Proceeding of Surabaya International Health Conference

July 13-14, 2017

THE EFFECTS OF PROGRESSIVE MUSCLE RELAXATION ON THE LEVEL OF

ANXIETY EXPERIENCED BY THE PRIMIGRAVID WOMEN IN THE THIRD
TRIMESTER IN BPM IKA MARDIYANTI PRAMBON SIDOARJO

Ika Mardiyanti
Faculty of Nursing and Midwifery
University of Nahdlatul Ulama Surabaya
Ika_mardiyanti@unusa. [Link]

Abstract

Besides the psychological problem that leads to anxiety, the common problem often occurs
in pregnant women is the physical problem dealing with discomfort resulting from the
changes in the body shape and posture. This psychological burden is often experienced by
the pregnant women, especially the primigravid women in the third trimester. The treatment
for anxiety can be done by giving pharmacological and non-pharmacological therapy. One
of the non-pharmacological therapies is progressive muscle relaxation, the systematic
technique to achieve a state of relaxation. Therefore, this study was purposed to analyze the
effects of progressive muscle relaxation on the level of anxiety experienced by the
primigravid women in the third trimester. This quasi-experimental study was done using
one group pretest-posttest design. The study conducted in BPM Ika Mardiyanti involved 32
pregnant women chosen by using accidental sampling technique. The instrument used to
measure the level of anxiety was Zung Self-Rating Anxiety Scale (ZSAS). Moreover, the
non-parametric test using Wilcoxon signed rank test with the significance level of α = 0.05
was used to analyze the collected data. Each pregnant woman received the intervention by
performing progressive muscle relaxation once a day for 10 minutes done on 3 consecutive
days. The results of statistical analysis using Wilcoxon signed rank test showed that p value
was 0.000 (p value < 0.05) illustrating that progressive muscle relaxation therapy
was effective on the level of anxiety experience by the primigravid women in the third
trimester in BPM Ika Mardiyanti, Prambon, Sidoarjo.

Key words: primigravid women, anxiety, progressive muscle relaxation.

INTRODUCTION resulting from the changes in the body

Pregnancy and labor are the shape and posture besides the
important and unforgettable experiences. psychological problem that leads to
However, pregnancy may also bring risks anxiety. The anxiety occurs during
to the health of a mother and her baby pregnancy is not far different from the
(Bobak, 2011). During pregnancy, a anxiety experienced during labour. The
woman often has various pregnancy severe anxiety experienced by the
problems. One of them is dealing with pregnant women during labour also causes
physical problem which creates discomfort negative reactions to the physiological

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condition of the women and the fetuses trimester, a pregnant woman often feels
that may eventually become one of the worried about the real shape of the fetus
causes of the high maternal and fetal inside the uterus. In the second trimester,
mortality rate (Danuatmaja, 2008). she feels anxious and worried about the
The psychological factors role change from the one who receives
comprise of anxiety, lack of power, and love and affection to the one who provides
worry in facing labour process (Sumarsih, them for the fetus growing in her uterus.
2009). The anxiety experienced by the In the third trimester, the anxiety is caused
pregnant women is also resulted from the by feeling worried about something that
increasing progesterone hormone. might happen to the fetus, such as birth
Besides, it also causes emotional defects, problems during labor, and labor
disturbances and tiredness during pain (Bobak, 2011).
pregnancy that may eventually lead to The treatment for anxiety
antepartum bleeding (Marmi, 2011). In experienced by the primigravid women
addition, the increase of adrenaline during can be done by giving pharmacological
pregnancy can result in dysregulation of and non-pharmacological therapy in which
body’s biochemistry that makes pregnant pharmacological therapy is mostly used
women to have psychological tension or recently. Continuous pharmacological
stress causing anger, restlessness, inability treatment definitely brings bad effects that
to concentrate; they might even want to can trigger addiction to certain medicines.
run away from the reality. The anxiety in On the other hand, non-pharmacological
facing labour usually appears in the first treatment can be performed by doing
pregnancy or primigravid (Kartono, 2007). yoga, meditation, tai chi therapy,
Anxiety which is divided into 3 autogenic relaxation, and progressive
levels: mild, moderate, and severe, is a muscle relaxation (Micah, 2011).
combination of fear, worries, and Progressive muscle relaxation is a
powerlessness toward subjective things systematic technique to achieve a state of
(Stuart, 2007). Moreover, pregnancy is the relaxation developed by Edmund Jacobson
period of physical and psychological (Triwijaya, 2014). A study entitled The
adaptation. Effects of Progressive Muscle Relaxation
The psychological changes during (PMR) on The Decreasing Level of
pregnancy happen in each semester: Anxiety and Depression in Patients with
trimester I, II, and III. In the first Cancer in The Indonesian Cancer

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Foundation located In Surabaya in 2017 decrease the level of anxiety

shows that the level of anxiety and experienced by the pregnant women.
depression decreases after performing
progressive muscle relaxation. This study METHODS
shows that the treatment done once a day This quasi-experimental study
on 3 consecutive days for 10-20 minutes was done using one group pretest-posttest
can decrease the level of anxiety and design. The study conducted in BPM Ika
depression on day 1, 2, and 3 (Rahmawati, Mardiyanti involved 32 pregnant women
2017). chosen by using accidental sampling
The preliminary study (through technique.
observation and interview) done to 5 The instrument used to measure
primigravid women in the third trimester the level of anxiety was Zung Self-Rating
of pregnancy showed that they had Anxiety Scale (ZSAS). The non-
anxiety. 4 of them were afraid of having parametric test using Wilcoxon signed
pain during labor and were worried about rank test with the significance level of α =
the condition of the baby (born in normal 0.05 was used to analyze the collected
or abnormal condition), whereas 1 woman data. Each pregnant woman received the
were anxious about the condition of the intervention by performing progressive
baby; she was worried that something muscle relaxation once a day for 10
unexpected will happen to her baby. minutes done on 3 consecutive days.
Besides, she was also worried about the
possible complications. RESULTS AND DISCUSSION
Based on the above-stated Results
description, the writer was interested to 1. The frequency distribution of the
general data
conduct a study on the effects of
progressive muscle relaxation on the level A. Age
of anxiety in the primigravid women in Table 1. The frequency distribution of the
respondents’ characteristic based on age in
the third trimester in BPM Ika Mardiyanti,
BPM Ika Mardiyanti, Prambon, Sidoarjo
Prambon, Sidoarjo (independent midwifery
Age (year) Frequency Percentage
clinic). The results of this study are < 20 0 0
20-35 30 93,8
expected to develop the sciences, >35 2 6,2
Total 32 100
especially the midwifery update on
progressive muscle relaxation aimed to

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B. Level of education
Table 2. The frequency distribution of the
According to table 4, after receiving
respondents’ characteristic based on the
level of education in BPM Ika Mardiyanti, progressive muscle relaxation, most of
Prambon, Sidoarjo
the respondents experienced mild level of
Level of Frequency Percentage anxiety, totaling 23 22 respondents (68.8
Education
Elementary 2 6,3
Secondary 29 90,6
%).
Higher Education 1 3,1
Total 32 100

3. The effects of progressive muscle

2. The frequency distribution of the relaxation on the level of anxiety
specific data experienced by the primigravid
women in trimester III in BPM Ika
A. The level of anxiety before receiving Mardiyanti, Prambon, Sidoarjo
progressive muscle relaxation

Table 3. The frequency distribution of the Table 5. The effects of progressive muscle
respondents’ characteristic based on the relaxation on the level of anxiety
level of anxiety before receiving experienced by the primigravid women in
progressive muscle relaxation in BPM Ika trimester III in BPM Ika Mardiyanti,
Mardiyanti, Prambon, Sidoarjo Prambon, Sidoarjo
Level of Anxiety Frequency Percentage The level of anxiety after PMR Total P value
Mild 7 21,9 Mild Moderate Severe
Moderate 23 71,9 n(%) n(%) n(%) N(%)
Severe 2 6,2 The level of Mild 6 1 0 7
Total 32 100 anxiety (85,7) (14,3) (0) (100) 0,000
before Moderat 16 7 0 23
PMR e (69,6) (30,4) (0) (100)
Severe 0 1 1 2
According to table 3, before receiving (0) (50) (50) (100)
Total 22 9 1 32
(68,8) (28,1) (3,1) (100)
progressive muscle relaxation, most of
the respondents experienced moderate
According to table 5, Wilcoxon signed
level of anxiety, totaling 23 respondents
rank test showing the statistic result in
(71.9 %).
which p value was 0.000 (p value ≤ 0.05)
illustrated that progressive muscle
B. The level of anxiety after receiving
progressive muscle relaxation relaxation was effective on decreasing
level of anxiety experienced by the
Table 4. The frequency distribution of the
respondents’ characteristic based on the primigravid women in trimester III in
level of anxiety after receiving progressive
BPM Ika Mardiyanti, Prambon, Sidoarjo.
muscle relaxation in BPM Ika Mardiyanti,
Prambon, Sidoarjo It is shown by p value which was less
Level of Anxiety Frequency Percentage than the significance level = 0.05 (p =
Mild 22 68,8
Moderate 9 28,1 0.000 < 0.05).
Severe 1 3,1
Total 32 100

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Discussion which threatens a pregnant woman

1. The level of anxiety experienced by that causes stress, worried, and afraid
the primigravid women before
when facing labor. Besides, the level of
receiving progressive muscle
relaxation in BPM Ika Mardiyanti, anxiety increases during the third
Prambon, Sidoarjo
trimester until several minutes before
labor. Labor pain is also one of the
Based on the results of pretest,
factors which brings fear and anxiety to
6.2% of the respondents experienced
the pregnant women before labor
severe level of anxiety; 71.9%
(Bobak, 2011).
experienced moderate level; and 21.9%
had mild anxiety. Most of the 2. The level of anxiety experienced by
primigravid women in the third the primigravid women after receiving
progressive muscle relaxation in BPM
trimester had moderate level of anxiety. Ika Mardiyanti, Prambon, Sidoarjo
Anxiety is an emotional
condition which is unpleasant According to the results of
characterized by stressful unexpected posttest, 3.1% respondents had severe
psychological symptoms (Davies, level of anxiety; 28.1% had moderate
2009). Anxiety manifested in level of anxiety; and 68.8% experienced
unavoidable worry or fear can cause mild level. In short, most of the
responses to the body. An individual primigravid women in the third
who is often worried about something trimester experienced moderate level of
has a high risk to have anxiety (Stuart, anxiety. It showed that the anxiety level
2007). decreased after the treatment.
Anxiety experienced by the Generally, primigravid women do
pregnant women is resulted from their not have any description about the things
incorrect perception of labor process. they will face at the end of the pregnancy
They often perceive labor as the fearful (during labor). This condition creates
process that causes extreme pain It anxiety when facing labor (Bobak, 2011).
definitely causes them to have severe Giving information about labor and
level of anxiety when facing childbirth childbirth is useful to increase the
(Zamriati, 2013). It is in line with the understanding and belief to manage the
theory proposed by Zanden (2007) anxiety and fear about the unknown.
stating that the third trimester of This claim is also supported by
pregnancy is a concrete condition Zamriati (2013) stating that self-

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preparation by collecting various the muscle fibers have contractions, gets

information about labor is one of the best smaller and shrinks. Stress occurs when an
ways before facing labor. When a individual gets anxious; so anxiety is gone
pregnant woman has got information or when stress disappears.
knowledge about the things known the The results of this study is in line
things which will happen to her, the with Astuti (2015) stating that
anxiety experienced by her tends to progressive muscle relaxation can be
decrease (Aprilia, 2011). used to decrease the anxiety level because
it can give pressures to the sympathetic
3. The effects of progressive muscle
relaxation on the level of anxiety nerves to compress stress experienced by
experienced by the primigravid an individual reciprocally to create
women in the third trimester in BPM
Ika Mardiyanti, Prambon, Sidoarjo. counter conditioning.
Anxiety is also affected by some
Based on the result of Wilcoxon
factors: age and level of education. Age
signed rank test, p value was 0.000 <
affects the anxiety level as shown in table
0.05. This result showed that progressive
1 illustrating that most of the
muscle relaxation was effective to decrease
respondents, totaling 30 women (93.8 %)
the level of anxiety experienced by the
were at the age of 20-35 years.
primigravid women in the third trimester
Age brings some effects to the
in BPM Ika Mardiyanti, Prambon,
anxiety level. During healthy
Sidoarjo.
reproductive age, the safe age for
The related study on progressive
pregnancy and labor is 20-35 years. The
muscle relaxation has been conducted by
maternal death during pregnancy and
Rahmawati (2017) to measure the effects
labor at the age of 20 years is twice to
of progressive muscle relaxation (PMR)
five times higher than the maternal death
therapy to decrease the level of anxiety
happens at 20-29 years old. It increases
and depression experienced by the
more at the age after 30-35 years. After
patients suffering from cancer in the
35 years, half of women are classified to
Indonesian Cancer Foundation. This
have high risks for congenital defects and
study is also supported by Suyatmo
complications during labor (Zamriati,
(2009) who develops progressive
2013).
muscle relaxation to fight the anxiety,
The level of education also affects
stress, and tension. The result of his study
the anxiety level as presented in table 2
shows that when an individual has stress,

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illustrating that most of the respondents system of sympathetic nerves will slow
90.6% graduated from secondary school down or weaken the works of the internal
Basically, education is useful to change parts of body, such as the decrease of
the mindset, behaviors, and decision heartbeats, the rhythm of breath, blood
making pattern. The low level of pressure, muscle tension, metabolic rate,
education possessed by an individual will and the production of hormones that
result in risks to have anxiety easily. If a cause stress. As the hormone causing
patient is clearly exposed to information stress decreases, all parts of the body start
about her disease, she will be relaxed functioning more healthily with more
when receiving the medical treatment. energy for healing, restoring, and
Moderate level of education will be rejuvenating.
useful to identify both internal and
external stressors. Educational level also CONCLUSION
influences the awareness and 1. Based on the respondents’
understanding of stimulus (Lutfa, 2008). characteristic of the anxiety level
Anxiety can be decreased by before receiving progressive muscle
performing progressive muscle relaxation relaxation, the result shows that most of
aimed to stimulate the discharge of them, totaling 23 respondents (71.9%)
endorphin and encephalin, as well as to had moderate level of anxiety.
stimulate the brain signals to make the 2. Based on the respondents’
muscle relaxed and increase the blood characteristic of the anxiety level after
circulation to the brain. receiving progressive muscle
This study is also in line with the relaxation, the result shows that most of
previous study done by Praptini (2015) them, totaling 22 respondents (68.8 %)
stating that physiologically, relaxation had mild level of anxiety.
exercise will reverse the effects of stress 3. Progressive muscle relaxation was
involving parasympathetic nerves of the effective to decrease the level of anxiety
center nervous system. Relaxation will experienced by the primigravid women
hamper the increase of sympathetic in the third trimester in BPM Ika
nerves so that the amount of hormones Mardiyanti, Prambon. Sidoarjo.
causing dysregulation of the body also
decreases. The system of parasympathetic
nerves which functions oppositely to the

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REFERENCES Skripsi. Fakultas Keperawatan dan

Kebidanan UNUSA
[Link]. 2009. Perawatan Ibu
Aprilia, Y. (2011). Siapa Bilang
Bersalin. Cetakan ke-3, Yogyakarta:
Melahirkan Itu Sakit. Yogyakarta:
Fitramaya.
C.V Andi Offset
Supriati, Lilik. 2010. Pengaruh terapi
Astuti, D. & Suandika, M. 2015.
thought stopping dan progressive
Efektifitas Pemberian Terapi
muscle relaxation terhadap ansietas
Relaksasi Otot Progresif dan Nafas
pada klien dengan gangguan fisik di
Dalam Terhadap Penururnan
RSUD Dr. Soedono Madiun. Tesis.
Insomnia pada Lansia di Unit
Tidak diplubikasikan.
Rehabilitasi Sosial Dewanata
Suyatmo., Prabandari, Y.S. & Machira,
Cilacap. Semarang : Jurusan
C.R. 2009. Pengaruh Relaksasi Otot
Keperawatan FK Undip.
Progresif Dalam Menurunkan Skor
Bobak. 2011. Buku Ajar Keperawatan
Kecemasan T-TMAS Mahasiswa
Maternitas. Jakarta: EGC.
Menjelang Ujian Akhir Program
Danuatmaja, B., dan Meilianasari, M.
Diakademi Keperawatan Notokusumo
2008. Persalinan Normal Tanpa
Yogyakarta. Berita Kedokteran
Rasa Sakit. Jakarta: Puspa Suara.
Masyara kat, Volume 25, No. 3, hal
Davies, T., Craig, T.K.J., 2009, ABC
142– 149.
Kesehatan Mental, Alih Bahasa
Stuart. 2007. Buku Saku Keperawatan
Alifa
Jiwa . Jakarta. EGC.
Dimati, 2009, Jakarta: Penerbit Buku
Triwijaya,Wagiyo, dan Elisa .2014.
Kedokteran EGC.
Pengaruh Relaksasi Otot Progresif
Kartono. 2007. Psikologi Wanita (jilid
Terhadap Penurunan Tingkat
2): Mengenal Wanita sebagai Ibu
Kecemasan Pada Ibu Intranatal Kala I
danNenek. Bandung: Mandar Maju.
Di RSUD Sala [Link]
Lutfa, U. & Maliya, A. 2008. Faktor-
faktor yang Mempengaruhi Keperawatan dan Kebidanan Vol 1
Kecemasan Pasien Dalam Tindakan No 6, diakses tanggal 20 Februari
Kemoterapi di Rumah Sakit Dr. 2016.
Moewardi Surakarta. Wulandari, P.Y. 2006. Efektivitas Senam
Marmi, 2011. Asuhan Kebidanan Pada Hamil seba gai Pelayanan Prenatal
masa Antenatal. Yogyakarta: Pustaka dalam Menurunkan Kecemasan
Pelajar. Menghada pi PersalinanPertama .
Micah R, Sadigh. 2011. A Mind-Body [Link]. 8 No. 2.
Approach to the Treatment of Chroni Zamriati, W.O., Hutagaol, E., &
Pain Syndrome and Stress-Related Wowiling, F. (2013). “Faktor-Faktor
Disorders (Mcfarland Health Topics). yang Berhubungan dengan
Praptini, K.D., Sulistiowati, N.M.D, Kecemasan Ibu Hamil Menjelang
Suarnata, I.K. 2015. Pengaruh Persalina n di Poli Kia Pkm
relaksasi otot progresif terhadap Tuminting”. Jurnal Keperawatan
tinkat kecemasan pasien kemoterapi Vol 1 No 1, diakses tanggal 21 Juni
di rumah singgah kanker Denpasar. 2016.
Jurnal Keperawatan Udayana. Zanden. 2007. Pengantar Psikologi
Rahmawati. Nur Aini 2017. Pengaruh Kebidanan. Kencana:Jakarta.
terapi Progressive Muscle Relaxation
(PMR) terhadap penurunan
kecemasan dan depresi pada pasien
kanker di Yayasan Kanker Indonesia .

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