effect of deep breathing relax technique on labor pain intensity in the active phase

Abstract

Labor pain is a combination of physical pain due to myometrial contractions accompanied by stretching of the lower segment of the uterus fused with the psychological condition of the mother during labor. The purpose of this study was to determine the effect of deep breathing relax technique on labor pain intensity in the active phase. Quasi-experimental Research Design with pre and post test without control. The sample in this study were 16 people. Sampling with purposive sampling method. The results of the research distribution of respondents before Deep Breathing Relax was mostly felt severe pain and after being given Deep breathing relax treatment most respondents experienced moderate to mild pain with a paried t test value of P = 0.000 < ? 0.05 thus there is an effect of deep breathing relax technique on labor pain intensity in the active phase.

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How to Cite
Muldaniyah, M., Wahyuni, I. S., Malinda, R., Susanti, N. Y., & Fitria, L. (2023). The effect of deep breathing relax
technique on labor pain intensity in the active phase. International Journal of Health & Medical Sciences, 6(1), 17-
22. https://doi.org/10.21744/ijhms.v6n1.2080
ISSN 2632-9433
Submitted: 09 November 2022|Revised: 18 December 2022| Accepted: 27 January 2023 17
The Effect of Deep Breathing Relax Technique on Labor Pain
Intensity in the Active Phase
Muldaniyah
Graha Edukasi College of Health Sciences, Makassar, South Sulawesi, Indonesia
Corresponding author email: niamilda33@gmail.com
Indah Sri Wahyuni
Politeknik Karya Husada, South Jakarta, DKI Jakarta, Indonesia
Email: indahsekali03@gmail.com
Risnati Malinda
Bustanul Ulum Langsa College of Health Sciences,Aceh, Indonesia
Email: linda.ristama@gmail.com
Neny Yuli Susanti
Universitas Ibrahimy Situbondo, East Java, Indonesia
Email: nenyyulisusanti@gmail.com
Lia Fitria
Universitas Ibrahimy Situbondo, East Java, Indonesia
Email: leeafitria@gmail.com
Abstract---Labor pain is a combination of physical pain due to myometrial contractions accompanied by stretching
of the lower segment of the uterus fused with the psychological condition of the mother during labor. The purpose of
this study was to determine the effect of deep breathing relax technique on labor pain intensity in the active phase.
Quasi-experimental Research Design with pre and post test without control. The sample in this study were 16 people.
Sampling with purposive sampling method. The results of the research distribution of respondents before Deep
Breathing Relax was mostly felt severe pain and after being given Deep breathing relax treatment most respondents
experienced moderate to mild pain with a paried t test value of P = 0.000 < α 0.05 thus there is an effect of deep
breathing relax technique on labor pain intensity in the active phase.
Keywords---active phase, deep breathing relax, labor pain, laboring mothers, quasi-experimental research.
Introduction
Labor care aims to strive for survival and achieve a high degree of health for mothers and their babies. The main
focus of normal labor care is to prevent complications during labor to reduce maternal morbidity and mortality. One
of the indicators in determining the health status of a nation is characterized by high maternal and infant mortality
rates. Maternal mortality is still a very important reproductive health problem in Indonesia (Anissa et al., 2017).
According to the World Organization (WHO) in 2018, the number of deliveries reached approximately 108 per
100,000 live births and complications reached 50.3 per 100,000 live births (Ministry of Health, 2018). Some
countries have high maternal mortality rates such as Sub-Saharan Africa 179,000, South Asia 69,000, and Southeast
Asia 16,000. Maternal mortality rates in Southeast Asian countries where Indonesia is 190 per 100,000 live births,

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Vietnam 49 per 100,000 live births, Thailand 26 per 100,000 live births, Brunei 27 per 100,000 live births, and
Malaysia 29 per 100,000 live births (WHO, 2020).
In South Sulawesi the number of maternal deaths reported by the District/ City Health Office has increased and
decreased, in 2021 the number of maternal deaths was 160 people or 110.26 per 100,000 live births, while in 2020 it
decreased to 115 people or 78.38 per 100,000 live births, in 2019 it increased again to 138 people or 93.20 per
100,000 live births. The main causes of maternal death are bleeding, infection, hypertension, preeclampsia-
eclampsia, abortion, and prolonged partus (South Sulawesi Health Profile, 2021). Labor pain is a combination of
physical pain due to myometrial contractions accompanied by stretching of the lower segment of the uterus together
with the psychological condition of the mother during labor. The anxiety of the mother's worries all merge so that
they can aggravate the physical pain that already exists. The perception of increasingly intense pain increases
maternal anxiety so that a cycle of fear, pain stress and so on occurs. Pain is an unpleasant and complex condition
that is an individualized phenomenon that is emotional in nature. Mothers feel worried about the pain that will be
faced during labor and birth and how the mother will react to pain and to overcome the pain (Indrayani & Djami,
2016).
Biswan et al. (2017) said that efforts to reduce pain during labor are carried out pharmacologically and non-
pharmacologically. Pharmacological pain management is more effective than non-pharmacological methods, but
pharmacological methods are more expensive and have the potential to have unfavorable effects, both for the mother
and the fetus. Meanwhile, non-pharmacological methods are cheaper, simpler, effective and without adverse effects
and can increase satisfaction during labor because the mother can control her feelings and strength (Fitri et al., 2019).
Deep breathing relaxation is one of the relaxation techniques that is often used to reduce pain and reduce pain
intensity by stimulating the central nervous system, namely the brain and spine to produce endrophins that function
as pain inhibitors. According to Andriana, the deep breath relaxation technique is a form of nursing care, in which
case the midwife teaches the client how to perform deep breathing techniques during contractions by using chest
breathing through the nose will flow oxygen to the blood, then flow throughout the body. So that the laboring mother
will feel relaxed and comfortable because the body will flow the endorphin hormone which is a natural pain reliever
in the body (Budiana, 2021).
Research by Fitri et al. (2019) entitled the relationship of deep breathing techniques to reducing active phase pain
intensity shows that the intensity of labor pain before treatment is 5.40 and after treatment is 4.07. The visible
difference value is 1.33 with a standard deviation of 1.163. The statistical test results obtained a p value of 0.000
<0.05, so Ho is rejected, which means that there is an effect of relaxation techniques on labor pain during phase I
with a p value of 0.000 (p value <0.05) (Astuti & Bangsawan, 2019). Based on this, the authors are interested in
conducting research on the effect of deep breathing relax techniques on the intensity of labor pain during the active
phase at Batara siang Pangkep Hospital (Alwan & Mohsen, 2022; Wahyuni & Maghfiroh, 2022).
Research Method
This study is a Quasi experiment using the one group pretest-postest type which aims to determine the effect of Deep
Breathing Relax on Labor Pain Intensity in the Active Phase. This study uses a Quasi-experimental research design
with pre and post test without control, which means that researchers only intervene in one group without comparison.
The effect of treatment is assessed by comparing the post test value with the pre test. The population in this study
were all laboring mothers with normal labor at Batara Siang Pangkep Hospital. The number of samples in this study
were 16 people. Sampling with purposive sampling method. The instruments used were SOAP observation sheet of
patented deep breathing technique, comparative plain scale to measure the level of pain before and after the action
and questionnaire sheet containing maternal demographic data, namely: name, age, occupation, education, and
parity. Data analysis with univariate to determine the frequency distribution of the characteristics of respondents and
bifariate analysis with the help of SPSS with paried t test (Annweiler et al., 2020; Been et al., 2020).

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Result and Discussion
Univariate Analysis
Table 1
Frequency Distribution of Respondent Characteristics
Respondent Characteristics
N
Frequency
Percentage (%)
Age
18-27 years old
6
37.5
28-40 years old
10
62.5
total
16
100
Occupation
Working
5
31.2
Not Work
11
68.8
total
16
100
Education
Elementary
2
12.5
Middle
4
25
High School
9
56.2
Undergraduate
1
6.3
total
16
100
Parity
Primipara
10
62.5
Multipara
5
31.2
Grandmultipara
1
6.3
total
16
100
Source: Primary Data
Table 2
Frequency distribution of pain levels before and after Deep Breathing Relax
Level Pain
Pretest
Postest
N
%
N
%
Mild
-
-
6
25.0
Medium
5
31.2
10
75.0
Heavy
11
68.8
-
-
Total
16
100
16
100
Source: Primary Data
Based on table 2 shows that before the back massage was analyzed, the most dominant pain was felt on a heavy pain
scale as many as 11 respondents with a percentage of (68.8) and 5 respondents with a percentage of (31.2) on a
medium pain scale. After the back massage treatment, the results showed a change in the intensity of the pain felt,
there was an increase in the mild pain scale as many as 6 respondents with a percentage of (25.0) and medium pain
as many as 10 respondents with a percentage of (75.0) (Muhler et al., 1992; Rouse etal., 1999).
Bivariate Analysis
Bivariate analysis is used to obtain an overview of whether there is a correlation between the independent variable
and the dependent variable. The results of this Bivariate analysis are presented in tabular form as follows:
Table 3
Dependent T Test Analysis of the Effect of Deep Breathing Relax on Labor Pain Intensity in the Active Phase
Treatment
N
Mean
SD
P-Value
Pretest
8
7.00
1.069
0.000
Postest
8
4.38
1.302
Source: paried t test

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Based on table 3, the average pain intensity before the deep breathing relax technique is 7.00 heavy pain with a
standard deviation of 1.069, while after treatment it is 4.38 medium pain with a standard deviation of 1.302. P <
0.000 means that there is an influence between pain scores before and after deep breathing relax, thus it is concluded
that the deep breathing relax technique is effective in reducing the intensity of labor pain in the Active phase. Based
on table 3 shows that the distribution of respondents before the deep breathing relax technique was carried out, most
of the respondents experienced severe pain as many as 11 people (68.8%), while in the results after being given Deep
Breathing Relax most of the respondents experienced a decrease in pain to medium, namely 10 people (75%) and
mild as many as 6 people (25%) (Bauernschuster & Schlotter, 2015; Simkin & Bolding, 2004).
Pain is a condition in the form of unpleasant feelings that are very subjective because feelings of pain are
different in each person in terms of scale or level, and only that person can explain or evaluate the pain he is
experiencing (Yuliasari &Santriani, 2018). One of the factors that cause pain in labor is anxiety/ fear in laboring
women will stimulate sympathetic nerves which result in spasm of uterine muscles resulting in ischemia of the
uterine muscles, as a result there is a lack of oxygen in the uterine muscles which stimulates the release of
prostaglandins to cause pain, and pain due to cervical dilatation stimulates the pain response to the cervical and
vertebral ganglion and then to the hypothalamus (Herawati, 2016).
In reducing pain can use respiratory relaxation techniques because it can increase concentration so that it makes it
easier to regulate breathing. If breathing can be regulated, oxygen in the blood will increase so as to provide a sense
of calm, reduce heart rate, and blood pressure so that pain will decrease (Hindriati, 2017). Relaxation is an effective
method to reduce pain which is an unpleasant sensory and emotional experience. One way to reduce pain is by
means of respiratory relaxation techniques. Relaxation techniques are techniques that can reduce the tension
experienced by laboring mothers and their babies, (Biswan et al., 2017). Maintaining components of the sympathetic
nervous system in a homeostatic state so that there is no increase in blood supply, reducing anxiety and fear so that
the mother can adapt to pain during labor and is more effective since pregnancy (Marmi, 2016).
Breathing is controlled automatically by the respiratory center in the brain, this respiratory center will respond to
carbon dioxide levels in the blood flowing through the center so that differences in carbon dioxide levels will disrupt
breathing patterns (fast and deep breaths) to normalize levels. Conditions of fear, anxiety, anger, frustration, pain or
the onset of strong contractions during labor will result in the use of oxygen and produce excessive carbon dioxide.
Encourage the mother to exhale slowly and forcefully. This breathing is done with the aim of preventing respiratory
distress and prolonged hyperventilation (Sonya & Monica, 2018).
From the calculation of data analysis using the Paired T test, the P value is 0.000 while the α value is 0.05. Due to
the value of P Value < α, Ho is rejected Ha is accepted, meaning that there is an effect of deep breathing relax
technique on the intensity of labor pain during the active phase at Batara siang Pangkep Hospital. Based on the
results of the study, it can be concluded that deep breathing techniques can reduce pain intensity in the active phase,
where before the pain intervention was carried out on a scale of 5.04 with a standard deviation of 1.595 and a
standard error of 0.4. After the intervention of deep breathing techniques, the pain intensity is on a scale of 4.07 and
a standard deviation of 1.163 where the standard error is 0.3. The results showed that there was a relationship
between the deep breathing technique method and the decrease in active phase labor pain intensity (Jarrah et al.,
2022; Chung et al., 2010).
From the results of this study, there is a significant difference in pain before and after being given deep breath
relaxation techniques, because the benefits of deep breath relaxation techniques can provide a sense of comfort to the
mother. Respiratory relaxation is one of the most useful skills to overcome labor pain. Respiratory relaxation skills to
overcome this pain can be used during labor in order to cope well with labor means not being overwhelmed or
panicked when facing a series of contractions. Women who use these skills usually feel less pain than women who
do not use them. Relaxation is the most commonly used non-pharmacological pain control method in the UK, in a
study reported by Steer in 1993 that 34% of women used relaxation techniques (Mander, 2012).
According to the researcher's assumption that during the labor process, deep breath relaxation techniques will
reduce pain. Mothers who do the deep breath relaxation technique will decrease their pain according to the his/
contractions experienced. The stronger the contractions, the more pain is felt. With the provision of deep breath
relaxation techniques, it can be concluded that there is a positive influence for laboring mothers who perform deep
breath relaxation techniques compared to mothers who do not perform deep breath relaxation techniques during the
labor process. Overall, based on what the researchers have observed, all respondents on average said that the labor
pain felt reduced and felt more comfortable even though the responses given were different (Notoatmodjo, 2012;
Lowe, 2002; Huntley et al., 2004).

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Conclusion
After the author conducts the research, it can be concluded that from the results of the calculation of data analysis
using the Paired T test, the P value is 0.000 while the α value is 0.05. Due to the value of P Value < α, Ho is rejected
Ha is accepted, meaning that there is an effect of deep breathing relax technique on labor pain intensity in the Active
phase at Batara siang Pangkep Hospital. It is expected for mothers to add knowledge about the importance of doing
deep breathing relaxation techniques to reduce the intensity of pain, especially when facing the onset of labor, and
for health workers to apply the deep breath relaxation technique that can be used as a consideration for midwives in
providing maternal care in order to reduce the level of pain and pain in facing childbirth.
Acknowledgments
Our deepest gratitude goes to all those who have been involved and helped complete this research, especially to the
research team who have coordinated well enough so that we can complete this research.
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