ANALISIS JURNAL

OLEH :

MUHAMMAD RIFAL MARDANI

NIM. 2021032059

CI LAHAN CI INSTITUSI

Tgl : Tgl :

Fithratunnufus, S.Kep., Ns
Ns. Ni Nyo
…………………………………………… Ns. Ni Nyoman Elfiyunai, S.Kep., M.Kes
NIK. NIK. 20210901131

PROGRAM STUDI PROFESI NERS

SEKOLAH TINGGI ILMU KESEHATAN WIDYA NUSANTARA PALU
2022

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 ANALISIS JURNAL :

THE EFFECT BONAPACE METHOD REDUCES LAPOR PAIN OF ACTIVE

PHASE 1 TO INTRANATAL CARE

1. Studi Kasus
Menurut beberapa ahli, nyeri yang terjadi dalam persalinan sebenarnya
disebabkan kerusakan jaringan. Rasa sakit persepsi sangat individual, banyak
dipengaruhi oleh fisiologis, patologis, emosional faktor. psikologis, kognitif,
lingkungan dan sosial (Bonapace, 2013). Nyeri persalinan bisa menyebabkan
stres yang menyebabkan pelepasan hormon yang berlebihan seperti
katekolamin dan steroid. Peningkatan hormon ini dapat menyebabkan
perubahan metabolik dan hemodinamik yang lebih buruk tenaga kerja. Selain
itu, dapat menyebabkan ketegangan pada otot polos dan pembuluh darah
penurunan kontraksi uterus dan sirkulasi uteroplasenter, penurunan aliran
darah dan oksigen ke rahim dan munculnya iskemia uterus yang membuat
impuls nyeri lebih banyak banyak Proses persalinan selalu dikaitkan dengan
ketidaknyamanan atau nyeri selama persalinan proses. Nyeri yang terjadi
selama persalinan disebabkan oleh peregangan serviks, kontraksi uterus dan
penurunan janin yang menyebabkan pelepasan prostaglandin yang dapat
menyebabkan nyeri. Sakit itu tidak teratasi dapat menimbulkan bahaya
fisiologis dan psikologis bagi ibu dan janin.
Penelitian terkait yang dilakukan oleh Afni (2018) bahwa beberapa ibu
yang melahirkan merasakan nyeri hebat, hanya 9-14% wanita melahirkan
mengalami nyeri ringan tanpa mengurangi persalinan rasa sakit. Baker (2001)
dalam Utami (2018), menjelaskan hasil penelitian yang dilakukan di Inggris,
dari wanita yang melahirkan, ditemukan bahwa 93,5% merasakan nyeri hebat

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 atau nyeri tak tertahankan. Hasil dari penelitian lain yang mendukung adalah
Pratiwi (2015), menemukan hanya 15% persalinan yang berlangsung tanpa
nyeri atau nyeri ringan, 35% persalinan disertai nyeri sedang, 30% persalinan
disertai nyeri hebat dan 20% persalinan disertai nyeri hebat.
Sesuai dengan teori yang dikemukakan oleh Deasyana (2015), bahwa
puncak nyeri terjadi pada akhir tahap pertama, yaitu fase aktif tempat
pembukaan menjadi lengkap, mencapai 10. Seiring dengan peningkatan
pembukaan, nyeri dan kontraksi menjadi lebih kuat, nyeri berasal dari
kontraksi uterus, sehingga kontraksi menjadi lebih fleksibel, lebih lama dan
lebih kuat sehingga nyeri terasa lebih hebat.

2. Penyusunan kata kunci PICO

a. P : Population
Populasi adalah semua intranatal fase aktif fase I di PMB Lilik Ernawati.
Desa Selosari, Kecamatan Kandat, Kabupaten Kediri. Sampel penelitian
adalah bagian intranatal bertempat di PMB LilikErnawati, Desa Selosari,
Kecamatan Kandat, Kabupaten Kediri dari bulan Januari hingga April
tahun 2020 dengan kriteria inklusi diantaranya ibu bersedia menjadi
responden dan pertama kali ibu melahirkan fase aktif Kriteria eksklusi
untuk penelitian ini adalah ibu bersalin dengan situasi darurat (rujukan).
b. I : (Intervention)
Memberikan metode bonapace yang menggabungkan beberapa non-
fatmakologis teknik relaksasi, pijat, akupresur dan pendampingan
keluarga.
c. C : Comparison
Tidak ada perbandingan
d. O : Outcome
Hasil Analisis data menyatakan bahwa sig (p) = 0,000 dimana α = 0,05, p
& lt; α, berarti ada dukungan untuk Metode Bonapace untuk perlindungan

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 persalinan kala satu pada fase aktif ibu saat melahirkan selama Korelasi
atau menggunakan Wilcoxon Correlation = -0,382.

3. Screening jurnal ( melalui alamat jurnal internasional, misal : ProQuest,

EBSCO, dst). Berisi uraian tahapan pencarian jurnal yang sesuia dengan
perumusan PICO.
a. Pencarian di Googlescholar dengan menggunakan keyword : Intrantal
care
b. Pencarian jurnal 5 tahun terakhir (tahun 2017-2021) : 2.180 jurnal

penelusuran pada GoogleScholar

hasil :
2.180 jurnal

screening jurnal yang sesuai dengan kriteria sampel

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inkusi studi dalam penelitian berjumlah : 1

4. Analisis Jurnal
a. Judul penelitian
The Effect Bonapace Method Reduces Lapor Pain Of Active Phase 1 To
Intranatal Care
b. Penulis
Luluk Susiloningtyas

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c. Nama jurnal tempat publikasi
STRADA Jurnal Ilmu Kesehatan Situs web: https://sjik.org/index.php/sjik
DOI: 10.30994 / sjik.v9i1.281 ISSN: 2252-3847 (cetak); 2614-350X
(online) Vol.9 No.1. Mei 2020. Halaman 248-257
d. Latar belakang masalah
Selama proses pembukaan serviks pasti disertai nyeri persalinan.
Sakit adalah komponen tenaga kerja yang tidak dapat dipisahkan. Nyeri
persalinan terjadi karena diikuti oleh rangsangan reseptor saraf kontraksi
otot uterus dan dirasakan di daerah lumbosakral, pinggul dan usus. Nyeri
persalinan dapat menyebabkan stres yang menyebabkan pelepasan
hormon yang berlebihan seperti katekolamin dan steroid. Peningkatan
hormon ini dapat menyebabkan perubahan metabolik dan hemodinamik
Lebih buruk dalam persalinan, dapat menyebabkan ketegangan pada otot
polos dan pembuluh darah, sehingga terjadi penurunan kontraksi uterus
dan sirkulasi uteroplasenter, berkurangnya aliran darah dan oksigen ke
uterus dan munculnya iskemia uterus yang membuat impuls nyeri
meningkat.
Nyeri merupakan proses fisiologis selama persalinan tetapi juga
dapat menyebabkan masalah jika tidak ditangani tepat. Beberapa masalah
yang bisa muncul jika nyeri tidak ditangani adalah stres pada ibu yang
dapat merangsang sekresi katekolamin. Akibat sekresi katekolamin akan
menyebabkan kontraksi uterus yang tidak adekuat, janin berisiko
mengalami gawat janin karena menurun perfusi uteroplasenta. Selain itu
nyeri persalinan merupakan stimulus yang tidak menyenangkan yang
menyebabkan rasa takut dan khawatir. Keadaan ini akan merangsang
peningkatan katekolamin yang dapat menyebabkan gangguan dengan
kuatnya kontraksi uterus sehingga terjadi insersi uterus jika tidak
diperbaiki, yang mana akan menyebabkan persalinan lama.

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 Nyeri diartikan sebagai pengalaman sensoris dan emosional yang
tidak menyenangkan yang berhubungan dengan actual atau potensi
kerusakan jaringan yang terdiri dari minimal dua komponen yang
didukung oleh satu komponen independen jalur neurofisiologis yaitu
komponen sensori deskriptif (intensitas) dan yang kedua komponennya
adalah motivasi efektif (ketidaknyamanan) yang dapat secara selektif
dalam modulasi. Meski intensitas nyeri yang dirasakan wanita saat
melahirkan biasanya tidak berhubungan dengan jaringan kerusakan,
penelitian sebelumnya telah mencatat nyeri persalinan sebagai salah satu
bentuk nyeri paling parah yang pernah ada direkam menggunakan McGill
Pain Questionnaire atau Visual Analog scale (VAS). Ada beberapa teknik
untuk mengurangi nyeri persalinan, yaitu farmakologis dan non-
farmakologis. Pendekatan farmakologis diarahkan untuk menghilangkan
sensasi fisik dalam nyeri persalinan. Sedangkan non farmakologi
diarahkan untuk mencegah penderitaan. Dalam survei dunia, file
pengalaman wanita selama persalinan ditemukan 69% diberikan
setidaknya satu non-metode farmakologis, sementara 70% wanita
menggunakan analgesia epidural 3. Selain itu, ribuan operasi caesar
terencana dan efektif setiap tahun terutama karena takut sakit wanita
nulipara. Melahirkan menyebabkan peningkatan epinefrin dan
norepinefrin, datar tekanan dan detak jantung, konsumsi oksigen untuk
ibu dan beta endorfin. Tambahan vasokonstriksi karena katekolamin
menyebabkan penurunan aliran darah uterus dan ini bisa menyebabkan
peningkatan distosia dan penurunan APGAR 4 neonatus .
Saat ini yang dikembangkan oleh unit perawatan kesehatan adalah
untuk mengurangi nyeri saat persalinan dengan memberikan metode non-
farmakologis dengan penerapan tanpa efek samping, membangun
kepercayaan diri dan partisipasi ibu bersalin. Oleh karena itu sebagai
bidan harus memberikan asuhan ibu tersayang, salah satunya adalah

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pengurangan rasa sakit. Salah satu metode nonfarmakologis adalah
metode bonapace. Metode Bonapace adalah metode alternatif untuk
mengatasi nyeri persalinan, melibatkan suami atau keluarga ibu dalam
persalinan. Metode ini menggabungkan beberapa non-teknik
fatmakologis yaitu relaksasi, pijat, akupresur dan pendampingan keluarga.
Metode ini menggunakan beberapa teknik manajemen nyeri untuk
mengontrol nyeri berdasarkan tiga model modulasi nyeri neurofisiologis,
pertama-tama mengendalikan sistem saraf pusat melalui pernapasan,
relaksasi dan regulasi kognitif, kedua menggunakan stimulus, ketiga
mengurangi penghambatan dengan hiperstimulasi akupresur terkuat. Jadi,
bonapace ini. Metode ini dianggap efektif dalam pengobatan nyeri
persalinan 4 . Hasil observasi dalam melaksanakan asuhan persalinan
dalam membantu mengurangi nyeri pada dalam perawatan intranatal,
terlihat bahwa metode bonapace masih dalam tahap intervensi atau
mengendalikan susunan saraf pusat hanya dengan cara teknik pernafasan
saja, belum melakukan relaksasi ringan pada punggung selama kontraksi
dan pemberian hiperstimulasi analgesik selama kontraksi. Langkah
pemberian hiperstimulasi analgesik dapat dilakukan dengan membantu
persalinan membuat penyebab kedua nyeri dengan pijatan dengan
penekanan kuat pada trigger point yaitu punggung bawah, kemudian
bergantian dengan titik pada tangan dan bokong, hingga pasien dapat
memilih poin mana yang dirasa paling berkontribusi terhadap penurunan
nyeri persalinan. Metode Bonapace merupakan salah satu metode non
farmakologis yang efektif dalam pengobatan membantu ibu dalam
mengurangi rasa sakit. Karena perlu dilakukan metode pengurangan nyeri
dengan metode bonapace yang tepat sehingga dapat membantu
mengurangi nyeri intranatal selama persalinan memfasilitasi persalinan

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e. Tujuan dan pertanyaan penelitian
Untuk mengetahui apakah ada pengaruh pemberian bonapace methods
terhdap penurunan nyeri persalinan
f. Metodologi penelitian
Desain penelitian yang digunakan penelitian ini adalah Quasi
Eksperimental dengan rancangan cross sectional pendekatan. Desain
penelitian yang digunakan adalah one group pretest-posttest design.
g. Uji statistik
Data dianalisis menggunakan uji Wilcoxon Sign Rank.
h. Hasil penelitian
Setelah diberi Metode Bonapace, terjadilah penurunan nyeri yaitu
responden yang mengalami nyeri hebat sebelum diberikan metode
bonapace penurunan dari 15 responden sebagian besar mengalami nyeri
sedang yaitu 11 responden (55%), kriteria nyeri hebat sebanyak 3
responden (15%). Berdasarkan hasil uji statistik dapat disimpulkan bahwa
terdapat perbedaan nyeri sebelum dan sesudah diberikan metode bonapace
dengan nilai P = 0,000.
i. Kekuatan penelitian
1. Penelitian ini menggunakan instrument penelitian yang baku sehingga
mempermudah dalam analisa data
2. Penyajian data lengkap, padat, dan jelas
3. Pembahasan hasil penelitian mudah dipahami
j. Kelemahan penelitian
1. Pada penelitian ini tidak ada kelompok pembanding untuk mengetahui
perbedaan nilai dari kelompok intervensi dan kelompok tanpa
intervensi sehingga dihasilakan data yang lebih akurat.
2. Sampel yang digunakan sangat minim, akan lebih baik jika jumlah
sampel yang dipakai lebih besar.

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k. Manfaat penelitian yang didapat pada jurnal ini bagi keperawatan
Dapat dijadikan sebagai referensi mengenai pentingnya
meningkatkan inovasi dalam pemberian intervensi kepada pasien
khususnya dalam upaya pemberian kenyamanan pada ibu yang akan
melahirkan. Pada kasus ini, proses melahirkan mengakibatkan rasa nyeri
yang dapat menggaggu kenyamanan. Nyeri persalinan terjadi karena
diikuti oleh rangsangan reseptor saraf kontraksi otot uterus dan dirasakan
di daerah lumbosakral, pinggul dan usus. Nyeri persalinan dapat
menyebabkan stres yang menyebabkan pelepasan hormon yang berlebihan
seperti katekolamin dan steroid. Peningkatan hormon ini dapat
menyebabkan perubahan metabolik dan hemodinamik lebih buruk dalam
persalinan, dapat menyebabkan ketegangan pada otot polos dan pembuluh
darah, sehingga terjadi penurunan kontraksi uterus dan sirkulasi
uteroplasenter, berkurangnya aliran darah dan oksigen ke uterus dan
munculnya iskemia uterus yang membuat impuls nyeri meningkat. Selain
itu nyeri akan berdampak pada sisi psikologis yang menyebabkan ibu
stress dan merasa takut sehingga perlu diberikan terapi dukungan non
farmakologis untuk mengurangi nyeri dan rasa sakit. Salah satu metode
nonfarmakologis adalah metode bonapace dengan melibatkan suami atau
keluarga ibu dalam persalinan.

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 The Effect Bonapace Method Reduces
Labor Pain Of Active Phase I To Intranatal
Care
Luluk Susiloningtyas, Ratna Feti
Wulandari STIKES Pamenang, Kediri,
Indonesia
luluksusiloningtyas@gmail.com

ABSTRACT
The Pain is an inseparable component of labor. The labor pain occurs due to
nerve receptor stimuli followed by uterine muscle contractions and is accepted
in the lumbosacral region, hips and intestines. During the process of opening the
cervix must be accompanied by labor pain. Pain is a physiological process
during labor but can cause problems that cannot be resolved properly. The
problems pain aren’t implementation can be stress intra natal that can stimulate
secretion catecholamines. The catecholamines secretion will cause inadequate
uterine contractions intranatal, the fetus is risk fetal distress due to decreased
utero placental perfusion. Labor pain is also one of the things makes
uncomfortable intra natal. The level of pain felt to intranatal can be alleviated by
a variety actions. One non-pharmacological method for reduces labor painis the
Bonapace method. The Bonapace Method is an alternative method for dealing
with labor pain, involving the husband or family intranatal. This method
combines several non- pharmacological techniques, namely relaxation, massage,
acupressure and family assistance, so can be effective management pain labor
care. This purpose study was effect bonapace method reduces labor pain of
active phase I to intranatal care in PMB Lilik Ernawati, S.ST Selosari Village,
Kandat District, Kediri Regency in 2020. The type of research used was Quasi
Experimental by using cross sectional, looking for one group pretest research.
posttest design. The sampling technique was Accidental Sampling. The
independent variable was the Bonapace Method, the instrument used was a
checklist. Dependent variable was the storage of labor pain in the active phase I,
the instrument used to measure the level of pre and post pain with an
observation sheet with a pain scale between 0 to 10 and an interview using the
Verbal Desuctive Scale (VDS), scale, value 0 = no injury , 1-3 = mild illness, 4-
6 = moderate illness, 7-9 = severe illness, 10 = very severe illness. Analysis of
data using the Wilcoxon Sign Rank. The results data analysis stated that sig (p)
= 0,000 where α = 0.05, p <α, means that there was support for the Bonapace
Method for the protection of the first stage of labor in the active phase of the

10
mother during child birth during Correlation or using the Wilcoxon Correlation
= -0.382.

Key Words: Bonapace Method, Labor, Reduces pain

Received December, 25, 2019; Revised January 24, 2020; Accepted February 15, 2020

CI LAHAN
Tgl :

Fithratunnufus, S.Kep., Ns
Ns. Ni Nyo
……………………………………………
NIK.

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INTRODUCTION
During the process of opening the cervix must be accompanied by labor pain. Pain is an
inseparable component of labor. Labor pain occurs due to nerve receptor stimuli followed by
uterine muscle contractions and is felt in the lumbosacral region, hips and intestines. Labor
pain can cause stress which causes excessive release of hormones such as catecholamines and
steroids. This increase in hormones can cause metabolic and hemodynamic changes that are
worse in labor, can cause tension in smooth muscles and blood vessels, resulting in decreased
uterine contractions and uteroplasenter circulation, reduced blood flow and oxygen to the
uterus and the emergence of uterine ischemia which makes the pain impulses increase1.
Pain is a physiological process during labor but can also cause problems if it is not
treated properly. Some of the problems that can arise if pain is not treated is stress in the
mother which can stimulate the secretion of catecholamines. As a result of catecholamine
secretion will cause inadequate uterine contractions, the fetus is at risk of fetal distress due to
decreased uteroplacental perfusion. In addition labor pain is an unpleasant stimulus that causes
fear and worry. This situation will stimulate an increase in catecholamines which can cause
interference with the strength of uterine contractions so that uterine insertion occurs if not
corrected, which will cause prolonged labor 2.
Pain is defined as an unpleasant sensory and emotional experience associated with
actual or potential tissue damage consisting of at least two components supported by an
independent neurophysiological pathway namely a descriptive sensory component (intensity)
and the second component is effective motivation (discomfort) which can be selectively in
modulation. Although the intensity of pain felt by women during childbirth is usually not
related to tissue damage, previous studies have noted labor pain as one of the most severe
forms of pain ever recorded using the McGill Pain Questionnaire or the Visual Analog scale
(VAS)1
There are several techniques to reduce labor pain, namely pharmacological and non-
pharmacological. Pharmacological approaches are directed at eliminating physical sensations
in labor pain. While non pharmacology is directed to prevent suffering. In the world survey,
the experience of women during childbirth is found to be 69% given at least one non-
pharmacological method, while 70% of women use epidural analgesia 3. In addition,
thousands of cesarean surgeries are planned and effective every year for fear of illness,
especially nulliparous women. Childbirth causes an increase in epinephrine and
norepinephrine, flat pressure and heart rate, oxygen consumption for the mother and beta
endorphins. In addition vasoconstriction due to catecholamines causes a decrease in uterine
blood flow and this can cause increased dystocia and decreased neonatal APGAR 4.
Currently developed by the health care unit is to reduce pain during labor by providing
non-pharmacological methods with implementation without side effects, building self-
confidence and participation of maternity mothers. Therefore as a midwife must provide care
dear mother, one of which is a reduction in pain. One non-pharmacological method is the
Bonapace Method. The Bonapace Method is an alternative method for dealing with labor pain,
involving the husband or family of the mother in labor. This method combines several non-
fatmacological techniques, namely relaxation, massage, acupressure and family assistance.
This method uses several pain management techniques to control pain based on three
neurophysiological pain modulation models, first controlling the central nervous system
through breathing, relaxation and cognitive regulation, second using the stimulus, third

12
decreasing the inhibition by the strongest acupressure hyperstimulation. Thus, this bonapace
method is considered effective in the treatment of labor pain 4.
The observation results in carrying out childbirth care in helping to reduce pain in
intranatal care, it can be seen that the bonapace method was still in the stage of intervening or
controlling the central nervous system only by means of breathing techniques only, not yet
doing light relaxation on the back during contractions and administration of hyperstimulation
analgesics during contractions. The step of giving analgesic hyperstimulation can do by
assisting childbirth to make the second cause of pain by massage with a strong emphasis on
the trigger point, namely the lower back, then alternating with the points on the hands and
buttocks, until the patient can choose which points are felt to be most contributing to the
reduction in labor pain. Bonapace method is one of the non-pharmacological methods that is
effective in helping mothers in reducing pain. Because necessary it was done pain reduction
methods with the right Bonapace method so that it can help intranatal reducing pain during
labor so as to facilitate labor.
Based on the description above, the researcher was interested in conducting research
with the title the effect bonapace method reduces labor pain of active phase I to intranatal
carein PMB LilikErnawati, Selosari Village, Kandat District, Kediri Regency, which hopes to
reduce pain, increase the comfort and calm intranatal.

METHODS
Design

The research design used this study was Quasi Experimental with cross sectional
approach. The research design used was one group pretest-posttest design.
Research variable
The research variables observed included the independent variable, the Bonapace
Method. The dependent variable was Reduction of Stage I Active Labor pain in the laboring
intranatal. Research Subjects
The population was all intranatalin the first phase of active phase in PMB Lilik
Ernawati, Selosari Village, Kandat District, Kediri Regency. The research sample was part of
intranatal in PMB LilikErnawati, Selosari Village, Kandat District, Kediri Regency from
January to April 2020, sampling technique used accidental sampling so that a sample of 20
respondents was included in the inclusion criteria including mothers willing to be respondents
and first-time mothers giving birth Active phase The exclusion criteria for this study include
maternity women with emergency situations (referral).
Provision of the Bonapace Method
The Bonapace Method was an alternative method for dealing with labor pain, involving
the husband or family of the mother in labor. This method combines several non-
fatmacological techniques, namely relaxation, massage, acupressure and family assistance.
This method uses several pain management techniques to control pain based on three
neurophysiological pain modulation models, first controlling the central nervous system
through breathing, relaxation and cognitive regulation, second using the stimulus, third
decreasing the inhibition by the strongest acupressure hyperstimulation. Action Bonapace
method with the Cecklish Instrument Reduction of labor pain
Labor pain painwas felt by the mother during labor in the first phase of active phase
labor. Assessed by observation using the pain scale.Called a reduction in pain if there was a
13
ST
decrease

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 Vol.9 No.1. May 2020. Page.248-257

Website: https://sjik.org/index.php/sjik
| Email: publikasistrada@gmail.com
in criteria before and after the Bonapace Method was given. Reduction of labor pain in the
active phase I, the instrument used to measure the level of pre and post pain with an
observation sheet with a pain scale between 0 to 10 and an interview using the Verbal
Descriptive Scale (VDS), rating scale, value 0 = no pain, 1- 3 = mild pain, 4-6 = moderate
pain, 7-9 = severe pain, 10 = very severe pain.
Measurement of the percentage of labor pain before Bonapace Method was given to the first
stage of labor in the active phase
Childbirth pain in the first-phase active intranatal can be known from observations with
pain scale before the respondent was given Bonapace Method then the data was processed so
that a percentage appears stating the percentage of labor pain criteria. While labor pain after
giving the Bonapace Method can known from the observation of labor pain after giving the
Bonapace Method with pain scale for respondents conducted in PMB Lilik Ernawati Selosari
Village, Kandat District, Kediri Regency, then was compared with pain before the Bonapace
Method.
Statistic analysis
Bivariate analysis was used to determine the effect between independent variables and
dependent variables. Data were analyzed using the Wilcoxon Sign Rank test. To determine
whether there was an influence between the independent variable and the dependent variable,
then using the p value compared to the error rate used is 5% or 0.05. If p value ≤ 0.05, then Ho
was rejected, which means there was a significant influence between the independent variable
and the dependent variable. While the level of correlation uses Wilcoxon correlation.

RESULTS AND DISCUSSION

The percentage of maternal pain during the first phase of active labor before being given
the Bonapace Method:
Table 1. Labor pain during first phase of active labor before giving Bonapace Method
No Labor Pain Criteria Frequency Percentage (%)
1 No pain 0 0
2 Mild Pain 0 0
3 Moderate Pain 0 0
4 Severe pain 15 75
5 Very Pain 5 25
Total 20 100,00

Based on the results of research conducted in PMB Lilik Ernawati, Selosari Village,
Kandat District, Kediri Regency on January 2 - April 23, 2019 before giving hydrotherapy
from 20 respondents, it can be seen that those who experience severe labor pain were 15
respondents (75%) while some respondents namely as many as 5 respondents (25%) have very
severe pain criteria
According to some experts, the pain that occurs in labor due to real tissue damage.
Pain perception was very individual, much influenced by physiological, pathological,
emotional factors. psychological, cognitive, environmental and social (Bonapace, 2013).
Labor pain can

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 Vol.9 No.1. May 2020. Page.248-257

Website: https://sjik.org/index.php/sjik
| Email: publikasistrada@gmail.com
cause stress which causes excessive release of hormones such as catecholamines and steroids.
This increase in hormones can cause metabolic and hemodynamic changes that are worse in
labor. In addition, it can cause tension in smooth muscle and blood vessels, resulting in
decreased uterine contractions and uteroplasenter circulation, reduced blood flow and oxygen
to the uterus and the emergence of uterine ischemia that makes the pain impulses more
numerous (Sumarah, 2009)
The delivery process was associated with discomfort alwaysor pain during the delivery
process. Pain that occurs during labor was caused by cervical stretching, uterine contractions
and fetal decline that causes prostaglandin to be released which can cause pain. Pain that was
not resolved can pose a physiological and psychological danger to the mother and fetus.
A related study was conducted by Afni (2018) that some mothers who gave birth felt
severe pain, only 9-14% of women gave birth to experience mild pain without reducing labor
pain. Baker (2001) in Utami (2018), explained the results of a study conducted in the UK, of
women who gave birth, found that 93.5% felt severe pain or unbearable pain. The results of
other studies that support is Pratiwi (2015), found only 15% of deliveries that took place
without pain or mild pain, 35% of deliveries accompanied by moderate pain, 30% of
deliveries accompanied by severe pain and 20% of deliveries accompanied by extreme pain.
In accordance with the theory put forward by Deasyana (2015), that the peak of pain
occurs at the end of the first stage, which was the active phase where the opening becomes
complete, reaching 10. Along with increased opening, the pain and contractions become
stronger, the pain comes from uterine contractions , so the contractions become more flexible,
longer and stronger so that the pain felt more intense.
Thus it was expected that all mothers who will face childbirth always routinely conduct
Antenatal Care visits. This was so that every mother can receive information provided by
health workers, including preparation for mothers in the face of childbirth later. So that every
mother who will give birth can have a picture of what will be experienced, including pain in
childbirth. The percentage of intranatal pain during the first phase of active labor after the
Bonapace
Method was given:
Table 2. Maternal pain during the active phase after administration of the Bonapace
Method
No Labor Pain Criteria Frequency Percentage (%)
1 No pain 0 0
2 Mild Pain 2 10
3 Moderate Pain 15 75
4 Severe pain 3 15
5 Very Pain 0 0
Total 20 100,00

Based on the results of the study showed that labor pain in the first stage of labor for
women active during delivery after gotBonapace Method was mostly on the criteria of being
as many as 15 respondents (75%), and partly of 2 respondents (10%) have criteria of mild pain
and partly again as many as 3 respondents (15%) have severe pain criteria.

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The Bonapace Method was an alternative method for dealing with labor pain, involving
the husband or family of the mother in labor. This method combines several non-
pharmacological techniques, namely relaxation, massage, acupressure and family assistance.
This method was uses several pain management techniques to control pain based on three
neurophysiological pain modulation models, first controlling the central nervous system
through breathing, relaxation and cognitive regulation, second using the stimulus, third
decreasing the inhibition by the strongest acupressure hyperstimulation. Thus, this bonapace
method was considered effective in the treatment of labor pain 4.
Several studies that used the Bonapace Method in labor have proven that the Bonapace
Method can reduce the used of tools in labor and did not require a long time in women with
dystocic labor. Bonapace method was a technique that can be chosen to reduce pain, increase
relaxation and comfort of maternity so that this bonapace method was considered effective in
handling labor pain 4.
Based on an assessment of research results relating to the administration of the
Bonapace Method in reducing labor pain. The Bonapace Method was the right course of
action to relieve pain in some women. The effectiveness of the bonapace method was assessed
more for maternity pain due to a combination of several non-pharmacological techniques 1.
The Bonapace Method was one of the non-pharmacological methods that was
implemented without any side effects, can build self-confidence, and participation from
patients so that it was expected to reduce the level of referral 1. Mechanism Bonapace Method,
starting from the principle that the brain cannot focus pain in two places at once. Creating
secondary pain with a strong emphasis on labor contractions will help the body release
endorphins (a kind of natural morphine) which will help relieve pain from contractions. So,
this bonapace method was considered effective in handling labor pain 1. This bonapace
method technique starts with the intervention or control of the central nervous system,
intervention or control of the central nervous system was done by means of respiratory
techniques. Relaxation during labor affects the psychological and work systems of the brain in
controlling labor pain. Besides relaxing light massage on the back during contractions,
massage or emphasis on certain parts of the body was considered to describe a stimulus that
can interfere with the transmission of pain to the brain, which is effectively able to close the
gate for pain reception, which also stimulates the release of endorphins and increased levels of
serotonin, to inhibit the transmission of nerve signals dangerous to the brain. In addition, the
administration of hyperstimulation analgesics during contractions, hyperstimulation analgesics
during contractions done by assisting childbirth to make the second cause of pain (by massage
with a strong emphasis) at the trigger point, namely the lower back, then alternating with the
points in the hand and in the buttocks, until the patient can choose which points were felt to
contribute most to the reduction in labor pain. Family assistance during childbirth can also
affect the psychological and brain work systems in controlling labor pain 1
Various methods have been introduced to intranatal in dealing with labor pain, both
pharmacologically and non pharmacologically. Pharmacological methods were more
expensive and potentially have adverse effects, while non-pharmacological methods were
cheaper and more effective and have no side effects. Some nonpharmacological methods that
are often performed include relaxation, breathing techniques, movement and position changes,
massage, hydrotherapy, heat / cold therapy, music therapy, acupressure and aromatherapy
(Handerson, 2009).

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For this reason, it was expected that health workers especially midwives and families
can help reduce the discomfort of labor pain experienced by intranatalby reducing labor pain
with non-pharmacological techniques, one of which was by giving Bonapace Method
The Influence of the Bonapace Method on the Reduction of First Stage Active Labor
Pain in PMB LilikErnawati, Selosari Village, Kandat District, Kediri Regency in 2020 was
illustrated in the following table:
Table 3. Cross Tabulation The Effect Bonapace Method Reduces Labor Pain Of
Active Phase I To Intranatal Carein PMB LilikErnawati, Selosari Village, Kandat District,
Kediri Regency in 2020
Criteria for Labor Pain After Giving the
Criteria for Labor Pain Before Bonapace Method
Giving the Bonapace Method No pain Mild Pain Moderate Severe Very Pain
Pain pain
∑ % ∑ % ∑ % ∑ % ∑ % ∑ %
No pain 0 0 0 0 0 0 0 0 0 0 0 0
Mild Pain 0 0 0 0 0 0 0 0 0 0 0 0
Moderate Pain 0 0 0 0 0 0 0 0 0 0 0 0
Severe pain 15 75 0 0 2 10 11 55 3 15 0 0
Very Pain 5 25 0 0 0 0 4 20 0 0 0 0

Total 20 100 0 0 2 10 15 75 3 15 0 0
Based on the table above showed that respondent data The Influence of Bonapace
Method Against Reduction of First Stage of Labor Pain Active Phase of Maternity Women in
PMB Lilik Ernawati Selosari Village Kandat District Kediri District respondents (75%) and 5
respondents (25%) experienced very severe pain criteria. After being given the Bonapace
Method, there was a reduction in pain, namely respondents who experienced severe pain
before being given the Bonapace Method, a decrease of 15 respondents mostly experienced
moderate pain, namely 11 respondents (55%), criteria for severe pain as many as 3
respondents (15%)
The results of the statistical test of the research on the Effect of the Bonapace Method
on the Reduction of First Stage Active Labor Pain in PMB Lilik Ernawati, Selosari Village,
Kandat District, Kediri Regency in 2020 were followed:
Wilcoxon correlation calculation results can see in the appendix
Statistics Test b
Pain after the Bonapace Method
(deselerasi)
–
Pain Before the Bonapace Method
(deselerasi)
Z -3,852a
Asymp.Sig.
(2- tailed) ,000
a. Based on positiverank
b. Wilcoxon Signed RankTest
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The results of calculations did to computer software using the Wilcoxon Correlation
formula obtained ρ value = 0,000 thus ρ <α then (H1) was accepted and (H0) was rejected,
meaning that there was an influence between the Bonapace Method on reducing labor pain
when I Active Phase. With a Wilcoxon Correlation value of - 3, 852
Based on the results of statistical tests it can be concluded that there are differences in
pain before and after the Bonapace Method was given with a value of P = 0,000. The results
obtained showed that there was a decrease in labor pain scale after being given the Bonapace
Method of labor pain before and after being given the Bonapace Method. The decrease in pain
scale caused by creating secondary pain with a strong emphasis on labor contractions will help
the body release endorphins (a kind of natural morphine) which will help relieve pain from
contractions. This shows a significant reduction in pain compared to those didn’t use
This was accordance with Nasriyah's research (2014) which examines the Application of
the Bonapace Method for labor pain between conventional methods and the bonapace method,
which states that the Bonapace Method was more effective in reducing labor pain. The results
showed, the statistical test results with the Wilcoxon test in the control group obtained a
synificancy value of 0.083 (p> 0.05) there was no significant difference between before and
after the administration of conventional methods, whereas in the treatment group (Bonapace
method) the statistical test with test Wilcoxon obtained a significance value of 0,000 (p>
0.05), there was a significant difference between before and after the administration of the
Bonapace method to decrease labor pain. The Bonapace Method can reduce pain
significantly14
This was line with the research of Bonapace et al. (2013) who assessed the effect of
the Bonapace method compared to traditional labor training methods (TCTPs), the results
showed a positive correlation between treatment with pain (pain intensity: P, 0.01; pain
discomfort: P, 0, 01). When compared with TCTP, the Bonapace method showed a
significantly lower overall pain perception for both intensity (45%, P, 0.01) and discomfort
(46%, P, 0.01) 15. This was also in accordance with the study. This was also accordance with
research conducted by Nurul, Fania. (2014) entitled the Bonapace Method for labor pain
which showed that the administration of the Bonapace Method was very effective in reducing
labor pain2.
The results also showed that mothers with severe pain as much as 3 respondents after
being given the Bonapace method were still experiencing severe pain. This showed that labor
pain may also be influenced by other factors. Factors affecting labor pain include the age of
very young women and elderly mothers complaining of higher labor pain levels, primiparas
experienced greater pain at the beginning of labor, whereas multiparas experienced an
increase in pain levels after labor with a rapid decrease in the second stage of labor. ,
intranatalwho have small pelvis, large babies, babies with abnormal presentations, mothers
who have a history of dysmenorrhoea can experience increased pain perception, possibly due
to excess prostaglandin production, anxiety will increase individual response to pain,
unpreparedness to undergo childbirth, support and companions for labor and social and
cultural factors16.
Therefore, as health workers, especially midwives and families to be able to helped
reduce labor pain experienced by mothers in various ways, including one by non-
pharmacological ways, one of which is by providing Bonapace Method which has been
proven effective in reducing labor pain in mothers so that labor can proceed safely and
smoothly.
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CONCLUSIONS
Conclusions Administration of the Bonapace Method can influence the reduction of
labor pain in the active phase I. It is recommended that the Bonapace Method be used as an
alternative to reduce maternal pain in first phase active mothers.
Suggestions There should be further research on the administration of the Bonapace
Method to the labor process in the first stage and other factors that influence labor pain in the
active phase.
Suggestions from researchers for research sites are for Research Sites to increase the
role of health workers in the delivery room to better understand and apply non-farnakologi
techniques such as the Bonapace Method, while respondents are expected to provide
information to maternity mothers and families about appropriate pain reduction methods safe
and effective non pharmacology to reduce pain in labor so that it can provide comfort to the
mother in the first phase of the Active phase.

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