Pengaruh Masase pada Punggung Terhadap Intensitas Nyeri Kala I Fase Laten Persalinan Normal Melalui Peningkatan Kadar Endorfin

Yeni Aryani, Masrul ., Lisma Evareny

Abstract

AbstrakNyeri saat persalinan merupakan proses yang fisiologis. Sebanyak 12% - 67% wanita merasa khawatir dengan nyeri yang akan dialami saat persalinan. Salah satu upaya untuk mengurangi nyeri persalinan adalah dengan masase. Tujuan Penelitian ini untuk mengetahui pengaruh masase pada punggung terhadap intensitas nyeri kala I fase laten persalinan normal melaui peningkatan kadar endorfin. Ini merupakan suatu penelitian experimental dengan post test only control group design yang dibagi atas kelompok perlakuan yang melakukan masase pada punggung dan kelompok kontrol yang tidak masase. Intensitas nyeri dinilai dengan kuisioner dan kadar endorfin diukur dengan human beta endorfin Elisa Kit. Data dianalisis menggunakan uji t-test independent dan korelasi Spearmen. Hasil penelitian ini ditemukan ibu bersalin yang dimasase memiliki intensitas nyeri lebih rendah 29.62 point dari pada yang tidak dimasase nilai p=0.001, ada pengaruh masase terhadap intensitas nyeri kala I persalinan normal. Ibu bersalin yang dimasase memiliki endorfin lebih tinggi dari pada yang tidak dimasase sebesar 142.82 pcg/mlnilai p=0.001 ada pengaruh masase terhadap kadar endorfin ibu bersalin normal. Ada korelasi kadar endorfin dengan penurunan intensitas nyeri dengan nilai r= 0,795 dan nilai p=0.001. Kesimpulan penelitian ini adalah masase pada punggung berpengaruh terhadap intensitas nyeri dan kadar endorfin ibu bersalin kala I fase laten persalinan normal serta kadar endorfin berkorelasi dengan intensitas nyeri kala I fase laten persalinan normal.Kata kunci: masase pada punggung, intensitas nyeri, kadar endorfin.

AbstractPain in delivery is a physiological process. About 12% - 67% of women feel the pain during delivery. One of the ways to reduce pain during delivery process is to massage mother’s back. The objective of this research was to determine the effect of massage on the back to the pain intensity in normal delivery based on the level of endorphin. This study was an experimental study with post test only control group design by massaging mother’s back in normal delivery process of primiparous phase I for 30 minutes. Data collection was done for three months. The subject were choosen randomly block with 52 respondents. Data processing was done based on the Independent t-test and Spearmen Correlation. The results of this study shows that mothers who have massage on the back before delivery process, feel lower pain intensity in 29.62 points than those who do not have massage. The result of statistical test was p =0.001, so, the massage reduces the pain intensity. Mothers who have massage, get their endorphin increased as much as 142.82 PCG/ml compared to mothers who did not have massage. There was a correlation between the increase of endorphin level with the reduction of pain intensity. The result of

statistical test shows that there is a strong correlation between the endorphin level with pain intensity with a value,r=0.795andp=0.001. It can be conluded that massage on the back can reduce pain intensity in normal delivery and increase the leve lof endorphin. Furthemore, there is a strong correlation between the increase of endorphin level with pain intensity in normal delivery. It is recommended that massage on the back can be done regularly in every normal delivery. Keywords: massage on the back, pain intensity, level of endorphin

Nonpharmacologic relief of pain during labor: Systematic reviews of five methodsCited in Scopus: 109

Penny P. Simkin, MaryAnn O'Hara

American Journal of Obstetrics and Gynecology, Vol. 186, Issue 5, S131–S159

Published in issue: May 2002

Nonpharmacologic measures to reduce labor pain have been used throughout history. Despite reports that some of these methods reduce pain, increase maternal satisfaction, and improve other obstetric outcomes, they have received limited attention in the medical literature and are not commonly available to women in North America. The controlled studies of nonpharmacologic methods are limited in number and sometimes provide conflicting results. This systematic review was conducted to assess the safety and efficacy of the best studied techniques, as well as to highlight areas in need of further research. Five comfort measures were selected for review, based on these criteria: they have been evaluated with prospective controlled studies and they require institutional support (eg, skills, policies, equipment). These 5 methods included continuous labor support, baths, touch and massage, maternal movement and positioning, and intradermal water blocks for back pain relief. An extensive search of electronic databases and other sources identified studies for consideration. Critical evaluation of controlled studies of these 5 methods suggests that all 5 may be effective in reducing labor pain and improving other obstetric outcomes, and they are safe when used appropriately. Additional well-designed studies are warranted to further clarify their effect and to evaluate their cost effectiveness. (Am J Obstet Gynecol 2002;186:S131-59.)

Epidural analgesia is used by more than half of laboring women, yet there is no consensus about what unintended effects it causes. To evaluate the state of our knowledge, we performed a systematic review of the literature examining the unintended maternal, fetal, and neonatal effects of epidural analgesia used for pain relief in labor by low-risk women. Our review included randomized and observational studies appearing in peer review journals since 1980. Much of the evidence is equivocal. Existing randomized trials are either small or do not allow clear interpretation of the data because of problems with protocol compliance. In addition, few observational studies control for the confounding factors that result because women who request epidural are different from women who do not. There is considerable variation in the association of epidural with some outcomes, particularly those that are heavily practice-based. Despite this variation, there is sufficient evidence to conclude that epidural is associated with a lower rate of spontaneous vaginal delivery, a higher rate of instrumental vaginal delivery and longer labors, particularly in nulliparous women. Women receiving epidural are also more likely to have intrapartum fever and their infants are more likely to be evaluated and treated for suspected sepsis. There is insufficient evidence to determine whether epidural does or does not tend to increase the risk of cesarean delivery or fetal malposition. Adverse effects on the fetus may occur in the subset of women who are febrile. Women should be informed of unintended effects of epidural clearly supported by the evidence, especially since epidural use is almost always an elective procedure. Further research is needed to advance our understanding of the unintended effects of epidural. Improved information would permit women to make truly informed decisions about the use of pain relief during labor. (Am J Obstet Gynecol 2002;186:S31-68.)

Acupuncture for labor pain management: A systematic reviewCited in Scopus: 46

Hyangsook Lee, Edzard Ernst

American Journal of Obstetrics and Gynecology, Vol. 191, Issue 5, p1573–1579

Published in issue: November 2004

Acupuncture is widely used to alleviate symptoms in a variety of painful conditions. In obstetrics and gynecology, acupuncture has also been applied to a range of conditions including labor pain. This systematic review aims to critically evaluate the evidence on analgesic effect of acupuncture during labor. Computerized literature searches of 7 databases were performed for randomized clinical trials (RCTs) of acupuncture involving needle insertion for pain during labor. Three RCTs were identified and their methodologic quality was generally good. Two RCTs compared adjunctive acupuncture with usual care only and reported a reduction of meperidine and/or epidural analgesia. One placebo acupuncture controlled trial showed a statistically significant difference in both subjective and objective outcome measures of pain. No adverse events were reported in any of the trials. It is concluded that the evidence for acupuncture as an adjunct to conventional pain control during labor is promising but, because of the paucity of trial data, not convincing. Further research is warranted to clearly define its place in labor pain management.