129
THE INFLUENCE OF ENDORPHIN MASSAGE TOWARDS THE LABORING IMPROVEMENT ON
PRIMPAROUS MOTHER AT MS. ANNA PRIVATE MIDWIFE PRACTICE IN BANDUNG REGENCY
1Indria Astuti*, 2Rd Noucie Septryliana Stikes Jenderal Achmad Yani Cimahi
*Email : [email protected]
Abstract
Laboring is a physiological occurrence experienced by a woman. Laboring that can not be handled properly can leadprolong labor. Factors that affect it is because of maternal discomfort during laboring which can be caused by pain affect the increase in body glucose consumption in maternal so that mothers can experience fatigue and catecholamine secretion that impact on uterine contractions. Abnormal contractions can cause the occurrence prolonged in labor. Prolong labor can cause intrapartum infections, uterine rupture, pathologic retraction rings until maternal and infant deaths. One of the efforts to improve uterine contractions is by endorphin massage. The purpose of this study is to determine.The influence of endorphin massage towards the laboring improvement on primiparous mother.
The research design used was Quasi Experiment with "Posttest-Only Control Design" divided into 2 groups, 16 respondents who were not given massage treatment and 16 respondents who were treated massages whereas progress of labor was assessed using patographic observation sheet, the data were analyzed using Test T Dependent. The results of the analysis showed that for the group that did not give endorphin massage had an average of 2 hours and 11 minutes of labor and the group who getendorphin massage had an average of 7 hours 26 minutes. Its means that there is an influence of endorphin massage towards the laboring improvement on primiparous mother with P <0,000. It is expected that endorphin massage can be used as an alternative method in providing maternal care to maternal that have an impact on laboring improvement
Keywords: Quasi experimental design, endorphin massage, laboring improvement
International Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi
130 INTRODUCTION
Labor is a physiological occurrence experienced by a woman. Labor that cannot be handled properly can lead the delivery process does not go smoothly and can cause prolong the labor. At the time of labor, the mother condition will respond to the pain, and her brain will perceive any contractions as pain, and cause stress (Hoseini, 2013).
The pain in labor is a painful uterine contraction that may result in increased the activity of the sympathetic nervous system. Severe pain in labor can lead to physiological changes in the body, such as increased blood pressure, rising heart rate, and an increase in respiratory rates, and if not treated properly, this will increase fear, tension, fear and stress.
The increased of glucose consumption on maternal who stressed can cause fatigue and catecholamine secretions that inhibit uterine contractions, and this causes prolonged labor (Bobak, 2005, Cuningham 2004).
The duration of labor affects on the outcomes and complications of labor. It is also accompanied by higher risk of infection, physical and mental disorders, and infant mortality, high possibility of postpartum hemorrhage, infection, fatigue, anxiety and psychosis.
The presence of interconnectedness between fear or anxiety with pain. If the mother is not ready for labor, the mother will feel very sick during the process of labor.
Anxiety can lead the production of stress hormones, namely adrenaline hormone which can add to the pain that already exists. The accumulation of oxytocin and adrenaline can cause the pain become severe (Jannah & Widajaka, 2012).
The pain that appear during labor normally will continue to increase as the opening and will continue until the labor (Jannah & Widajaka, 2012). Pain and anticipation of pain lead anxiety, so it can cause muscle tension and release of the substances of trigger. The result is the acceleration of the pain cycle-anxiety- tension, emotional pain and increase the tension levels of cortisol and ketakolamine which may influence the duration and intensity of labor (Scholt & Priest, 2002).
Efforts that can be performed to reduce the occurrence of prolong labor is to improve the uterine contractions. One of the nonpharmacological efforts to improve uterine contractions is endorphin massage. Endorphin massage is a technique of touch and light massage performed on the head, neck, shoulders, back and thighs. The benefits are to normalize the heart rate and blood pressure, and improve the relaxed conditions on the mother body by triggering a feeling of comfort. This technique can increase the release of oxytocin substances (Aprillia, 2010: 113).
The influence of endorphin massage on uterine contractions can take place in two ways, which can directand indirect affect on contraction. The influence of endorphin massage directly on contraction is continuous stimulation/ massage in the endorphin receptor location will stimulate the body's natural morphine expenditure, the endorphin hormone. The strength of endorphins is huge and almost 200 times more potent than morphine. This is very natural and every human being has it. Because endorphins are a natural hormone produced by the human body, endorphins are the best pain relievers (Aprilia, 2010).
131 Endorphins can be activated by stimulating the endorphin receptor location in the midbrain of periaqueductus gray substances. Giving stimulation of endorphin massage in the arm, neck, back (thoracic 10 to 12 and lumbar 1) which are the source of innervation of the uterus and cervic can stimulate ascending nerve receptors where the stimulation is delivered to the hypothalamus through the spinal cord, and continued to the gray part of the midbrain (periaqueductus). The stimulus received by the periaqueduct is conveyed to the hypothalamus, and hypothalamus deliver to the descending nerve pathway, and last the endorphin and oxytocin hormone secreted into the blood vessels (Aprillia, 2010: 113-115) .
The endorphin hormone will increase the level of relaxation of the mother that affects contraction stability and the oxytocin hormone will stimulate smooth muscle of the uterus to contract adequately (Aprillia, 2010: 113-115). When the body condition is relaxed, it occurs the increase in parasympathetic nerve work in delivering orders to the back of the brain, so it result the increasing the production of oxytocin and endorphin hormones (Aprillia, 2010:
113).
Endorphin massage is safe to performed. There are no side effectsbecause it does not use drugs and does not cause harm because it does not use chemicals (Aprillia, 2010: 113- 115). With the same stimulus, the level of endorphin will be different for each person. This is because sensitivity to stimuli for the release of endorphins varies in each person (Danuatmaja and Meiliasari, 2008: 67-68). Maternal mothers who performed massage for 20 minutes have higher levels of endorphine than those without a massage of 142.82 pcg / ml (Aryani, et al., 2015).
The purpose of this study was to determine the influence of endorphin massage towards laboring improvement on maternal primiparous.
RESEARCH METHOD
This research is a quasi-experimental by giving intervention of endorphin massage with the type of design used Posttest-Only Control Design. The population is all primiparous mothers at Ms. Anna private midwife practice in Bandung Regency. The subjects of the study were chosen by purposive sampling technique which is all maternal who met the criteria.
Inclusion criteria are primigravida maternal, stage I is active phase and exclusion criteria of complicated or complicated mother and maternal who doesn’t accompanied by the her husband. Sample are 32 people divided into 2 groups (1 group did not get endorphin massage and 1 group get endorphin massage)
The endorphin massage in group was done continuously from the respondent who met the criteria, then performed the endorphin massage for 20 minutes, observation of contraction for 10 minutes with a rest break for 20 minutes until the stage phase I ended (cervical opening 4 cm).
In the control group, anamnesa was performed and observed the labor improvement every 60 minutes. The massage is performed in accordance with the SOP of endorphin massage. Instrument used is the observation sheet (partograf). Place of research carried at Ms. Anna private midwife practice in Bandung Regency. The data collection is from March to August 2017.
International Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi
132 RESULT AND DISCUSSION
Tabel 4.1 The Distribution of labour Process of Primipara Between Massaged Endorphin and Not Massaged Endorphin
Treatm
ent Jumlah
responden. Min Max Rata-rata
Group of Massaged Endorphin Group of Not Massaged Endorphine
1 6 1 6
1 hour 5 hour
4 hour 12 hour
2 hour 18 minute 7 hour 26 minute 4 second
source : Primary data of 2017
Based on 4.1 table, it obtained the average value of labor improvement in primipara maternal mother is 2 hours 18 minutes and maternal mother who does not get endorphin massage is average 7 hours 26 4 seconds.
In line with the theory that endorphine levels in the body will increase after 20 minutes after massage every hour during labor (Aryani, et al., 2015 and Aprillia, 2010: 113- 115). Maternal mothers who are on a 20-minute massage have higher endorphine levels than those without a massage around 142.82 pcg / ml (Aryani, et al., 2015).
Endorphin hormones produced in the body can be triggered through various activities, such as deep breathing, relaxation, meditation and endorphin massage. The level of endorphin released by the body varies from one to another (Danuatmaja and Meiliasari, 2008:
67-68). Endorphin hormones can be activated by stimulating the endhorphin receptor location in the midbrain periaqueductus gray substances which is released into the blood vessels. The endorphin hormone present in the maternal blood vessels will increase the level of relaxation of the mother that affects contraction stability, and the oxytocin hormone will stimulate smooth muscle of the uterus to contract adequately (Aprillia, 2010: 113-115).
Table 4.2 influence of Endorphin Massage towards labor improvement in primiparous maternal mothers
Treatment Asymp. Sig. (2-
tailed) N
Control Group
0,000 3
2 Case Group
Sumber : Data primer tahun 2017 .
Based on 4.2 table, the value of = 0,000, if the value of ≤ 0.05 means "Ho is rejected", there is a significant difference in the labor improvement which is not performed endorphin massage with endorphin massage, this shows that there is influence of endorphin massage on the labor improvement on primiparous maternal mother.
Mothers who performs endorphin massage will be more relaxed and calm, anxiety and fear of the mother to face the process of labor will be reduced and increase contraction (Danuatmaja and Meiliasari, 2008: 68).
The endorphin is a hormone produced in the hypothalamus and transported by the acsoplasmic flow to the anterior pituitary and then released into the blood. This hormone gives a relaxing effect (Lestari, et al., 2012). The relaxation effect in the maternal causes a decrease in muscle tension and relaxation of the abdominal muscles and this can lead to a lack of friction between the uterus and the abdominal wall. This occurrence can lead to an increased of uterine contractions with the release of oxytocin and help decrease the fetus more quickly (http://journal.unair.ac.id).
133 In addition, the relaxed condition experienced by the mother who performs massage can improve the genital blood circulation and improve cervical elasticity, so it can accelerate cervical opening (http://journal.unair.ac.id).
The secretion of oxytocin and endorphin hormone in the blood increases after the massage. Oxytocin is a hormone produced in the hypothalamus and is transported through the axoplasmic flow to the posterior pituitary and then released into the bloodstream. Endorphin gives the acceleration effect of labor by stimulating uterine smooth muscle contraction (Lestari, et al. 2012). The oxytocin that flows smoothly in the mother's body makes maternal contractions adequate. The adequate uterine contractions are directly proportional to cervical dilatation. The more adequate the contractions of the uterus, the faster the cervical opening and thinning (progress of labor) (jurnal.stikesstrada.ac.id).
This research is in line with the results of Ningrum's research, A.G. (2013). She mentions that quantitatively there is a transformation due to the treatment of massage on the labor improvement at the stage I active phase of the majority of respondents (71.4%) suffered adequate uterine contractions (jurnal.stikesstrada.ac.id). Another study conducted by Indah Lestari, et al. (2012). It states that the ratio of the opening velocity between the two groups shows that p = 0.000. It means that there is an influence of massage on the opening rate of the cervix. Giving massage will cause decreased muscle tension and relaxation, including abdominal muscles that can increase uterine contractions with the release of oxytocin (http://journal.unair.ac.id).
CONCLUSION
The labor improvement of maternal who gets endorphin massaged faster than those who did not get, so that there is influence of endorphin massage towards the labor improvement of Primiparous maternal with a value of P 0.001.
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