Enferm Clin.

2020;30(S2):570---572

www.elsevier.es/enfermeriaclinica

Potential combination of back massage therapy and

acupressure as complementary therapy in postpartum
women for the increase in the hormone oxytocin夽
Fajar Dhini Yahya a,∗ , Mardiana Ahmad a , Andi Nilawati Usman a ,
A. Wardihan Sinrang a , Ema Alasiry b , Burhanuddin Bahar a

a
Department of Midwifery, Graduate School, Hasanuddin University, Indonesia
b
Faculty of Medicine, Hasanuddin University, Indonesia

Received 29 May 2019; accepted 15 July 2019

KEYWORDS Abstract
Complementary care; Objective: This study was designed to determine the effect of back massage, acupres-
Levels of oxytocin; sure, and a combination of a back massage and acupressure to the levels of the hormone
Acupressure; oxytocin and uterine involution of postpartum primipara mothers.
Back massage Method: It was a quasi-experimental design with a pretest---posttest control group design that
is observations made before and after treatment of the subject. Subjects consisted of 45 prim-
ipara postpartum mothers divided into three groups, each group consisting of 15 mothers. The
interventions carried out were back massage, acupressure, and a combination of back massage.
All interventions were carried out once a day for three days daily with a duration of 30 min every
morning at 09.00---09.15. Massage is carried out along the vertebrae until the 5th and 6th costal
bone; then acupressure is performed at the LU point 1-rib 2, point CV 17, and point SI 1.
Results: All groups given complementary therapy showed a significant increase in the oxy-
tocin hormone. However, the highest increase was in the combination of back massage and
acupressure.
Conclusion: The combination of back massage and acupressure therapy is worth considering as a
complementary therapy for postpartum primiparous women in helping to increase the hormone
oxytocin.
© 2019 Elsevier España, S.L.U. All rights reserved.

夽 Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on

Quality of Life (WOSQUAL-2019). Full-text and the content of it is under responsibility of authors of the article.
∗ Corresponding author.

E-mail address: fajar@pasca.unhas.ac.id (F.D. Yahya).

https://doi.org/10.1016/j.enfcli.2019.07.163
1130-8621/© 2019 Elsevier España, S.L.U. All rights reserved.
Potential combination of back massage therapy and acupressure 571

Introduction mothers who resigned as subjects, infants died, labor

The hormone oxytocin is a hormone produced by the poste-
rior lobe of the pituitary and can be given directly or with
massage could stimulate the release of oxytocin. The hor-
mone oxytocin serves to strengthen and regulate uterine
contractions, as well as the secretion of breast milk.1---3
Postpartum hemorrhage and subinvolution uterus remain
one of the major causes of death in the world and Indonesia,
so it is important to find a preventive measure it and one
of the efforts is to give a back massage and acupressure
to increase the production of the hormone oxytocin, which
stimulates contractions uterus.
Methods
This research approved by the research ethics com-
mittee Hasanuddin University, Makassar, with numbers:
583/UN4.6.4.5.31/PP36/2019 and obtain written consent
from all subjects. It was a quasi-experimental design with
a pretest---posttest control group design that is observations
made before and after treatment of the subject. Subjects
consisted of 45 primipara postpartum mothers divided into
three groups, each group consisting of 15 mothers. Sub-
jects at the maternal and child hospital Siti Fatima and Sitti
Khadija 1 and the Makassar Barabaraya Community Health
Center.
The inclusion criteria of this study were first-day prim-
iparous postpartum mothers, vaginal delivery, and infant
weight ≥2500 g while the exclusion criteria were postpartum
complications, mothers with acute illness and infants with
abnormalities. Respondent characteristics were collected
using checklist sheets, Postpartum Depression Screening
Scale (PDSS) questionnaire sheets were used to measure
stress levels, and the Enzyme-Linked Immunosorbent Assay
(ELISA) kit to measure the levels of the hormone oxytocin.
Blood samples were taken by hospital analysts as much as
3 ccs 6 h after delivery in the back massage group, acupres-
sure, and back massage combination + acupressure before
the intervention (pretest). Oxytocin level examination was
performed at the laboratory Hasanuddin University Medical
Research Center (HUM-RC) Makassar.
The interventions carried out were back massage,
acupressure, and a combination of back massage and acu-
pressure. All interventions were carried out once a day for
three days daily with a duration of 30 min every morning at
09.00---09.15 AM. Massage is carried out along the vertebrae
until the 5th and 6th costal bone, and then acupressure is
performed at the LU point 1-rib 2, point CV 17, and point SI
1.
Results
Table 1 shows that there were no significant differences
between all the characteristics of subjects between groups.
In general, the characteristics of all groups are highly edu-
cated, not working, age was still categorized as low risk,
the majority of all groups did Early Breastfeeding Initiation,
normal BMI, and did not experience depression (Table 1).

Table 1 Characteristics of respondents based intervention group.

Variables Intervention

Back massage Acupressure Combination back massage and p-Value

acupressure
n = 15 % n = 15 % n = 15 %
Education
High 11 29.7 12 32.4 14 37.8 0.353a
Low 4 50.0 3 37.5 1 12.5
Occupation
Work 2 33.3 1 16.7 3 50.0 0.569a
Does not work 13 33.3 14 35.9 12 30.8
Age
High risk 2 28.6 3 42.9 2 28.6 0.848a
Low risk 13 34.2 12 31.6 13 34.2
Early initiation of breastfeeding
Yes 13 33.3 13 33.3 13 33.3 1.000b
No 2 33.3 2 33.3 2 33.3
Body mass index
Normal 11 36.7 11 36.7 8 26.7 0.251
Abnormal 4 26.7 4 26.7 7 46.7
Stress/depression
Yes 5 50.0 3 30.0 2 20.0 0.415a
No 10 28.6 12 34.3 13 37.1
a Kruskal---Wallis test.
b Chi-square test.
572
Table 2 Analysis of oxytocin levels based on the intervention group.
Examination time
Back massage
Mean ± SD
Pretest 13.13 ± 6.52
Posttest 15.73 ± 6.67
p-Value 0.000a
a Paired T-test.
b Uji Wilcoxon.
All groups given complementary therapy showed a sig-
nificant increase in the oxytocin hormone. However, the
highest increase was in the combination of back massage
and acupressure (Table 2).
Discussion
These results indicate differences between the mean levels
of the hormone oxytocin postpartum mothers, acupressure,
and massage combination of back massage and acupres-
sure. The results showed that care complementary able to
increase the production of the hormone oxytocin based on
evidence from hormone levels oxytocin before and after
complimentary care especially combination back massage
and acupressure. It is consistent with the theory that
explains that giving a massage on the whole spine (verte-
brae) and emphasis on the acupressure-point will stimulate
the posterior pituitary for secretion of oxytocin.4,5 This is in
line with another research that there is an increase in the
hormone oxytocin and pressing arginine-vasopressin (AVP)
and suppress the hormone cortisol after massaging.6
Back massage, acupressure, and a combination of a back
massage and acupressure reduce discomfort in postpartum
mothers and helping mothers postpartum for relaxation,
resulting in decreased levels of epinephrine and nore-
pinephrine in the blood so that there is a balance and
stimulate endorphin secretion.7,8
Conclusion
Based on the results of this study concluded that the combi-
nation of back massage and acupressure therapy is worth
considering as a complementary therapy for postpartum
primiparous women in helping to increase the hormone oxy-
tocin.
F.D. Yahya et al.
Intervention
Acupressure Combination back massage and acupressure
Mean ± SD Mean ± SD
12.5333 ± 4.32 12.800 ± 6.81
14.7333 ± 4.39 16.7333 ± 6.37
0.001b 0.001b
Conflict of interest
The authors declare no conflict of interest.
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