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1483
THE EFFECT OF THE USE OF BIRTHING BALL ON PAIN REDUCTION
IN WOMEN IN PMB YUYU YULIYATI, S. ST
Ayu Idaningsih¹, Yuyun Wahyu², Mitha Annisa Royani³
Faculty of Health, University of YPIB Majalengka, Indonesia¹,²,³
Email : ayuidaningsih2011@gmail.com, indah.yani08@gmail.com, annisamitha337@gmail.com
ARTICLE INFO
ABSTRACT
Date received : 10 August 2022
Revision date : 16 August 2022
Date approved : 25 August 2022
Introduction. Pain in labor can be overcome pharmacologic and
non-pharmacologic to prevent excessive pain. One effort to
reduce pain in labor is to use the birthing ball technique.
Destinations. This study aims to determine the effect of using
the birthing ball technique on reducing pain in labor. Methods.
In this study, the researcher used a pre-experimental research
design using a one-shot case study design. The sample of this
study was 15 people according to the interpretation of
childbirth carried out in March - May 2022 at PMB Yuyu Yuliyati
S.ST. Univariate and bivariate analysis in this study used
computer assistance with a software program (SPSS). Results
and Conclusions. The results showed that the pain scale before
the birthing ball was done on average 6.93 and after the
birthing ball was done the average was 4.60. This shows the
effect of the use of birthing balls on reducing pain in mothers
giving birth at PMB Yuyu Yuliyati, S. ST with (p-value = 0.00).
In this study, it was proven that the use of birthing balls in
laboring mothers had an effect on reducing pain, so the use of
birthing balls could be used as complementary midwifery care
in the labor process as an effort to reduce pain during labor
and can add knowledge and insight and can be used as a
reference for further research.
Keywords: labor; pain
reduction; birth ball.
This work is licensed under CC BY-SA 4.0
INTRODUCTION
Maternal health is currently still a problem in several countries, especially
developing countries, mothers still have a high risk when giving birth. This situation has
prompted the international community to commit to addressing problems in maternal
health. This commitment is realized by including maternal health as one of the targets in
the development of "Healthy Indonesia" (Ministry of Health, 2018).
Maternal Mortality Rate is the number of maternal deaths resulting from the
process of pregnancy, childbirth and postpartum which is used as an indicator of women's
The Effect of Birthing Ball Use on Pain Reduction in Maternal Maternity in PMB Yuyu Yuliyati, S.
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health status. The Maternal Mortality Rate (MMR) is one of the global Sustainable
Development Goals (SDGs) targets in reducing the Maternal Mortality Rate (MMR) to 70
per 100,000 live births in 2030. The maternal mortality rate (MMR) in the world is 303,000
people (WHO, 2010). 2019). The Maternal Mortality Rate (MMR) in ASEAN is 235 per
100,000 live births (ASEAN Secretariat, 2020). According to the Indonesian Demographic
and Health Survey (IDHS) data, the maternal mortality rate (MMR) in Indonesia increased
from 228 per 100,000 live births in 2002-2007 to 359 per 100,000 live births in 2007-
2012. The Maternal Mortality Rate (MMR) decreased in 2015-2016 to 305 per 100,000
live births and the number of maternal deaths in Indonesia in 2019 was 4,221 cases
(Kemenkes RI, 2019). The number of maternal mortality rates (MMR) in West Java is 735
cases (Kemenkes RI, 2020). According to the results of the Maternal and Child Health
and Family Planning Human Development Cadre (KPM KIA KB) of the Majalengka District
Health Office, the number of maternal deaths reached 25 cases with a maternal mortality
rate of around 126.03 per 100,000 live births (Majalengka District Health Office, 2021).
To reduce the Maternal Mortality Rate (MMR) it is necessary to have related efforts, one
of which is to ensure that every mother is able to access quality maternal health services,
such as health services for pregnant women, delivery assistance by trained health workers
in health care facilities, postpartum care for mothers. and infants, special care and referral
in case of complications, ease of obtaining maternity and maternity leave and family
planning services.
Labor is a physiological process that allows a series of major changes in the mother
to be able to give birth to her fetus through the birth canal (Astari, 2016). The feelings
that arise as a result of childbirth include pain, anxiety, worry, fear and happiness.
However, pain caused by childbirth is a natural thing that can occur in maternity because
physiologically pain occurs when the uterine muscles contract in an effort to open the
cervix and push the baby's head towards the pelvis. Various attempts have been made
to reduce pain in childbirth both pharmacologically and non-pharmacologically to prevent
excessive pain. Pharmacological pain management is more effective than non-
pharmacological methods. However, pharmacological methods are more expensive and
can cause adverse effects and not all health facilities provide these services. In terms of
the risk of non-pharmacological methods there are no clinical risks or side effects. In
addition to the description above, there are also efforts to reduce pain in labor, namely
by using the birthing ball technique. Birthing ball is a physical therapy or simple exercise
using a ball, where the exercise is applied to pregnant women, mothers giving birth and
postpartum mothers. Indications for the use of a birthing ball are to relieve pain in
parturient mothers, for prolonged opening and for lowering the old baby's head (Kustari,
2012).
The Effect of Birthing Ball Use on Pain Reduction in Maternal Maternity in PMB Yuyu Yuliyati, S.
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Birthing ball is a physical therapy ball that helps inpartu mothers in the first stage
of labor progress which can be used in various positions. One of the movements is by
sitting on the ball and rocking to make you feel comfortable and help the progress of
labor by using gravity while increasing the release of endorphins because the elasticity
and curvature of the ball stimulate the receptors in the pelvis that are responsible for
secreting endorphins (Kartini, 2017). The use of a birthing ball during labor during the
first stage of the active phase can reduce the level of pain because it can stimulate
postural reflexes and maintain the muscles and keep the spine posture in good condition,
so that it can help the process of lowering the fetal head into the pelvic cavity, reducing
the length of the first stage, accelerate cervical dilation and facilitate labor (Raidanti,
2021).
According to research conducted by (Indrayani & Riyanti, 2019) Bekasi, it shows
that there is a significant difference in pain scores before and after using the birthing ball,
namely the p-value obtained is 0.019. then the p-value <0.05 so it can be concluded that
the use of birthing balls during labor can reduce pain scores in labor. Based on a
preliminary survey in December 2021 at the Independent Midwife Practice (PMB) Yuyu
Yuliyati, S.ST, it was found that the population of mothers giving birth in December 2021
was 12 people recorded in the delivery bag. Researchers have observed 10 respondents
who were taken at random, it was found that 8 out of 10 mothers giving birth during the
first stage of the active phase experienced severe pain marked by the mother being
unable to follow orders but the client was able to respond well to the actions given and
the other 2 experienced moderate pain. marked by the mother can show the location of
the pain, the mother can follow orders well. The samples taken in the preliminary survey
have never used the birthing ball technique (Noviyanti et al., 2021).
Due to the high incidence of labor pain in laboring mothers and to smooth the
delivery process and prevent the increase in the Maternal Mortality Rate (MMR) in
Majalengka Regency, with this, researchers will conduct complementary midwifery care
interventions with birthing ball techniques to determine the effect of using birthing balls
on pain reduction. for mothers giving birth at PMB Yuyu Yuliyati, S.ST with the aim of
reducing morbidity during childbirth, facilitating childbirth and preventing the increase in
the Maternal Mortality Rate (MMR) in Majalengka Regency (Anggraeni et al., 2021). Based
on this background, the researchers are interested in conducting research on "The Effect
of using a birthing ball on reducing pain in mothers giving birth at PMB Yuyu Yuliyati,
S.ST". The purpose of this study was to determine the effect of the birthing ball on
reducing pain in women giving birth at PMB Yuyu Yuliyati, S. ST.
The Effect of Birthing Ball Use on Pain Reduction in Maternal Maternity in PMB Yuyu Yuliyati, S.
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METHOD
In this study, the researcher used a pre-experimental research design using a one-
shot case study design. The design begins by observing labor pain before using a birthing
ball, then after using a birthing ball. To see a comparison of the use of birthing balls, to
decrease pain in laboring mothers (Notoatmodjo et al., 2018).
The population in this study were all mothers giving birth in the first active phase
at PMB Yuyu Yuliyati, S.ST which based on the interpretation of childbirth in March - May
2022 amounted to 20 people. In taking the sample the researcher has 2 criteria that have
been made by the author. The sample in this study was 15 people based on the
interpretation of labor without a control group (Puteri, 2020).
RESULTS AND DISCUSSION
Table 1.
Distribution of Pain Frequency in Maternal Maternity Before Using
Birthing Ball at PMB Yuyu Yuliyati, S.ST
Based on table 1, it shows that the average pain scale before the birthing ball is
6.93 with a median of 7.00 and a standard deviation of 1.09. The lowest pain scale was
obtained at 5 and the highest 8. According to the 95% CI results, it is believed that the
pain scale for maternity mothers at PMB Yuyu Yuliyati, S.ST is between 1.68-4.01.
Table 1.
Frequency Distribution Pain in Maternal Maternity After Using
Birthing
Ball
at PMB Yuyu Yuliyati, S.ST
Frequency of
Pain in
Maternity
mean
median
Min
-
Max
95%
CI
Before Doing
Birthing Ball
6.93
1.09
5-8
1.68-
4.01
Frequency
of Pain in
Maternity
mean
medi
an
SD
Min-
Max
95%
CI
After Doing
Birthing Ball
4.60
5.00
0.63
4-6
1.59-
3.79
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Based on table 2, it shows that the pain scale after the
birthing ball
with the
average is 4.60, the median is 5.00 and the standard deviation is 0.63. The lowest pain
scale was obtained at 4 and the highest was 6. According to the results of 95% CI, it is
believed that the pain scale in childbirth at PMB Yuyu Yuliyati, S.ST is between 1.59-3.79.
Table 3.
The Effect of Birthing Ball Use on Pain Reduction in Maternal Maternity
in PMB Yuyu Yuliyati, S.ST
Based on table 3, it shows that the average pain scale before the birthing ball is
6.93, the average pain scale after the birthing ball is 4.60. This means that there is a
change or decrease of 2.33. Statistically with paired t test obtained value = 0.00 which
means value < (0.05) thus the use of birthing balls has an effect on reducing pain in
maternity mothers at PMB Yuyu Yuliyati, S. ST.
DISCUSSION
Univariate Analysis
Based on the results of the study, it showed that the average pain scale before
the
birthing ball was performed
of 6.93. This shows that the pain felt by the mother giving
birth at PMB Yuyu Yuliyati, S.ST is very painful. In accordance with (Afroh et al., 2012)
explaining that the pain scale is very sick objectively the mother cannot follow orders but
still responds to actions, can show the location of pain, cannot describe and cannot be
overcome by changing positions, taking deep breaths and distractions.
Cause of labor pain is the movement of uterine contractions causing the muscles
of the uterine wall to contract, pinch the blood vessels causing pain. The vagina (birth
canal) and the soft tissues around it stretch, causing pain. There are still maternity
Reduction
of Pain in
Maternity
mean
N
SD
value
Before
Doing
Birthing
Ball
6.93
15
1.09
0.00
After Doing
Birthing
Ball
4.60
15
0.63
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mothers who feel very painful labor pains that can cause anxiety and unpreparedness for
childbirth, so the efforts made to reduce pain in maternity mothers are to carry out
complementary midwifery care for mothers in active phase I birth using the
birthing ball
technique
(Irawati et al., 2019)
.
The average pain scale after birthing ball was 4.60. This
shows that the pain felt by the mother giving birth at PMB Yuyu Yuliyati, S.ST is classified
as moderate pain. Based on the theory (Afroh et al, 2012) explains that the moderate
pain scale is objectively the mother can hiss, grin, can show the location of pain, can
describe it and can follow orders well.
If you look closely, actually the
birthing ball movement
contains a relaxing effect
that can stabilize the emotions of the mother giving birth and can make her feel
comfortable and happy when she does it. Through
birthing ball
mothers who give birth
will be taught how to reduce anxiety and reduce fear by means of physical relaxation, as
well as get information that prepares them to experience what will happen during labor
and birth. In addition, the
birthing ball technique
is very good to strongly encourage the
mother's energy needed during childbirth, the upright posture helps the fetus in the
optimal position, making it easier to give birth normally.
Bivariate Analysis
Based on the results of the study, it was shown that the use of
birthing balls
to
reduce pain in women giving birth at PMB Yuyu Yuliyati, S. ST (
value
= 0.00). The
influence of this is because the
birthing ball
technique can reduce labor pain and provide
a sense of comfort and calm to the mother in labor, while also strengthening the muscles
of pregnant women so that pregnant women in facing labor become more prepared, less
anxious and delivery becomes smooth.
The results of this study are in line with the theory that the birthing ball
movement
is
useful to help reduce labor pain, help uterine contractions more effectively and
accelerate the descent of the baby through the pelvis.
The pressure of the baby's head on the cervix remains constant when the mother
gives birth in an upright position so that the cervix dilates quickly. The pelvic muscle
ligaments relax and the pelvic area becomes wider, making it easier for the baby to
descend to the pelvic floor. In this context, the use of the Swiss ball allows the woman
to take different positions, also before and after the use of epidural anesthesia (Kustari,
2012).
In this study, it was proven that the use of
birthing balls
in maternity had an effect
on reducing pain , therefore the Independent Midwife Practice (PMB) Yuyu Yuliyati , S.
ST can make
birthing balls
as complementary midwifery care during labor as an effort to
reduce pain during labor, overcome anxiety, relax more easily, facilitate labor and reduce
pressure on the
sacroiliac joints.,
blood vessels around the uterus and pressure on the
The Effect of Birthing Ball Use on Pain Reduction in Maternal Maternity in PMB Yuyu Yuliyati, S.
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Indonesian Journal of Multidisciplinary Science
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bladder, back, waist, tailbone and can reduce pressure on the perineum (Erniyati & Putri,
2012).
CONCLUSION
Based on the results of research on the effect of the use of birthing balls on
reducing pain in childbirth at the Independent Midwife Practice (PMB) Yuyu Yuliyati, S.ST,
it can be concluded that the average pain before doing the birthing ball for mothers giving
birth at the Independent Midwife Practice (PMB) Yuyu Yuliyati, S.ST was 6.93, the
average pain after birthing ball for mothers giving birth at the Independent Midwife
Practice (PMB) Yuyu Yuliyati, S.ST was 4.60. There is an effect of using a birthing ball on
the reduction of pain in maternity at the Independent Midwife Practice (PMB) Yuyu
Yuliyati, S.ST, ( value = 0.00).
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