Journal of Critical Reviews

ISSN- 2394-5125 Vol 7, Issue 14, 2020

DEEP BACK MASSAGE AFFECTING THE DECREASE IN PAIN INTENSITY AND

ACCELERATING THE OPENING OF CERVIX ON MATERNAL DELIVERY
Enny Fitriahadi1, Istri Utami1
1 Faculty of Health Sciences, Aisyiyah University of Yogyakarta, Yogyakarta, Indonesia
Email: ennyfitriahadi@unisayogya.ac.id
Received: 08.04.2020 Revised: 10.05.2020 Accepted: 05.06.2020

Abstract
In developing countries, 36 countries found that only 15% of births take place without pain or mild pain, 35% of deliveries with
moderate pain, 30% of births with severe pain, and 20% of births accompanied by extreme pain. Massage techniques that can be done
are a deep back massage. The purpose of the study is to determine the effect of deep back massage on labour pain intensity reduction
and the acceleration of the opening of cervix in women giving birth. The samples were 15 samples of intervention group. The method
used quantitative research methods with quays experimental design and non-randomized pre-test and post-test group design. A paired
sample of pre-test and post-test in the experimental group used the analysis of T-test. The results showed sig. the value was less than
0.05 (p =
0.000 <0.05), so that it can be stated that there is a significant difference in pain reduction intensity and the opening of cervix in the
experimental group. The conclusion of this study that the method of deep back massage has an influence on the intensity of pain and
opening of cervix in pregnant women, in which pregnant women who do this intervention, pain intensity will decrease and the cervical
opening will quickly so the women will feel more comfortable in labour.

Keywords: Deep Back Massage, Cervix, Maternal Delivery, Pain Intensity

©2020byAdvance Scientific Research. This is an open-access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
DOI: http://dx.doi.org/10.31838/jcr.07.14.21

INTRODUCTION test. In this study, the intervention group was measured before
Childbirth is a natural process along with a woman's cycle to treatment of pain and opening of cervix during pre-test and then
bear the products of conception (the fetus and placenta). This given intervention (deep back massage) and then be re-evaluated
process gives a different meaning to each individual and makes a with post-test that assessed the level of pain and their opening of
unique experience. This condition is due to various factors, one the cervix.
of which is the presence of pain during childbirth. The pain can The populations in this study were all women giving birth in BPM
affect the condition of the mother in the form of fatigue, fear, Sleman. The population is homogeneous that is having the same
anxiety, and stress. Stress can lead to a weakening of uterine characteristics [3] of 15 maternal. The samples were 15
contractions and lead to long labour and even death in women respondents. The sampling technique is total sampling. The
[1]. Based on the research of Lestari in 2012 of 2,700 parturient statistical test that will be used to determine the influence of pre-
in 121 obstetrics centres from 36 countries found that only 15% test and post-test in the experimental group is the Wilcoxon, and
of births take place without pain or mild pain, 35% of deliveries to determine differences in pre-test and post-test is the T-test [4].
with moderate pain, 30% of births with severe pain and 20% of
births with extreme pain [1]. RESULTS AND DISCUSSION
Characteristics of Respondents
One method used to reduce labour pain can be done by The respondents are the third-trimester pregnant women who
pharmacological and non-pharmacological. A massage technique have met the criteria of the respondent sample at BPM Istri
that can be done with a deep back massage. In this case it needs Utami and Tutik Purwani Sleman, Yogyakarta. The
examination of the influence of deep back massage which can characteristics of respondents in this study were age, gestational
then be offered to the mother. Based on the description above, age, parity, education, employment, and socio-economic. The
the writer is interested in conducting research that aims to research results on the characteristics of respondents can be
analyse the influence of deep back massage methods with pain shown in the following table:
reduction intensity and accelerating the opening of cervix in
women giving birth [1]. Objective: To identify how the Table 1. Frequency distribution characteristics of respondents
implementation of the deep back massage, Investigating the
effect of the method to the pain reduction intensity and Age (years) F %
acceleration of the opening of cervix in women giving birth, ≤ 20 3 20
Knowing how profound back massage benefits to the 20-35 10 66.7
reproductive organ systems. ≥ 35 2 13.3
Age Pregnancy (week)
METHOD <38 10 66.7
The study used a quasi-experimental design and measure the 38-39 3 20
influence of the deep back massage to decrease pain intensity > 40 2 13.3
and acceleration of the opening of the cervix in women giving parity
birth. This study provides treatment to a given treatment group primigravida 7 46.7
(intervention group). The design used non-randomized pre-test multigravida 8 53.3
and post-test Group [2]. Education
Model design is: Elementary-Junior 6 40
Pre-test Intervention Post-test High School 9 60
experiment 01 X 02 college 0 0
The formation of the group is by pre-test and then intervene or
perform deep back massage treatment and subsequently post-

Journal of critical reviews 1

 DEEP BACK MASSAGE AFFECTING THE DECREASE IN PAIN INTENSITY AND ACCELERATING THE OPENING OF CERVIX
ON MATERNAL DELIVERY

Age (years) F % According to researchers at parity multigravida, already adapting

Occupation
Does not work 8 53.3
Work 7 46.7
Socioeconomic
<IDR. 1,000,000.00 8 53.3
≥IDR. 1,000,000.00 7 46.7
Total 15 100%
Source: Primary data 2019
According to the table 1 is known that the frequency distribution
characteristics of the respondents, is the age of most respondents
in the age of 20-35 years as many as 10 people (66.7%), mostly
in the age gestational age <38 weeks by 10 (66.7%), the highest
parity multigravida as many as eight (53.3%), most high school
education of 9 (60%), occupation most mothers did not work of 8
(53.3%), and highest socioeconomic on <IDR. 1,000,000.00 of 8
(53.3%).
At childbirth, the age of less than 20 years and above 35 years
risks much health to mother and fetus. Pregnancy and childbirth
in women of 20-35 years of age are optimal for reproductive
health. Childbirth is influenced by age because age is the cause of
pain because the more age of a person will change and vary
according to age [5].
Here are some factors affecting pain perception of which is age.
Younger maternal age has more intense sensory pain compared
with older mothers. Young age tends to be associated with
psychological conditions, which are still unstable, triggering
anxiety that the pain felt increasingly stronger [6]. This study
showed that more mothers are at 20-35 years old of age group,
which means the age of appropriate reproductive health.
to the pain experienced before, because ever did before while
assuming the pain is a natural thing because it has experienced
before. As presented by Batbual, a person who succeeded in
overcoming the pain of the past, and this time the pain arises, it
will be easier to overcome the pain. In the parity, mother
primiparity intensity of uterine contractions stronger than in
women who are multiparous and grandee multigravida [7]. In
this study, the majority of parity is multigravida, which means
they have been experienced in the delivery process.
Education is concerned with understanding someone and have
the respective meanings. Education, in general, is useful in
changing the mindset, behave, and patterns of decision-making.
The level of education also affects awareness and understanding
of the stimulus. The response to labour pain each person is
different for different individual adaptations used by the level of
education. Individuals with low educational levels using adaptive
maladaptation, whereas individuals with higher education levels
using an adaptive adaptation. Thus, low education will have an
impact on the understanding of the occurrence and treatment of
pain [6]. In this study that a high school education may not have
an understanding of the birth process. Based on the research,
maternal occupation and socioeconomic status will impact
labour, especially pain during labour and opening of the cervix.
Univariate Analysis
Univariate analysis was conducted to see the average of the value
of the pain intensity and the opening of the cervix in women
giving birth from each group. The result of the calculation as
follows:

Table 2. Results of value average - average pain intensity of value and opening of cervix of each group
The experimental group
Average pain intensity (pre) Average pain intensity (post)
4.4000 2.7000
Average opening of the cervix (pre) Average opening of the cervix (post)
6.8000 9.1000
Average difference of pre and post
The average difference in pain intensity (treatment group)
0:14
Average difference of opening of the cervix (the treatment group)
0:14

The Intensity of Pain and the Opening of the Cervix Before

Given the Intervention of the Deep Back Massage
The intensity of pain in the experimental group before
intervention is 4.4000. The opening of the cervix in the
experimental group before intervention is 6.8000. This study
coincides with findings by Lester, et al. there is a difference
(decrease) of the pain level before and after giving deep back
massage [1]. The research of Wulandari, et al. stating the results
of massage effleurage in primigravida mother stage 1 of the
active phase to give effect to the reduction of the labour pain.
The absence of the influence of the deep back massage, in this
case, was because of the perception or tolerance to pain is
different and can be due to inappropriate repression of current
massage. The pain felt by someone is personal and unique, where
every individual is different and cannot be equated despite
having the same condition [9]. The different perceptions of the
pain of each mother led to a different response to labour.
The Intensity of Pain and Opening of the Cervix After Given
Intervention of the Deep Back Massage
The intensity of pain in the experimental group after the
intervention is 2.7500. The opening of the cervix in the
experimental group after the intervention is 2.7000. The method
of deep back massage is one method of pain control in the form
of repression or massage by applying pressure on the sacrum
area and solidly backs with palms, release, and press again, and
so on. The patient is lying on her side, during  20 minutes
during contraction (6 contractions). By doing a deep back
massage method, giving a sense of relaxation that maternal
anxiety is reduced and women can handle the pain in labour. This
is in line with the gate control theory, the first rationale of gate
control theory is that the presence and intensity of the
experience of pain depend on the particular transmission on
impulse - nerve impulses. The second, the mechanism of gate or
door throughout the nervous system controls or controlling the
transmission of pain. Finally, if the gate is open, the impulse
which causes the sensation of pain can reach the level of
consciousness. If the gate is closed, the impulse does not reach
the level of consciousness and pain sensation is not experienced.
The most critical indicator of presence and intensity of pain is the
mother reports about the pain itself. However, the intensity of
pain can also be determined in various ways one of which is to
ask the mother to describe pain or her discomfort [10]. Their
reduced anxiety will affect the opening of cervix accelerated so
that the delivery process runs

Journal of critical reviews 2

smoothly.
Bivariate Analysis
In bivariate analysis, the paired t-test was used to determine
whether there is a difference in pain intensity and the opening of
cervix in the experimental group (treated). The conclusion was
significant that when t> t table at a significance level of 5% and a
value of p <0.05. Here is a summary of the results of the paired t-
test in the experimental group (treated with deep back massage).
Table 3 Results of Bivariate Data Analysis with Paired T-Test
Group P expected to do a deep back massage performed by a husband or
Experiment 0,000
Based on the results of the t-test calculations obtained, the
average increase in the experimental group of 2.22500, It is also
known from the t value of 7.660 and sig. value 0.000. So, it can be
concluded that the significantly less than 0.05 (p = 0.000 <0.05),
so that it can be stated there is a significant difference in pain
reduction intensity and opening of cervix in the experimental
group.
The Effect of Deep Back Massage on Pain Intensity and the
Opening of Cervix in Women Giving Birth in BPM Sleman
Based on the results of the t-test calculations known to the
average of increase in the experimental group of 2.22500, It is
also known from the t value of 7.660 and sig. value 0.000. So, it
can be concluded that the significantly less than 0.05 (p = 0.000
<0.05), so that it can be stated there is a significant difference
in pain reduction intensity and the opening of cervix in the
experimental group.
According to the research of Maita stated that the pain in the first
stage of labour could be overcome with a deep back massage.
The survey results revealed that out of 13 respondents feel pain
(score 6-10) before deep back massage experienced a decrease in
pain (0-4) after the deep back massage as many as 9 (42.9%) of
respondents, while women who experienced pain (score 6-10)
before deep back massage did not experience a decrease in pain
(score 6-10) after the deep back massage 4 (19%) of
respondents. This represents a decrease in maternal childbirth
pain. Based on statistical test p-value obtained was 0.004 (p
<0.05). This pain is caused by a decrease in maternal conditions
that can control stress; mothers who stay calm and believe that
they can control their pain [11].
According to the research of Nafiah, the labour pain stage 1
inactive phase before the method of deep back massage at the
Pratama Mutiara Bunda Kawalu of Tasikmalaya City is in severe
pain controlled with the average score of 7.97 after the deep back
massage methods are at moderate pain with value 5. There is an
effect of the method of deep back massage on pain after birth
stage 1 active phase of the first stage of labour at the Pratama
Mutiara Bunda Kawalu of Tasikmalaya with value (ρ = 0.001)
[12].
CONCLUSION
The results of the preliminary study at the analysis stage Based
on the results of the t-test calculations known to the average of
increase in the experimental group of 2.22500, It is also known
from the t value of 7.660 and sig. value 0.000. So, it can be
concluded that the significantly less than 0.05 (p = 0.000 <0.05),
so that it can be stated there is a significant difference in pain
reduction intensity and the opening of cervix in the experimental
group. From this study, we concluded that the method of deep
back massage has an influence on the intensity of pain and
opening of cervix in pregnant women, in which pregnant women
who do this intervention, pain intensity will decrease, and the
opening of cervix will be fast. Advice for pregnant women is
midwife so that the intensity of pain during first stage of labour
can be reduced and the opening of cervix is increasing. In
addition to these interventions mother diminishing labour pain
that mothers feel more comfortable during labour.
ACKNOWLEDGMENT
The author would like to thank in advance to the Ministry of
Research, Technology, and Higher Education, which has provided
funding for this research. The author also expressed gratitude to
the team and students who helped prepare the set-up of
equipment and assist retrieval of data
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