Internasional Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi
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The Influence Of Zilgrei Method On Anxiety Of Primigravida Mother In Second Stage Labor
Ati Nurwita
Midwifery Study Program, Stikes Jendeal A. Yani Cimahi
*Email: [email protected]
Abstract
Laboring is a nature phenomenon. It can cause physical and psychological changes. In Indonesia coverage of labor is quite high. If it is not manage properly can cause maternal and child mortalities. The cause of maternal mortality is caused by direct and indirect causes. One of the indirect factors causes is psychological condition of mother at the time of laboring, who are unprepared for labor will experience anxiety. Some of distraction technique have been effective to reduce anxiety. Zilgrei method is one of distraction technique on labor, but not yet implemented in reducing anxiety. This study was aimed to analyze the influence of Zilgrei methode over anxiety primigravida mother in second stage of labor. This study is analitic wih static group comparison/ post test onlycontrol design, number of respondents were 40 respondents, they were 20 respondents of intervention group and 20 respondents of no intervention group. Bivariate analysis showed that Zilgrei method and anxiety on labor is not significantly correlated with mean difference -2,50 and significancy value 0,416 (P <0.005). This is maybe to be related with timing of the application of the zilgrei method. In the other study can be applied from one stage in labor.
A combination of methods can be tried in other studies.
Key words:, anxiety, labor, Zilgrei method
Introduction
The physiological transition of pregnant to be mother have a major physical and psychological change. This influence and change if not controlled will affect the delivery process (Myles, 2009). Labor is a process that begins with contractions, cervical dilation and the birth of a baby and placenta (Varney, 2008).
The factors of influence labor are power, passage, passengger, psychological and helper (Varney, 2008) (Myles, 2009).
The coverage of labor in Indonesia is quite high, at 2016 until 5 million. If it is not manage properly can cause maternal and child mortalities (Kemenkes, 2017). Based on Indonesia Population Basic Survey at 2012 the mortality rate is 359 per 100.00 live birth. The cause of maternal mortality is caused by direct and indirect causes. One of the factor indirect causes is psychological condition of mother at the time of labor (Kemenkes, 2014).
The psychological conditions of maternal birth were different, makes the mother prepare and anticipate labor. During labor, the mother will feel pain and the perception of it is differen. Those who do not prepare for labor will be anxious. Excessive anxiety will increase the stress hormone. Risk during labor is will be obstructed of cervical dilatation, increase of pain perception, prolonged labor and shoulder dystocia (Myles, 2009). Maternal anxiety on labor with normal delivery and cesarean are different significantly especially in social aspect (Aminabhavi and Hunagund, 2010). The result of study mention the risk of anxiety on labor is age, parity and traumatic (Zamriati et al., 2013).
Many methods are applied as distraction techniques to reduce anxiety. For examples pregnancy gymnastic (Larasati and Wibowo, 2012), murrotal therapy (Handayani et al., 2014), and support from husban (Diponegoro and Hastuti, 2009). The zilgrei methode is one of distraction methode on labor.This is apply a breathing technique, position and mobility during labor. The breathing technique helps the relaxation muscles, with long breathing and expiration through the mouth and is repeated at 5 seconds. Deep breathing increases the supply of oxygen to brain and stimulates the parasympathetic Nervous system and promotes a state of calmness.
Internasional Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi
115
Breathing techniques helps to feel connected to our body which brings awareness away from the worries and quiets the mind (Mary et al., 2016). The position technique with tilted to the left and movement pulls the knee to the abdomen its helps to relaxation of muscle. So with this technique the mother does not feel pain (Danuatmaja, 2008). The results showed the intensity of pain when stage I latent phase and stage I active phase of labor with a combination of Zilgrei and Endorphine massage methods is lower than the group that only given intervention method Zilgrei (Nurochmi, 2014).
In this study, to minimize labor anxiety apply a zilgrei methode. This study aims to analyze the influence of zilgrei methode to anxiety mother primigravida in second stage labor.
Method
This study is quantitative analytic with static group comparison/ Post test onlycontrol design (Hidayat, 2014). Population of this study were mother of birth in Isti Dariah and Lilis K. Anggono midwives practic independently. The sample in this study was calculated using sample technique for a simple experimental study using an experimental group with a control group, the number of samples of each strata 10-20 (Sugiyono, 2011). The inclusion criteria in this study were the mother primipara of the second stage with a presentation behind the head, without complications of labor, without psychological disorder and mother is willing to be a research respondent. The Exclusion criteria were the mother was referred for complicated labor and the baby born dies in the process of delivery. A set of questionnaires was adopted from Hamilton Anxiety Rating Scale (HARS) (Gabbard, 2000). Data collection was conducted through interviews on the mother after 2 hours postpartum. To analyze the difference of mean anxiety, when the data is normally distributed with unpaired t-tests, if not normally distributed with tested by Mann Whitney (Dahlan, 2011).
Result
A total of 40 respondents were contribute this study, they are 20 respondents experimental group and 20 respondents control group. As the present study aimed at influence of zilgrei methode to anxiety mother primigravida in second stage labor. the obtained scores analysis with unpaired t-tests, to analyze the difference of mean anxiety. The outcome of the analysis is presented in the table below:
Table 1. The influence of zilgrei methode to anxiety of primigravida mother in second stage labor.
Group n Mean + standar
deviation
Mean difference p
Zilgrei Method 20 16,9 + 11 2,5 (3,6 – 8,6) 0,416
Without Zilgrei 20 19,4 + 7,9
Method
The result of bivariate analysis showed that zilgrei methode was not significantly to anxiety (p=0, 416) with mean difference 2,5.
Discussion:
The authors has applied Zilgrei method at second stage of labor. The mother in second stage of labor is guident to take a deep breath, tilted position and movement pulls the knee to the abdomen. This is done aimed to reducing anxiety in second stage of labor.
The high level of depression leads to anxiety (Arshad and Razzaq, 2015). Positive thinking plays a significant role in dealing with anxiety, and challenging our negative thoughts which has the potential to provide our mind with some relief over its anxiety symptoms. Negative thinking is anxiety. It's not a matter of whether or not you have the thought consciously. In order to be afraid of things, and in order to feel fear, anxiousness, or stress, our mind has to be focusing on the negative, so the fact that we are experiencing anxiety is an indication that these negative thoughts are occurring (Mary et al., 2016).
The anxiety is coused by labor pain, that pain scores are higher according to the evolution of cervical dilation. However it has been shown that pain which accompanies it, is a subjective and complex experience that varies from individual to individual. Some women feel little pain whilst others find the pain extremely distressing (Jones Leanne, 2012). Pain during the course of labor is a common symptom in the stage before delivery and, unlike other acute and chronic pain experiences, this pain is not associated with disease but with the reproductive cycle of a woman (Mafetoni and Shimo, 2014). Then, its characteristics may involve age, parity and traumatic (Zamriati et al., 2013).
Internasional Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi
116
To reduce anxiety due to pain in during labor, apllied a method to minimize anxieties. They were is Pharmacological and Non-pharmacological methods (NPMs). NPMs encouraged by the World Health Organization (WHO) in their recommendations for care in normal labor are classified by it as ― conducts that are clearly useful and should be encouraged‖, and they are strategies used during labor to increase tolerance to pain (Mafetoni and Shimo, 2014).
Zilgrei method is one of NPMs. This is apply a breathing technique, position and mobility during labor. the breathing exercise technique provided physical and emotional we a combination of methods can be tried in other studiesll-being. The changes in posture and mobility of the body resulted in positive effects, such as increased pain tolerance and reduction in the use of analgesics and anesthetics. In this study, Zilgrei method is not significantly correlated. This is maybe to be related with timing of the application of the zilgrei method. In the other study can be applied from one stage in labor.
Conclusion
This study only applied Zilgei method in second stage labor. This research is expected to be the initial data, to the other study about Zilgrei method. This study finding suggest the necessity of researching influence of Zilgrei method on anxiety in one stage until second stage labor. A combination of methods can be tried in other studies.
Acknowledgement
This research is made possible by support from research grant administered by research and community services department (LPPM), Stikes Jenderal A Yani, Cimahi.
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