n = 107) versus those who did not (n = 91) demonstrated shorter first stage labor by 29 min (p = .053) and second stage labor by 11 min (p < .001). The intervention was associated with a significantly lower incidence of cesarean surgery (OR = 0.41, p = .04). The peanut ball is potentially a successful nursing intervention to help progress labor and support vaginal birth for women laboring under epidural analgesia.
Acuan Nasional Pelayanan Maternal dan Neonatal
  • Buku Sarwono
Sarwono, Buku Acuan Nasional Pelayanan Maternal dan Neonatal. Jakarta: PT. Bina Pustaka, 2009.
  • Azwar
Azwar, Asuhan Persalinan Normal. Jakarta : Depkes RI, 2008.
Buku Ajar Asuhan Kebidanan
  • H Varney
  • J M Kriebs
  • C L Gegor
Varney H, Kriebs JM, Gegor CL. Buku Ajar Asuhan Kebidanan,Ed.4 Vol 2. Jakarta: EGC, 2007.
The use of Birth Ball as a Method of Pain Management Labour. Hongkong : Gynaecol Obstetri
  • W L Hau
  • S Tsang
  • H Cheung
Hau, W L, Tsang, S L and Cheung, H Y, The use of Birth Ball as a Method of Pain Management Labour. Hongkong : Gynaecol Obstetri, 2012. pp. 63-68. Vol. 12, 2012.