International Journal of Community Medicine and Public Health

Darma IY et al. Int J Community Med Public Health. 2020 Dec;7(12):4745-4748

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

Original Research Article DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20205144

The effect of the implementation active birth technique using

hypnobirthing accelerated the progress of the first stage
of labor among intrapartum mother
Ika Yulia Darma*, Nurul Abdillah, Meldafia Idaman, Honesty Diana Morika

Department of Public Health, Syedza Saintika’s Health Science Institute, Padang, Indonesia

Received: 11 August 2020

Revised: 03 November 2020
Accepted: 07 November 2020

*Correspondence:
Dr. Ika Yulia Darma,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Problems in childbirth, including old labor, which is one of the causes of death for mothers and
newborns, is still widely found in Indonesia. Factors that influence labor to take longer are abnormal presentation,
inadequate contractions, birth canal abnormalities, multiple pregnancies and anemia. To deal with prolonged labor,
the UK has introduced active birth techniques. Hypnobirthing is one of the active birth methods that can be used
during the first stage of labor. This research purposes to study the effect of the application of the active birth
technique using hypnobirthing on the progress of the first stage of labor in the mother.
Methods: This type of research was quasi experimental with the post-test only design approach. This research was
conducted from 15 May to 18 August 2020, in 4 independent practice midwives (BPM) Padang City in 2020. Data
were collected through observation sheets using non-probability sampling techniques, namely purposive sampling
with a total sample of 15 samples. Data were collected using observation sheets. Data were analysed using univariate
and bivariate analysis using the dependent T-test.
Results: The results showed that the mean labor progress using hypnobirthing was 3.67 and SD±1.49 with a
minimum value of 1 and a maximum of 6. Based on the statistical test, the p value was 0.000 (p<0.05).
Conclusions: There is the effect of the application of active birth techniques using hypnobirthing on the progress of
stage I labor in maternal labor.

Keywords: Active birth, Intrapartum mother, The progress of the first stage of labor

INTRODUCTION cm to 8-10 cm. At this stage, cramp-like contractions pain

originating from distension of uterine tissue and cervical
Childbirth is a natural process. Physiologically, the dilation, spreading through the spinal cord to the
mother will experience contractions that cause cervical abdominal area and lumbosacral area. Since, most women
thinning and opening. This will cause the mother to feel describe pain during childbirth as the most intensive pain
pain and this pain is often perceived as the most intense they have ever experienced, effective labor pain
pain experience a mother has ever felt during her life.1 management remains an important aspect of intrapartum
care.2
There are 2 phases in the first stage of labor where the
latent phase is when the cervix is dilated from 0 cm to 3-4 According to data reports from WHO (2015), it was noted
cm and the active phase start when the cervix dilates 3-4 that every day in 2015 there were 830 mothers who died

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 Darma IY et al. Int J Community Med Public Health. 2020 Dec;7(12):4745-4748

due to complications of pregnancy and childbirth. WHO hypnobirthing that have been carried out by midwifery
also recorded MMR in Indonesia (2015) of 126/100,000 care during childbirth to help the old labor. 9 The
live births.3 advantages of active birth include the progress of labor,
reduced pain due to uterine contractions moving towards
The 2012 Indonesian health demographic survey (IDHS) the front of the uterus naturally and not against gravity,
noted that MMR in Indonesia was still high at increased energy in the second stage, less risk of perineal
359/100,000 live births. This figure is still quite high tear in stage II and the condition of the mother and baby
when compared to neighboring countries in the ASEAN is more optimal because it reduces medical therapy that
region. The latest data from the Ministry of Health (2016) can cause side effects in both.10 Hypnobirthing is one of
states that up to semester I in 2017 there were 1,712 cases the active birth methods that can be used during the first
of maternal death during childbirth.4 The high MMR stage of labor.
illustrates that the level of welfare of the people in
Indonesia is still low.5 Data released by the Directorate of Research conducted by Rohmah in Gombang on the
Maternal Health in 2012 shows that maternal mortality in application of the active birth technique using a birth ball
Indonesia is caused by several factors. These factors to the progress of labor, namely the progress of labor
include bleeding (30.1%), hypertension (26.9%), becomes 2-3 hours faster.11
infection (5.6%), prolonged labor (1.8%), abortion (1.6%)
and other causes (34.5%). Based on these data, prolonged Hypnobirthing is an exercise in planting suggestions to
labor is one of the factors contributing to the contribution the mother’s subconscious mind to support her conscious
of maternal mortality in Indonesia, even though the mind and control her actions in undergoing labor.
percentage is quite small. In Indonesia, there are still Hypnobirthing is done by making direct contact with the
many problems during childbirth, including old labor, subconscious. Hypnobirthing can help mothers feel
which is one of the causes of death for mothers and calmer in facing labor. Planting concepts and
newborns.4 understanding in the mother’s subconscious mind will
greatly help the smooth running of the birth process. A
Long labor (prolonged labor) is labor that lasts more than mother who is consciously unable to do anything can let
24 hours for primiparous, and more than 18 hours for the subconscious work to calm her down and help her
multiparous, the problem that occurs in long labor is a through labor, except for the pushing stage which must be
latent phase of more than 8 hours, labor has lasted more done consciously. Hypnobirthing consists of various
than 12 hours but the baby has not been born, dilated relaxation techniques that mothers can use during
cervix to the right of the line alerts us to active phase childbirth. This relaxation technique is very useful for
labor.6 reducing pain and emotional stress during labor.12

Factors that influence labor to take longer are abnormal Hypnobirthing is a technique used to overcome the fear of
presentation, inadequate contractions, birth canal childbirth. Based on deep relaxation, breathing, and
abnormalities, multiple pregnancies and anemia. To deal visualization techniques, women are taught to trust their
with prolonged labor, the UK has introduced active birth bodies, regain confidence in their ability to give birth, and
techniques. The success of implementing the active birth free themselves from tension and pain. Using this
method in the UK is 46% born naturally with a kneeling technique, the mother who is about to give birth can
position 29%, a combination of 4 positions 28%, 23% left achieve a state of deep relaxation without losing touch
tilt, standing 9% and squatting 4%. More than 200 with reality. Maternity will produce endorphins that
midwives in the UK have implemented this method.7 reduce discomfort and pain intensity along with the need
for analgesics, while shortening the stage of labor.13
The active birth method in Indonesia has actually been
implemented as one of the care services in the delivery The research objective was to study the effect of the
process, namely in terms of mobilization which application of the active birth technique using
encourages the mother to choose the position that is hypnobirthing on the progress of the first stage of labor in
considered the most comfortable with the aim of the mother.
minimizing pain and can affect the length of the first
stage and second stage of labor, this is in accordance with METHODS
the standards of midwives according to WHO in 2010 in
terms of midwives as assistants for delivery. In general, This type of research is quantitative with a design. This
there are still many mothers who experience prolonged type of research is quasi experimental with a Post -test
period I and more mothers go through the first stage by Only Design approach 14. The research was conducted in
lying in bed because they cannot stand the pain of 4 independent practice midwives (BPM) Padang city.
contractions and some patients for other reasons.8 Conducted on 15 May-18 August 2020. The population in
this study were all mothers giving birth at the midwife
Methods that can be used in the active birth technique are independent practice in Padang City with a full-term
taking walks, tilting to the left, mobilizing, mentoring gestation ≥37-42 weeks with no pregnancy complications.
husbands, yoga, warm cold compresses, birth balls and The sampling technique used non probability sampling,

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 Darma IY et al. Int J Community Med Public Health. 2020 Dec;7(12):4745-4748

namely purposive sampling. Data obtained using delivery process (stages I and II are smoother). The
observation sheets. The sample in this study were 15 results of research conducted by Mahmuda show that the
mothers with the treatment of hypnobirthing technique. hypnobirthing group has an average length of delivery of
Inclusion criteria were pregnant women with gestational 2.47 hours, this shows that the mother hypnobirthing is
age ≥37-42 weeks, stage I active phase (opening >4 cm), pregnant who gives birth faster than pregnant women
head presentation, no complications of pregnancy/ who are not doing hypnobirthing.16
mothers with complications (former secio caesarea, Mc
Donald >40 cm, maternal TB <145 cm, maternal blood In this study, performed by giving treatment to 10
pressure >140/90 mm/Hg, anemia mother), normal FHR. samples given hypnobirthing treatment. The treatment is
Data were collected using observation sheets. Data were given to mothers who are already in the active phase I
analyzed descriptively using univariate and bivariate phase.
analysis using the dependent T-test.
The factor that influences the length of labor is labor pain.
RESULTS Labor pain is a physiological condition, labor pain begins
to appear in the first stage of labor in the latent phase and
Based on Table 1, it was found that the mean progress of the active phase. The latent phase opens up to 3 cm,
labor using hypnobirthing was 3.67 and SD±1.49 with a lasting as long as 8 hours. Pain comes from uterine
minimum value of 1 and a maximum of 6 compared to contractions and cervical dilation, with increasing volume
the existing theory, the mean is 4.27 and SD±1.38 and the and frequency of uterine contractions, the pain you feel
minimum value of 2 and maximum 6. will get stronger, the peak of pain occurs in the active
phase, where the opening occurs from 3 cm to 10 cm and
Table 1: Average frequency distribution of the lasts for 6 hours. Pain that occurs can affect the condition
application of active birth techniques using of the mother in the form of fatigue, fear, worry and cause
hypnobirthing to the progress of first stage labor in stress. Stress can cause the contraction of the uterus to
maternity. weaken and result in prolonged labor and even death.17
Treatment Mean Min-Max SD Hypnobirthing is associated with shortening the first stage
Hypnobirthing 3.67 1-6 ±1.49 of labor, especially in primiparous mothers and may
Theory 4.27 2-6 ±1.38 reduce analgesic use. Labor can be skipped without
complications and does not require surgery, forceps or
Table 2 shows that the results of the statistical test with a vacuum and even the baby who is born has a normal
p value of 0.000 (p<0.05) means that there is an effect of APGAR value. Hypnobirthing is a method that teaches
the application of active birth techniques using mothers to understand and release fear tension, pain
hypnobirthing on the progress of first stage labor in syndrome (syndrome of fear, tension and pain) which
maternal labor. causes pain and discomfort during labor.18

Table 2: Effect of the application of active birth Hypnobirthing is a non-pharmacological pain reliever
techniques using birth balls on the progress of first method of delivery. Its use is physically beneficial during
stage labor in maternity. pregnancy and childbirth.19 The hypnobirthing method is
a combination of natural birth processes with hypnosis to
Treatment n P value build positive perceptions and self-confidence and reduce
Hypnobirthing 15 0.000 fear, anxiety and tension, and panic before, during and
after childbirth.20 The suggested benefits of using
DISCUSSION hypnobirthing during labor include reduced pain,
decreased anxiety levels, less use of analgesics, easier
Based on the results of the study showed that the results fetal head delivery and rotation, shorter duration than one
of the statistical test with a p-value of 0.000 (p<0.05) stage of labor and increased maternal satisfaction and
meant that there was an effect of the application of active well-being.
birth techniques using birth ball and hypnobirthing on the
progress of first stage labor in maternity. In this study, the use of hypnobirthing during labor,
precisely in the active phase, greatly influenced the
In addition, it is also in line with the results of research by progress of labor. Hypnobirthing helps the first stage of
Buulolo showing that there is an effect of hypnobirthing labor to be shorter. Hypnobirthing method is based on the
with the duration of the active phase I labor process in belief that every mother giving birth has the potential to
primiparous and multiparous labor mothers with a p value undergo the birth process naturally, calmly, and
<0.005.15 comfortably (without pain). This method is used to
control the mother’s mind and enter positive suggestions
The positive impact on mothers who carry out in the mother’s mind, so that it can provide a feeling of
hypnobirthing therapy during childbirth can facilitate the relaxation to the mother, an increase in the mother’s sense

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 Darma IY et al. Int J Community Med Public Health. 2020 Dec;7(12):4745-4748

of well-being can encourage the physiological process of 9. Bobak. Textbook of Maternity Nursing, Book
labor. Medical Publishers EGC, Jakarta; 2010.
10. Icesmi, Margareth. Pregnancy, childbirth, and
This study is relatively the same as research conducted by postpartum Yogyakarya. NuhaMedika Bandung;
Phillips-Moore which concluded that mothers who gave 2013.
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CONCLUSION 13. Rohmah. The application of the active birth
technique using the birth ball to the progress of
There is an effect of the application of active birth labor during the active phase of maternity at BPM
techniques using hypnobirthing on the progress of stage I Wiwik Gunandari, S.SiT. Health Res J. 2017;4(2).
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ACKNOWLEDGEMENTS 15. Bonapace J, Gatineau QC, Gagné GP, Montréal,
QC, Chaillet N, Gagnon R, Hébert E, Buckley S.
Thank you to all parties LLDIKTI Region X and Physiologic basis of pain in labour and delivery: an
Kemenristek-Brin and BPM Padang city. evidence-based approach to its management. J
Obstet Gynaecol Can. 2018;40(2):227-45.
Funding: Kemenristek-Brin 16. Siyoto. Basic Research Methodology. Yogyakarta:
Conflict of interest: None declared Literacy Media Publishing; 2015
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Institutional Ethics Committee techniques on the duration of the process stage I
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