The Effect of Effleurage Massage Technique on Pain Changes in

PostPartum at Salewangang Regional Public Hospital of Maros

Julia Fitrianingsih1, Ayu Lestari2, Nurhidayat Triananinsi3

1
Doctoral program, Faculty of Public health science, Hasanuddin University, Makassar
2
Nursing Study Program, Midwifery and Nursing Faculty of Megarezky University
3
Midwifery Study Program, Midwifery and Nursing Faculty of Megarezky University
[email protected]

Abstract
The aim of research is to investigate the effect of effleurage massage technique on pain changes in
postpartum at Salewangang Regional Public Hospital of Maros. Uterine contraction pain is a sensory
and uncomfortable feeling in normal postpartum due to uterine involution after removal the fetus.
The recommended technique for dealing with uterine contraction pain in the postpartum period by
doing effleurage massage technique which is non-pharmacological therapy. This research used a
quantitative method namely pre-experimental analytic research design withone-group pretest-
posttest. The sampling technique used purposive sampling, total respondents were 20 respondents.
Research instrument used the Numeric Rating Scale (NRS) pain scale observation sheet. Result of T-
Dependent test was obtained Pvalue = 0.000, it means that there is an effect of effleurage massage
technique on pain changes in postpartum

Keywords : Effleurage massage technique and pain changes, postpartum

INTRODUCTION
The introduction of the paper, Pain is a subjective sensory and unpleasant emotional experience
related to actual, potential or perceived tissue damage in events when damage occurs. Pain is caused
by uterine contraction requires various handling to minimize the pain felt by mother so that their
comfort can be felt. The role of a nurse in that condition is to help to relieve postpartum maternal
pain by providing intervention in pain relief(1,2).
Pain management strategy is an action to reduce pain, which can be done by pharmacological
and non-pharmacological therapy. Nonpharmacological therapy can be done by massage therapy to
mothers called effleurage massage technique.(3,4)
Effleurage is a massage using palms that pressure on surface of body in a circular direction
repeatedly.(3,5) This technique aims to improve blood circulation, make pressure on, and warm the
abdominal muscles also increase physical and mental relaxation. It is a massage technique that is
safe, easy to do, does not require a lot of equipment, no spend more cost, has no side effects and can
be done alone or with helping others.(5,6) The main action of effleurage massage is the application of
Gate Control theory that can "close the gate" to inhibit the circulation of excitatory pain at the higher
center in the central nervous system.(4,5)
The steps to do this technique are both palms sweeping lightly, firmly and constantly with a
circular abdominal movement pattern, starting from the lower abdomen on pubic symphysis, pointing
to the side of abdomen, continuing to the uterine fundus then get down to the umbilicus and back to
the abdomen the lower part, on the pubic symphysis.(4,6) the shape of movement pattern is like a
"butterfly". Repeat the movements above for 3-5 minutes and give extra lotion or oil / baby oil if it is
needed.(4,5)
Medical record data at Salewangang Regional Public Hospital of Maros in 2017, there were
1,356 mothers gave birth in 2015, gave birth 963 (71.01%) and Section of Cessarea (28.98%).
Whereas in 2016 (January - July) 776 normal delivery was 568 (73.19%) and SC 208 (26.80%).
(Medical Record Data of Salewangang Regional Public Hospital of Maros in 2017).

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The result of a preliminary studieswas conducted in February 2017 at Salewangang Regional Public
Hospital of Marosfrom 7 normal postpartum is obtained data that all mothers experienced pain in the
first day, 2 mothers experienced pain during> 3-4 hours postpartum and 5 motherswhen > 1-2 hours
postpartum. Characteristics felt by postpartum in the first day are heartburn in the lower abdomen with
a scale of 4-5 which means medium pain. Pain in uterine contractions that are felt arises when mother
is silent and does activities. Duration of pain felt by mother ranges from 1-5 minutes. Pain
management performed by mother is to do deep breathing technique, distraction by walking,
slowlyactivity, and silent for a momen.

VIII. METHODS
Types of research used Experiment through Quasi Experimental. The aim was to investigate
whetherthere is or no an effect of effleurage massage technique on pain changes in postpartum.

IX. RESULT
The results section is where you report the findings of your study based upon the The stage
was carried out the distribution analysisof the percentages of variables referred to general
characteristics of respondents such as: age, education, and occupation that can be seen in the table
following:

a. Frequency distribution based on age

Table 4.1
Frequency distribution based on the age of respondents in the maternity ward at
Salewangang Regional Public Hospital of Maros in 2017
Age Frequency (f) Percentage (%)

<20 and>35 years 7 35

20 – 35 years 13 65

Total 20 100

Source : Primary Data 2017.

Table 4.1 showed 20 respondents as sample including 7 respondents (30%) whose age <20
years and >35 years, and 13respondents (65%) whose age of 20-35 years old.

b. Distribution of frequency based on education

Table 4.2
Frequency distribution based on respondents education in the maternity wardat Salewangang
Regional Public Hospital of Maros in March 2017
Education Frequency (f) Percentage (%)

Elementary 9 45
(Elementary and Junior High School)
Higher 11 55
(Senior High School and University)
Total 20 100

Source : Primary Data 2017

Table 4.2 described 20 respondents as sample including9 respondents (45%) had graduated
from elementary school, 11 respondents (55%) had graduated from senior high school and
university.

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c. Frequency of distribution based on occupation
Table 4.3
Frequency of distribution based on respondents’ occupation in maternity wardat Salewangang
Regional Public Hospital of Maros in March 2017
Occupation Frequency (f) Percentage (%)

Housewife 17 85

Private 3 15

TOTAL 20 100

Source : Primary Data 2017

Table 4.3 described there were20 respondents as sample including17 respondents (85%) were
housewives and 3 respondents (15%) were private.

d. Frequency distribution based on parity

Table 4.4
Frequency distribution based on the parity of respondents in the maternity ward at
Salewangang Regional Public Hospital of Maros in 2017
Criteria Frequency (f) Percentage(%)

Primiparous 9 45

Multiparous 11 55

Total 20 100

Source : Primary Data 2017

Based on table above , the result of data was obtained of maternity. There were 9 respondents
(45%) who were primiparous. While 11 respondents (55%) were multiparous
e. Pain of Uterine Contraction before Effleurage technique
Table 4.5
List of frequency distribution based on average of uterine contraction pain
Pre effleurage massage technique in the maternity room at Salewangang Regional
Public Hospital of Maros
Average of uterine Frequency (f) Percentage(%)
contraction pain
Mild pain 2 10

Medium pain 16 80

Intense pain 2 10

TOTAL 20 100

Source : Primary Data 2017

As showed in Table 4.5, there were 2 respondents (10%) who got mild pain. Then, there were 16
respondents (80%) who got medium pain. Next, there were 2 respondents (10%) who got intense
pain.
f. Pain of Uterine Contraction post effleurage technique
Table 4.6

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 The frequency distribution based on the average pain of uterine contractions post
effleurage massage technique in maternity ward at
Salewangang Regional Public Hospital of Maros in 2017
Average of uterine Frequency (f) Percentage (%)
contraction pain
Mild pain 13 65

Medium pain 7 35

TOTAL 20 100

Source : Primary Data 2017

As described in Table 4.6, there were 13 respondents (65%) who got mild pain. Then, there were
7 respondents (35%) who got medium pain.

2. Bivariate Analysis
Hypothesis
Both of datathat had been collected then analyzed by using the Mann Whitney Test . This test
was used to investigate the effect of effleurage massage technique before and after taking action at
Salewangang Regional Public Hospital of Maros. Here were the result of normality test.

Table 4.8
Tests of normality
Treatment of Kolmogorov-smirnovb
Effleurage
Massage Statistics Df Sig.

Pre 0.385 3 .

Post 0.181 10 0.200

0.349 5 0.046

Because data were not distributed normal, so hypothesis of this research used parametric test
by analysis of Mann whidney test.
Tabel 4.9
The frequency distribution of pre-post Effleurage Technique
on Pain Changes to Postpartum
Effleurage technique N Mean Sum p=0,05
Pre test 20 27.60 552.00 0,000
Post test 19 12.00 228.0
Total 39
As showed in table 4.9, it described pre natal using effleurage technique. There was 27.60 mean,
552.00 sum before effleurage technique. Then there was 12.00 mean, 228.0 sum and p-value=0.000
after effleurage technique. It meant that there was effect of effleurage technique on pain changes to
postpartum at Salewangang Regional Public Hospital of Maros.

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X. DISCUSSION
Researcher explained discussion of researchabout the effect of effleurage technique on pain changes
to postpartum at Salewangang Hospital of Maros in 2017.
This research aimed to investigate the effect of effleurage technique on pain changes to postpartum
and the level of uterine contraction pain pre and post effleurage technique. This research was
conducted as many as 20 postpartum as respondents in the first day 0-2 hours after parturition that
experienced pain of uterine contractions. This research was conducted by observing the pain of
postpartum using an observation sheet with a numeric scale. This research was influenced by the
characteristics of respondents based on age, education, occupation, and parity classification.
Table 4.4 showed that data was more than half (55%) categorized as multiparaous in the
parity classification. Women in the multiparous had the most pain scale. The average pain scale
was 6 (as medium to intense pain), whereas in the primiparous , it was obtained average of 5
(medium pain). Stated that parity factor has a quite important role.(7,15)
Pain of uterine contractions increased significantly after the baby came out. It caused by produced
of oxytocinhormone with the pituitary gland so that it can strengthen and regulate uterine
contractions.(11,13) Pretest is done before giving intervention of effleure massage technique by
observing and showing numeric rating scale (NRS) so that it was obtained by pain scalebased on
postpartum pain. Researchers did 20 respondents in pre-test during 2 hours after postpartum. It was
obtained by several pain scales would be added in order to find the result ofaverage scales.
An univariate analysis described frequency distribution based on pain of uterine contractions after
effleurage massage technique that explained in table 4.6, there was less than half (65%) of
postpartum experienced contractionary pain with an average mild pain scale (1-3). Pain experienced
by postpartum after effleurage massage technique was on the range of medium pain scale (4-6). The
pain scale (4-6) was the highest level of pain felt by the postpartum when did posttest.
The result of observation found that the highest pain scale was experienced by mothers who
experienced the highest pain scale when did pretest so that it decreased that not far from the result
of pretest. Other respondents who experienced the highest pain scale when did posttest that
experienced by primiparous mothers who did not experience any decline after doing intervention.
The lowest pain scale was 1 pain scale, because they experienced pain with the lowest scale when
they did pretest so that it decreased with a low pain scale too.

XI. CONCLUSION
Based on research and data analysis from pre and post effleurage massage technique in
postpartum using Mann Whitney test method, it can be concluded that there is an effect of
effleurage massage technique on pain changes in postpartum at SalewangangRegional Hospital
of Maros

REFERENCES

Marziyeh B, Asl H, Vatanchi A, Golmakani N, Najafi A, Hospital G. Electronic Physician ( ISSN :

2008-5842 ). 2018;(January):6240–8.
Mccauley M, Stewart C, Kebede B. A survey of healthcare providers ’ knowledge and attitudes
regarding pain relief in labor for women in Ethiopia. 2017;1–6.
Moraska A. Sports massage : A comprehensive review. 2014;(May).
Weerapong P, Hume PA, Kolt GS. The Mechanisms of Massage and Effects on Performance ,
Muscle Recovery and Injury Prevention. 2005;35(3):235–56.
135
Portillo-soto A, Eberman LE, Demchak TJ, Peebles C. Comparison of Blood Flow Changes with
Soft Tissue Mobilization and Massage Therapy. 2014;20(12):932–6.
Santiasari RN, Nurdiati DS, Lismidiati W, Saudah N. Health Notions , Volume 2 Number7 ( July
2018 ) Effectiveness of Effleurage and Counter-Pressure Massages in Reducing Labor Pain
721 | Publisher : Humanistic Network for Science and Technology Health Notions , Volume
2 Number7 ( July 2018 ) ISSN 2580-4936 722 | Publisher : Humanistic Network for Science
and Technology. 2018;2(July):2016–9.
Boucar M, Hill K, Coly A, Djibrina S, Saley Z, Sangare K, et al. Improving postpartum care for
mothers and newborns in Niger and Mali : a case study of an integrated maternal and
newborn improvement programme. 2014;127–33.
Carroll M, Daly D, Begley CM. The prevalence of women ’ s emotional and physical health
problems following a postpartum haemorrhage : a systematic review. BMC Pregnancy
Childbirth [Internet]. 2016; Available from: http://dx.doi.org/10.1186/s12884-016-1054-1
Gingnell M, Toffol S, Wikström J, Engman J, Bannbers E, Sundström-poromaa I. Emotional
anticipation after delivery – a longitudinal neuroimaging study of the postpartum period.
2017;(October 2016):1–6.
Jahangard L, Mikoteit T, Bahiraei S, Zamanibonab M, Haghighi M, Bahmani DS, et al. Prenatal
and Postnatal Hair Steroid Levels Predict Post-Partum Depression 12 Weeks after Delivery.
2019;
Yim IS, Stapleton LRT, Guardino CM, Hahn- J, Schetter CD, Behavior S, et al. Depression :
Systematic Review and Call for Integration. 2017;99–137.
Sazliyana S, Id S, Shahrir M, Said M, Mohd R. Predictors of SLE relapse in pregnancy and post-
partum among multi-ethnic patients in. 2019;1–16.
Mannion CA, Vinturache AE, Mcdonald SW. The Influence of Back Pain and Urinary
Incontinence on Daily Tasks of Mothers at 12 Months Postpartum. 2015;532:1–18.
Stephen CP, Johnson WH, Leblanc SJ, Foster RA, Chenier TS. The impact of ecbolic therapy in
the early postpartum period on uterine involution and reproductive health in dairy cows.
2019;491–8.
A L T E R A T I O N I N T H E C O L L A G E N C O N T E N T OF T H E H U M A N
UTERUS DURING PREGNANCY AND POST PARTUM BY THOMAS G . MORRIONE
, M . D ., AND SAM SEIFTER , PH . D . ( From the Department of Pathology , Long Island
College Hospital , Brooklyn , and the Department of Biochemistry , Albert Einstein College
of Medicine , Yeshiva University , New York ) ( Received for publication , October 13 ,
1961 ) The physiological resorption of collagen during recovery from experimental cirrhosis
was demonstrated in 1947 ( 1 ). Factors which influence the deposition and disappearance of
collagen in experimental cirrhosis , as well as the phenome- non of the regression of scar
tissue , were examined subsequently ( 2 , 3 ). A striking resorption of collagen from the rat
uterus following parturition was described b y Harkness and Harkness in 1954 ( 4 ). Later
these authors ( 5 ), and Hark- ness and Moralee ( 6 ), suggested that the post p a r t u m
uterus is especially suitable for investigation of the physiological dissolution and catabolism
of endogenous collagen . The present study was undertaken to determine the alterations in
the nature and content of collagen occurring in the myometrium of the h u m a n uterus

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during pregnancy and the post p a r t u m involutionary period . Materials and Methods
Specimens . --Human uteri were obtained from patients undergoing hysterectomy , caesarian
hysterectomy , or at autopsy . Some specimens were analyzed immediately after removal and
others were kept in the frozen state at --20 ° C and analyzed subsequently . The cervix was
excluded from the present study . Scars from previous caesarian sections , when recognized
in the gross , were excised and excluded from specimens chosen for analysis . Before being
employed for preparation of enzyme extracts or for chemical study , uteri were trimmed free
of endometrium , decidua , and blood clots . Histological Examination . --Sections of uteri
were prepared after fixation in formalin , formalin-mercury bichloride , and Zenker ’ s
solutions . Stains used were hematoxylin and eosin , Masson trichrome , van Gieson ’ s ,
Laldlaw ’ s reticulum , Schiff-McManus , Hales ’ colloidal iron , Sudan III , alcian blue-
chlorantine red , and luxol fast blue-periodic acid-Schiff . Fat-Free Dry Wdght . --Allquots of
minced uterine tissue were extracted for two 24 hour periods with i00 volumes of acetone
and then again by two slrnilnr treatments with ether . The materials were finally dried t….
1961;357–65.

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