LAPORAN PRESENTASI JURNAL

Nurses and Midwives’ Experiences Of Using Non-Pharmacological Interventions For Labour

Pain Management: A Qualitative Study In Ghana

Dosen Fasilitator :

Diah Eko Martin. S.Kep., Ns., M.Kep

Disusun Oleh Kelompok 2 Kelas 2 C Keperawatan

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S. P.
A.

PROGRAM STUDI S1 KEPERAWATAN

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH LAMONGAN

TAHUN 2022/2023
 KATA PENGANTAR

Bismillahirahmanirrahim.

Puji syukur kami panjatkan kehadirat Allah SWT atas rahmat dan hidayahnya, penulis bisa
menyelesaikan makalah yang berjudul “Nurses and Midwives’ Experiences Of Using Non-
Pharmacological Interventions For Labour Pain Management: A Qualitative Study In Ghana” dengan
baik meskipun di dapati hambatan. Makalah ini di buat untuk mendalami tugas mata kuliah
Keperawatan Maternitas dan membantu kegiatan belajar Keperawatan Maternitas semester 3
keperawatan.

Tak lupa kami mengucapkan terima kasih kepada:

1. Dr. Abdul Aziz Alimu Hidayat, S.Kep., Ns., M.Kes (selaku Rektor Universitas
Muhammadiyah Lamongan )
2. Dr. Virgianti Nur Farida, S.Kep., Ns., M.Kep (selaku Dekan Fakultas Ilmu Kesehatan
Universitas Muhammadiyah Lamongan)
3. Suratmi, S. Kep., Ns., M.Kep, (selaku Kaprodi S1 Keperawatan Universitas
Muhammadiyah Lamongan).
4. Diah Eko Martini, S.Kep., Ns., M.Kep (selaku Dosen PJMK dan Dosen Pembimbing
mata kuliah Keperawatan Maternitas)
5. Rekan-rekan dan pihak yang telah membantu kelancaran dalam pembuatan makalah.
Dalam penyusunan makalah ini, ditulis berdasarkan buku, dan informasi yang berhubungan
dengan Hidroterapi. Penulis menyadari bahwa makalah ini masih kurang sempurna. Untuk itu
diharapkan berbagai masukan yang bersifat membangun demi kesempurnaan.

Lamongan, 28 November 2023

Penyusun

DAFTAR ISI

COVER.....................................................................................................................i

KATA PENGANTAR ............................................................................................ii

DAFTAR ISI .........................................................................................................iii

BAB 1 PENDAHULUAN ......................................................................................1

1.1 Latar Belakang ..............................................................................................1

1.2 Tujuan Penulisan...........................................................................................1

BAB 2 JURNAL PENELITIAN .............................................................................3

BAB 3 PEMBAHASAN .......................................................................................15

3.1 Profil Penelitian ............................................................................................15

3.2 Deskripsi Penelitian PICo.............................................................................15

BAB 4 PENUTUP

4.1 Kesimpulan..................................................................................................15

4.2 Saran............................................................................................................15

DAFTAR PUSTAKA............................................................................................16

LEMBAR KONSUL..............................................................................................

BAB 1

PENDAHULUAN

1.1 Latar Belakang

 Nyeri yang dialami saat melahirkan merupakan fenomena kompleks, multidimensi dan
subyektif yang menjadi perhatian besar bagi ibu hamil dan profesional kesehatan bersalin.
Meskipun pengalaman nyeri merupakan hal yang melekat dalam proses melahirkan, nyeri
persalinan yang tidak diatasi dapat menimbulkan konsekuensi negatif bagi ibu hamil, keluarganya,
penyedia layanan kesehatan, dan sistem layanan kesehatan secara keseluruhan. Selain akibat yang
ditimbulkan pada ibu seperti meningkatnya stres, ketakutan, depresi, kebingungan, hipertensi,
hiperglikemia, dan konstipasi, nyeri persalinan yang tidak teratasi juga dapat mengganggu perfusi
plasenta yang menyebabkan asfiksia, deselerasi lambat, dan akibat dari gawat janin. Hal ini
menimbulkan perasaan bersalah dan tidak berdaya bagi keluarga perempuan tersebut serta
kurangnya kepercayaan terhadap kemampuan penyedia layanan kesehatan dan sistem secara
umum.

Beragam intervensi farmakologis dan non farmakologis tersedia untuk menghilangkan nyeri
persalinan. Penggunaan intervensi farmakologis untuk pengelolaan nyeri persalinan telah
mendominasi profesi perawatan bersalin karena kemanjuran tindakan ini dalam mengurangi nyeri
pada ibu hamil. Namun demikian, tindakan ini relatif mahal dan berhubungan dengan efek samping
seperti mual, muntah, mengantuk, demam, sakit kepala, hipotensi, retensi urin, cedera saraf, dan
depresi pernafasan pada janin. Selain itu, teknik pengobatan ini mungkin dikaitkan dengan
peningkatan risiko keterlambatan kala dua persalinan, augmentasi persalinan, persalinan dengan
alat dan operasi caesar.

Intervensi non-farmakologis menjanjikan pengurangan nyeri persalinan, dengan dampak

minimal atau tanpa bahaya terhadap ibu, janin, dan kemajuan persalinan, serta sederhana dan hemat
biaya. Hal ini berpotensi mengurangi konsumsi analgesik selama persalinan dan mencakup antara
lain pijat, teknik pernapasan, penentuan posisi, hidroterapi, musik, imajinasi terbimbing, akupresur,
aromaterapi.

1.2. Tujuan Penelitian.

1. Untuk mengetahui profile penelitian dari “pengalaman perawat dan bidan dalam menggunakan
intervesni non-farmakologis untuk manajemen persalinan.

2. Untuk mengetahui tujuan penelitian "Pengalaman perawat dan bidan dalam menggunakan
intervensi non- farmakologis untuk manajemen persalinan".

3. Untuk mengetahui Deskripsi penelitian berdasarkan metode PICO.

4. Untuk mengetahui desain penelitian "Pengalaman perawat dan bidan dalam menggunakan
intervensi non- farmakologis untuk manajemen nyeri persalinan".
5. Untuk mengetahui populasi/ sample dan problemnya pada penelitian tersebut.

6. Untuk mengetahui intervention dari penelitian tersebut.

7. Untuk mengetahui Comperator dari penelitian ini.

8. Untuk mengetahui Outcomees/Findings/ Hasil Penelitiannya.

9. Untuk mengetahui kelebihan dan kelemahan dari "pengalaman perawat dan bidan dalam
menggunakan intervensi non- farmakologus untuk manajemen persalinan".

10. Untuk mengetahui manfaat dari hasil penelitian bagi keperawatan.

BAB 2

JURNAL PENELITIAN
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168
https://doi.org/10.1186/s12884-019-2311-x

RESEARCH ARTICLE Open Access

Nurses and midwives’ experiences of using

non-pharmacological interventions for labour
pain management: a qualitative study in
Ghana
Edward Appiah Boateng1* , Linda Osaebea Kumi2 and Abigail Kusi-Amponsah Diji1

Abstract
Background: Non-pharmacological interventions hold promise in reducing labour pain, with minimal or no harm to the
mother, foetus and the progress of labour and are simple and cost-effective. Yet their use has not been adequately explored in
clinical settings, especially in sub-Saharan Africa.
Methods: This was a descriptive phenomenological study. Fifteen (15) nurses and midwives working in labour wards of two
hospitals in Ghana were interviewed. Data analysis was guided by the principles of coding by Bailey and the constant
comparative approach to generate themes. Ethics approval was obtained from the 37 Military Teaching Hospital
Institutional Review Board in Ghana.
Results: Three major themes were identified that described the experiences of nurses and midwives regarding their use of
non-pharmacological interventions in managing labour pain. These were familiarity with non- pharmacological
interventions, perceived benefits of non-pharmacological interventions, and barriers to the use of non-pharmacological
interventions in the management of labour pain.
Conclusions: While some non-pharmacological pain management interventions were known and used by the nurses and
midwives, they were not familiar with a good number of these interventions. Nurses and midwives perceived these
interventions to be beneficial yet a number of barriers prevented easy utilisation.
Keywords: Labour pain relief method(s), Non-drug technique(s), Phenomenology, Maternity care provider(s), Africa

Background perfusion leading to asphyxia, late decelerations and its re-

Pain experienced during childbirth is a complex, multidi-
mensional and subjective phenomenon [1] that is of great
concern to both the expectant mother and the maternity
healthcare professional. Although the experience of pain
is inherent in the childbearing process [2], unrelieved
labour pain can result in negative consequences for the
expectant mother, her family, healthcare providers and
healthcare systems at large. Apart from maternal conse-
quences such as heightened stress, fear, depression, confu-
sion [3], hypertension, hyperglycaemia, and constipation
[4], unresolved labour pain can also compromise placental
* Correspondence: guardian2405@yahoo.com
1
Department of Nursing, Kwame Nkrumah University of Science and Technology,
Kumasi, Ghana
Full list of author information is available at the end of the article
sultant foetal distress [5]. These create feelings of guilt
and helplessness for the woman’s family [6] as well as a
lack of confidence in the abilities of healthcare providers
and systems in general [7].
A wide array of pharmacological and non-pharma-
cological interventions are available for the relief of
labour pain [8, 9]. The use of pharmacological inter-
ventions for the management of labour pain has dom-
inated the maternity care profession due to the
efficacy of these measures in reducing pain in expect-
ant mothers [9]. Nevertheless, these measures are
relatively costly [10] and associated with adverse ef-
fects such as maternal nausea, vomiting, drowsiness
[11], fever [12], headache, hypotension, urinary reten-
tion, nerve injury [13], and foetal respiratory

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International
License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 2 of 36

depression [14]. Moreover, these drug techniques nurses and midwives who had worked on the labour
may be associated with increased risks of delayed sec- wards of
ond stage of labour, labour augmentation, instrumen-
tal delivery and caesarean section [15].
Non-pharmacological interventions hold promise in
reducing labour pain, with minimal or no harm to the
mother, foetus and the progress of labour and are simple
and cost-effective [9]. These have the potential to reduce
analgesic consumption during labour [8] and include
massage, breathing techniques, positioning, hydrother-
apy, music, guided imagery, acupressure, aromatherapy
among others [16].
Nurses and midwives play an essential role in the
management of labour pain and have been described by
Lundgren and Dahlberg [17] as “anchored companions”.
A professional nurse or midwife in Ghana is one who
has successfully completed nursing or midwifery training
in an accredited college or university and has registered
with the Nursing and Midwifery Council of Ghana. The
scope of practice of midwives, as set out by the Nursing
and Midwifery Council (NMC) of Ghana, permits them
to provide antenatal, intrapartum, postpartum, repro-
ductive health and infant care, and some specialized care
depending on their level of training. In Ghana, the mid-
wife to women in fertility age (WIFA) ratio was reported
to be 1: 907 [18]. Consequently, nurses are, sometimes,
assigned to maternity care areas as a way of improving
the ratios. Considering the central role nurses and mid-
wives play in the childbirth process, this study sought to
explore their experiences with using non-pharmacological
interventions in labour pain management.

Methods
Study setting
This study was carried out in 2 hospitals in Ghana
which we will call hospital A and B respectively for
purposes of anonymity and confidentiality. Hospital A
has a 400-bed capacity and an extended capacity of
600 beds in emergency situations. It serves as the
government’s emergency response health facility and
as a United Nation’s level IV medical facility in the
West African sub-region that provides healthcare to
soldiers and civilian workers. On the other hand,
Hospital B has an ultra-modern 420-bed capacity and
is currently being expanded to a 600-bed capacity. It
serves as a regional hospital in the country. Both hos-
pitals provide healthcare in varied specialities includ-
ing obstetrics and gynaecology.

Study design, participants and data collection procedures This

was a descriptive phenomenological study, and the
report was guided by the Consolidated Criteria for
Reporting Qualitative Research [19]. Fifteen (15)
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 3 of 36
the two hospitals for a minimum period of 6 months
were purposively sampled between May and October
2016. Following ethics approval, LOK approached eli-
gible participants. The purpose of the study, its benefits,
risks and the voluntary nature of participation were
explained to them before obtaining their written in-
formed consents. All eligible participants who were
approached agreed to be part of the study. Meetings
were subsequently arranged with participants who
signed the consent form based on their availability and
preferences. Characteristics of participants have been
provided in Table 1 including their rank and years of
clinical experience. Pseudonyms have been used to en-
sure the anonymity of participants. In-depth individual
interviews were conducted using a semi-structured
interview guide (Additional file 1) and were
audio-recorded after obtaining participants’ permission.
All individual interviews were conducted in the English
language and in a quiet private room within each hos-
pital, facilitated by one of the researchers (LOK). No
other person was present in the room aside LOK
and the participant during each interview session.
There were no repeat interviews. The questions were
framed based on the research objectives, existing
literature, ex- pert opinion and feedback from pre-
testing with 5 mid- wives in a similar hospital. Field
notes were written after each interview to detail
observations that could not be captured via the audio
recording. The duration of inter- views sessions ranged
between 27 and 56 min.

Data processing and analysis

The interviews were carefully listened to and tran-
scribed verbatim after each session. In order to
ensure non-distortion of collected data, the transcripts
were returned to participants for feedback and/or cor-
rections. Each participant-reviewed transcript was
then read multiple times, grouped and organised
throughout successive reads. The transcripts were
coded by 3 researchers (LOK, AKA, EAB) to identify
emerging themes which were discussed regularly
throughout data collection by the entire research
team. This was done to resolve differences and build
consensus on identified themes that required further
exploration in subsequent interviews.
Inductive data analysis was aided by NVivo version
12 and occurred concurrently with data collection.
Data analysis was undertaken based on the principles
of coding by Bailey [20] who describes two types of
coding; initial and focused coding. With the initial
coding, data was conceptualised and categorised
through line-by-line coding. Secondly, focused coding
involved grouping coded text into larger segments
which comprised smaller segments. This comprised
carefully identifying relationships between
concepts
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 4 of 36

Table 1 Characteristics of Participants

SN Participant Rank Years of clinical experience
1 Mary Staff midwife (SM) 5 years
2 Rhoda Staff midwife (SM) 6 years
3 Agartha Senior Nursing Officer (SNO) 7 years
4 Constance Staff midwife (SM) 1 year
5 Debbie Staff midwife (SM) 3 years
6 Elizabeth Staff midwife (SM) 3 years
7 Fatima Senior Nursing Officer (SNO) 13 years
8 Hannah Staff midwife (SM) 3 years
9 Joyce Staff midwife (SM) 17 years
10 Lady Staff midwife (SM) 17 years
11 Pat Rotation Midwife (RM) 6 months
12 Suzzy Staff midwife (SM) 3 years
13 Takyiwaa Senior Staff Midwife (SSM) 6 years
14 Vicky Senior Staff Midwife (SSM) 6 years
15 Wendy Senior Staff Midwife (SSM) 6 years

that made up the main themes. Constant comparison
between codes, memos and literature was maintained
throughout the research work. After exploring the
experiences of the nurses and midwives with using
non-pharmacological labour pain management tech-
niques, the results of the research study were com-
pared with existing evidence in order to bring
meaning to the research question. As suggested by
O’Reilly and Parker [21], thematic data saturation was
reached when no new themes emerged from the col-
lected data in each of the hospitals.
As explained above, member checks were also done
by sending transcripts to participants for feedback
and corrections [25].
Ethical considerations
Ethics approval, with reference number 37MH-IRB IPN
078/2016, was obtained from the 37 Military Teaching
Hospital Institutional Review Board. Participants were
assured of anonymity, privacy and confidentiality of their
responses as well as the voluntary nature of participation
in this study.

Trustworthiness of the study

A number of approaches were employed to enhance
the trustworthiness of this study. Credibility was en-
sured by collecting data from two different hospitals
to ensure comprehensive accounts on the experiences
Results
of nurses and midwives in Ghana [22]. All researchers
were involved in the data coding and entire analysis
process, meeting frequently to discuss and resolve
differences on emerging themes to ensure investigator
triangulation and comprehensive account of findings
[23]. Inclusion of participants’ quotes to support
researchers’ interpretations also added to the credibil-
ity of the study [24]. This approach also promoted
confirmability by ensuring that interpretations were
grounded in the data rather than mere viewpoints of
the researchers [23]. Efforts have been made to
describe the setting as well as key characteristics of
participants while maintaining anonymity and confi-
dentiality to ensure transferability of this study [23].
Analysis of the data identified three (3) major thematic
areas which described nurses and midwives’ experiences
with the use of non-pharmacological interventions for
labour pain management in the selected hospitals. These
were familiarity with non-pharmacological interventions,
benefits of non-pharmacological interventions, and bar-
riers to the use of non-pharmacological interventions in
the management of labour pain. These have been pre-
sented below, with relevant quotes from participants.
Familiarity with non-pharmacological interventions
This theme described participants’ awareness and usage
of non-pharmacological pain management techniques in
midwifery practice to manage labour-associated pains.
All participants provided an accurate explanation of
non-pharmacological interventions for labour pain
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 5 of 36
management.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168
“They [non-pharmacological interventions] are
ways of relieving labour pain in which no
medications are used.” (Constance, SM)
“…using other means to relieve pain other than
drugs” (Vicky, SSM)
Participants reported learning about these methods
from varied sources, including their midwifery or nurs-
ing training colleges, workplaces and workshops.
“I learnt [about] most of these [non-pharmacological]
methods on the wards especially the previous
places I’ve worked... and I know there [is] a lot I will
not even know of” (Joyce, SM)
“I went for this life-saving skills workshop some
time ago and this non-pharmacological therapy
was one of the topics” (Constance, SM)
“I was taught in school and my in-charge here
encour- aged me to use those methods” (Pat,
RM).
Participants were asked to provide examples of com-
mon non-pharmacological interventions they use in
managing labour pain. All participants were able to list,
at least, one non-pharmacological pain management
method which they were aware of and used in their
practice. The most frequently used methods as men-
tioned by participants were sacral massage, deep breath-
ing exercises and diversional therapy.
“You can also create the right environment by
giving some diversional therapy ... you can ask
the client to be breathing in and out, you can
give a sacral massage as well.” (Hannah, SM)
“You [can] encourage patient during labour and
give a sacral massage. You can involve the
patient in a conversation which is something like a
diversional therapy which will take her mind off the
pain” (Elizabeth, RM)
Other less often mentioned and presumably less fre-
quently utilised methods were ambulation, cold shower,
cold or warm compresses.
“... ambulation …she should walk about; we
usually tell the client that, she will feel the pain
more if she lies on one side or at one place…”
(Debbie, SM)
“…deep breathing exercise, encouraged to walk
about, listen to the music of her choice or watch
television… Then warm or cold towels can be
used on the client’s
Page 6 of 36
abdomen, forehead or anywhere she feels
comfortable especially when she is sweating.” (Joyce,
SM)
However, other types of non-pharmacological methods
such as guided imagery, chromotherapy, acupuncture,
transcutaneous electrical nerve stimulation (TENS) and
homoeopathy were not mentioned by any of the partici-
pants, suggesting limited awareness or infrequent usage
of these methods among our participants. Almost all the
participants revealed that they use non-pharmacological
methods on a daily basis in the management of labour
pain when they were asked about the frequency of use
of these methods.
“Here [in the labour ward] we use these [non-
pharmacological] methods every day, I mean very
often” (Rhoda, SM)
“We actually use it here, the majority of our clients
usually go through this method; the non-
pharmacological therapy” (Elizabeth, RM)
Benefits of non-pharmacological interventions in the management
of labour pain
The study also explored participants’ perspectives on
benefits associated with using non-pharmacological
interventions in managing labour pain. This theme
describes the perceived benefits that participants
recounted about non- pharmacological interventions
that they were aware of. A large number of the par-
ticipants mentioned that a key benefit among all the
benefits was that the methods presented no side ef-
fects, as indicated in the quotes below:
“There is no side effect. If you, for instance, come
in labour and I allow you to watch a movie for
instance, at least it will take your mind off the
pain without causing any harm to you or your
baby...” (Lady, SMO)
“… because there are no side effects and it can
be used any time…” (Wendy, SSM)
“It [non-pharmacological interventions] really
helps psychologically, comparing the
pharmacological management, for instance,
pethidine [which] sometimes affect the foetal
heart rate” (Elizabeth, RM)
Others also explained that using non-pharmacological
interventions serves as a way of relaxing the woman in
labour and making her more comfortable during the
process. The ultimate effect is that labour progresses
smoothly.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168
“It makes the client relaxed …the clients usually
remain calm and others remain comforted.”
(Rhoda, SM)
“Involving the client in a conversation actually
takes the client’s mind off the pain, somehow. You
do that [have conversation] and you realise that
even when the client is contracting, she does not
really exhibit the pain as when there is no
diversional therapy. It makes the client
comfortable and decreases anxiety, makes them
calm and makes the labour move on smoothly.”
(Elizabeth, RM)
“It really calms the client, making her comfortable
and takes her mind off the pain which thereby
allows the labour to progress smoothly. It really
helps and relaxes the client.” (Joyce, SM).
Additionally, using non-pharmacological interven-
tions was described as a means of fostering a good
relationship between the nurse/midwife and the client,
promoting client cooperation.
“…it makes the client feel that you are close to
her so whatever you ask her to do, naturally she
does it.” (Lady, SMO)
“… and it was relieving because when you want
to leave the client she goes like ‘auntie midwife,
don’t go, please come back, come and do it again”
(Agartha, SNO)
Additionally, one participant mentioned that non-
pharmacological interventions are easy to administer,
cheap and that they are non-invasive.
“…of course, since they are non-pharmacological,
there are not many side-effects as compared to
the pharmacological pain relievers. It’s the
easiest pain relief you can give because you
don’t have to use
any invasive procedures, it has no side effect.
It’s
just physical, no invasion; nothing and it’s not sold.”
(Vicky, SSM)
Barriers to the use of non-pharmacological interventions in the
management of labour pain
Participants described impediments in their practice
which discouraged and sometimes prevented them from
using non-pharmacologic pain management interventions
routinely in practice to assist expectant mothers in the
delivery process. These reported barriers could be cate-
gorised into three – clinician-related, health system-re-
lated and client-centred.
Page 7 of 36
Clinician-related barriers comprised perceptions and
beliefs of nurses and midwives which hindered their fre-
quent utilisation of non-pharmacological methods.
Indeed, the previous section has presented perceptions
about nurses and midwives on the benefits of utilising
non-pharmacological interventions in the management
of labour pain. Yet, a number of the nurses and mid-
wives were of the view that non-pharmacological inter-
ventions do not actually relieve the pain. Such views
were mainly held in comparison with pharmacological
interventions, which they believe ensure a complete
relief of pain.
“If you are, for instance, doing sacral massage for
the patient, that does not mean the pain is gone…
the patient is only coping with the pain and the
massage just takes her mind off the pain, that’s
all, it does not really relieve the pain.” (Joyce,
SM)
“I think that even though they feel relaxed the
pain is still there; they can’t compare the relief
they felt from that to the pharmacological
therapy… but it does not take the pain away,
that’s my own perception of it.” (Vicky, SSM)
“I think there are better ways to keep someone’s
mind off the pain and with the breathing in the
client still feels the pain, it is just that you the
midwife keeps the client’s mind occupied with it
but the pain still exists… but supposing you do the
epidural, the client relaxes and is able to
cooperate with you. The better way to relieve
labour pain is with pharmacological therapy.”
(Mary, SM)
Consequently, nurses and midwives were not always
ready to implement some of the aforementioned non-
pharmacological interventions for women experiencing
labour pain but preferred to administer pharmacologic
therapy in most cases.
“...if I did one [using non-pharmacological
method] and she [client] said I should stop, if it
were you would you have given her another [non-
pharmacological] method?” (Mary, SM)
Health system-related barriers were those that hin-
dered utilisation of non-pharmacologic methods as a
result of the structure of the healthcare system as well as
the physical design of the labour wards. The overwhelm-
ing responsibilities of nurses and midwives as a result of
the fewer numbers available within the healthcare facility
per shift is one of such barriers. The implication is that
the number of nurses and midwives available is not suf-
ficient to effectively carry out these non-pharmacological
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 8 of 36

interventions as some may require the constant presence “In my ward, we have two labour beds so when
of the attending maternity care provider to be effective.
you are involving one client in a conversation,
the other client might not want to be disturbed…
“Lack of staff, that is sometimes you have only
let’s say one client wants to listen to music and
two midwives on duty. These same midwives are
the other does not want to, it makes it difficult.”
to monitor clients to deliver, go to the theatre to
(Elizabeth, RM)
resuscitate caesarean sectioned babies and
write all that happens here as well as
The last but not the least barrier – client-centred –
decontaminate.” (Mary, SM)
described preferences of clients which hindered the use
of non-pharmacological methods in managing labour
“It is time-consuming; you have to be present
pain. Some midwives were of the opinion that client
beside the client before you can administer it. It
preferences, sometimes, serve as a barrier to the utilisa-
is not as if you are administering it and leaving,
tion of non-pharmacological interventions. Although
it’s only the pharmacological that you can
midwives may want to administer some of these inter-
administer and you can leave the client on her
ventions, the client may decide against them for various
own.” (Agartha, SNO)
reasons.
“If there are two women, who will I massage?
“Some patients can tell you ‘no, I don’t like this’
And remember I’m the same midwife who will go
or ‘when you do the sacral massage it irritates
and collect a baby at the [surgical] theatre and
me’ or ‘let me be, I think I’m OK without the
resuscitate, the same midwife managing an
sacral massage’”. (Elizabeth, RM)
impromptu second stage, and not to mention all
the documentation I have to do.” (Lady, SMO)
“I remember I used the sacral massage on one
client but she told me I should stop because it will
Others also identified the setting of health facilities as
make the baby’s eyes [become] red when it is
a major barrier to the utilisation of some non-pharmaco-
born so I stopped.” (Mary, SM)
logical interventions for managing labour pain. Some of
the interventions could easily be administered by sup-
This section has presented three main thematic areas
port persons of the woman in labour, including their
with relevant supporting statements. In summary, mid-
partners. While their mere presence could be soothing,
wives were generally familiar with non-pharmacologic
partners are also able to administer some of the
interventions for managing labour pain as well as their
non-pharmacological interventions when they are
benefits. However, a number of barriers that made the
around.
implementation of non-pharmacologic interventions
challenging in the delivery of care in certain respects
“…and sometimes in situations when the
have also been presented.
husbands are allowed to come into the labour
ward; sometimes they touch them, give them
massages and even the talk they have relieves
them of their pain.” (Vicky, SSM)

“When the partner is involved it relieves the Discussion

woman psychologically of pain since she feels
belonged because the husband is around to
caress her, give sacral massage [and] warm or
cold drinks.” (Takyiwaa, SSM)
However, there are no cubicles or private rooms for
each client, making it inappropriate to have partners of
each client in the labour ward. Other times, too, the pre-
ferred non-pharmacological intervention for one client
may inconvenience other clients in the labour ward.
“In our setting where we don’t have cubicles for
nursing our clients…it becomes difficult when you
have so many women in one room and you are to
get a support person to come in, it’s not going to
be comfortable” (Takyiwaa, SSM)
The current study explored nurses and midwives’ experi-
ences with using non-pharmacological interventions for
labour pain management. Our study revealed that nurses
and midwives were familiar with some non-
pharmacologic approaches such as sacral massage, deep
breathing, diver- sional therapy; and frequently use them
in their practice to manage labour pain. The frequent
usage of these methods has been reported in previous
studies [26, 27] and can be at- tributed to the familiarity of
the midwives with these approaches [28]. Other less
frequently used methods like ambulation, cold shower,
cold and warm compresses were also reported by nurses
and midwives in the present study. While insufficient
knowledge may account for the less fre- quent use of these
methods, other factors such as inadequate human and
material resources may have contributed to this
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 9 of 36
observation, similar to what has been reported in other
stud- ies [29–31].
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168
Although the nurses and midwives were aware of and
used some non-pharmacologic labour pain management
approaches, they were equally unaware of a good number
of these techniques. Considering the critical role of nurses
and midwives in the birthing process, this situation could
limit the labour pain management options that expectant
mothers have to choose from and may lead to
sub-optimal labour pain relief. Non-pharmacological in-
terventions such as water immersion [32], guided
imagery, aromatherapy, chromotherapy, homoeopathy,
acupunc- ture, transcutaneous electrical nerve stimulation
(TENS), floral therapy, and energy-level support [33]
have been shown to be successful in reducing labour pain
in other settings. The use of these other non-
pharmacological pain management interventions could be
explored further in future studies.
Our study also revealed that the perceived benefits of
non-pharmacological interventions for labour pain man-
agement contributed to its usage by the nurses and mid-
wives. As reiterated in previous studies, participants
perceived non-pharmacological interventions for pain
management to be relatively cheap, non-invasive, easy to
administer, associated with minimal or no side effects
[34], reduce anxiety, promote comfort and help to form a
trusting relationship between the attending midwife and
the expectant mother [33, 35]. In spite of the reported use
of non-pharmacologic methods, participating nurses and
midwives also reported barriers which prevented them
from using these methods in certain situations. Among
them were their belief that such interventions do not
really relieve pain as compared to pharmacological
approaches, insufficient staff to deliver some of the
time-consuming non-pharmacologic interventions, in-
appropriate layout of labour wards to ensure privacy and
family participation, inconveniences to other clients and
pregnant women’s refusal of some methods due to their
perceived negative conceptions about some methods.
Participants’ belief that non-pharmacological methods
“do not really” relieve pain is a demonstration of their
insufficient knowledge on labour pain physiology and
the mechanism of action of these non-pharmacologic
techniques. Although non-pharmacological methods do
not possess the same analgesic properties as pharmaco-
logic techniques, they can reduce labour pain to an
appreciable level [28, 36]. Considering that analgesics
may be associated with untoward effects to both the
labouring woman and her unborn baby [11, 14], the
usage of non-pharmacological methods in addition to
drug techniques hold promise in maximizing pain relief
while minimizing side effects in the labour process [8,
37]. This is due to the reduced consumption of analgesics
and their associated side effects when non-pharmacologic
techniques are used to complement pharmacologic inter-
ventions. Moreover, several studies have demonstrated the
Page 10 of 36
effectiveness of non-pharmacological methods in reducing
labour pain [28, 32, 38]. Exposure to and utilisation of
diverse types of non-pharmacological methods could con-
tribute to reducing the perception that these methods do
not really relieve pain and this could be achieved through
frequent training sessions on these lesser known methods.
Indeed, our study revealed that nurses and midwives learn
about non-pharmacological methods of labour pain man-
agement from various sources, including nursing and
midwifery training colleges, wards and workshops. Em-
phasis on these methods during pre- and post-registration
nursing and midwifery education would, therefore, build
their knowledge-base while enhancing the utilisation of
di- verse forms of non-pharmacologic methods.
Similar to other studies [39, 40], insufficient staff
served as a barrier to the utilisation of nonpharmacolo-
gical methods in managing labour pain. Participants per-
ceived some of the non-pharmacologic approaches to be
time-consuming for the few attending maternity care
providers to administer considering their heavy work-
load and increased client turnover. Excessive workload
and increased client turnover invariably place a lot of
stress on the few practising nurses and midwives, leading
to staff burnout and impaired work efficiency [41, 42].
Incorporating teaching sessions on non-pharmacological
interventions during ante-natal care could empower the
expectant mother to support the few nurses and
midwives in utilising these methods during labour
management.
Another barrier that prevented the nurses and mid-
wives from using non-pharmacologic labour pain relief
strategies was the inappropriate design and layout of the
delivery rooms which does not allow for privacy and
family participation during the childbirth process. The
process of labour is an intimate affair requiring the pres-
ence of supportive partners and family members without
compromises on privacy [43, 44]. The poor state and
layout of delivery rooms not only affects utilisation of
non-pharmacological interventions for pain management
but also often secludes the expectant mother from her
loved ones and alone in the hands of healthcare profes-
sionals during the delivery process. This accounts for
women delivering at home or with traditional birth
attendants owing to their welcoming environment and
company received during labour [45]. Designing labour
wards to allow for the presence of family and significant
others of the expectant mother will not only provide
emotional support for the woman but also support
with some non-pharmacological methods. In a setting
where insufficient numbers of nurses and midwives
serve as a barrier to the increased utilisation of these
methods, ensuring the presence of a supportive family
is an urgent requirement for effective utilisation of
non-pharmacological methods.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 11 of 36

The inconveniences of some nonpharmacological for the usage of non-pharmacologic techniques include their
methods to other clients were reported as one of the non-invasiveness, inexpensive nature, ease of use,
barriers to their usage at the labour wards. While some
methods such as music listening or watching television
serve as a form of distraction from pain for some
women, other clients may prefer a noise-free environ-
ment during the delivery process. The international lit-
erature is clear about the advantages of ambience during
labour [1, 46]. Creation of a conducive environment for
the expectant mother can effectively reduce painful sen-
sations during labour [47]. On this premise, it is import-
ant for maternity care providers to respect the
individuality of each client and be prepared to modify
the delivery environment to suit diverse clients [33].
Reported misconceptions by some clients also prevented
nurses and midwives from using some of the non-
pharmacologic pain relief techniques. For instance, one
midwife shared an experience where a client perceived
sacral massage to be associated with reddening of the
newborn baby’s eyes. This suggests the need for client
education on labour pain management during the ante-
natal period and reinforcement during the delivery
process, so as to correct misconceptions. Special emphasis
ought to be placed on the role of non-pharmacologic
techniques as adjuncts to analgesics to improve labour
pain relief and maximize birth outcomes without unneces-
sary medical interventions. Evidence suggests that many
women opt for unnecessary interventions such as caesar-
ean sections, instrumental delivery among others for fear
of unrelieved labour pain [48, 49]. Considering that these
interventions are not without complications such as
excessive blood loss, infections, dense adhesions, birth
traumas [50], all efforts should be made to improve pain
relief and promote natural delivery methods.

Limitations
Like all qualitative studies, the findings of this study can-
not be generalised but can be transferred to other simi-
lar settings. The selected hospitals are both based in
cities where access to drugs and specialists is relatively
easier. Experiences of nurses and midwives in rural areas
of the country may differ due to their relatively limited
access to drugs and specialists and would need to be
explored in future studies.

Conclusions
Nurses and midwives are familiar with some non-pharma-
cological labour pain management techniques and fre-
quently use them in their practice. A good number of
non-pharmacologic techniques remain unknown to nurses
and midwives and are subsequently not used in practice
to reduce childbirth associated pain. Some of the reasons
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 12 of 36
safety, comfort enhancement and bonding. Nevertheless,
barriers such as staff and client misconceptions about
their efficacy, insufficient staff and resources prevent
opti- mal use by nurses and midwives in Ghana. Indeed,
there is support for non-pharmacological methods
among nurses and midwives. However, these are mostly
perceived as a second option to pharmacological
methods and mainly lead to an overreliance on the latter
due to its perceived superior efficacy, coupled with the
other re- ported barriers to the utilization of non-
pharmacological methods. Maternity care providers and
clients alike should be educated on labour pain relief
options, with emphasis on the role of non-
pharmacologic techniques in comple- menting
analgesics to provide maximal pain relief with minimal
side effects. While client and staff education ought to be
strengthened in this area, the identified bar- riers should
be addressed at both institutional and na- tional levels to
improve pain management for expectant mothers. Future
studies should experimentally examine the efficacy of
some of these non-pharmacologic methods on labour
pain relief and other birth outcomes, especially in
resource-constrained settings so as to get balanced evi-
dence as most of such studies have been conducted in
de- veloped countries.

Additional file
Additional file 1: Interview Guide (Labour Pain Management): Interview
Abbreviations Guide: This guided data collection for this study. (DOCX 16 kb)
RM: Rotation Midwife; SM: Staff Midwife; SNO: Senior Nursing Officer;
SSM: Senior Staff Midwife

Acknowledgements
Not applicable

Funding
The authors did not receive any financial support for conducting the research,
authorship, and/or publication of this research article.

Availability of data and materials

Data analysed during this study may be available from the corresponding author
upon reasonable request.

Authors’ contributions
EAB, LOK and AKAD conceptualised and designed the study. LOK collected
data for this study while EAB, LOK and AKAD were all involved in the data
analysis and write-up of the manuscript. All authors critically reviewed and
approved the final version of the manuscript.

Ethics approval and consent to participate

Ethics approval with reference number 37MH-IRB IPN 078/2016 was obtained
from the 37 Military Hospital Institutional Review Board. All participants signed
an informed consent form before being interviewed.

Consent for publication

Not applicable

Competing interests
The authors declare that they have no competing interests.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of Nursing, Kwame Nkrumah University of Science and Technology,
Kumasi, Ghana. 237 Military Teaching Hospital, Accra, Ghana.
Received: 4 February 2019 Accepted: 23 April 2019
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BAB 3

PEMBAHASAN

3.1 Profile Penelitian

 Judul Penelitian:
Nurses and midwives’ experiences of using non-pharmacological
interventions for labour pain management: a qualitative study in Ghana
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 3 of 36

 Pengarang/ Author/s:Edward Appiah Boateng, Linda Osaeba Kumi dan

Abigail Kusi-Amponsah Diji
 Sumber/ Source:Boateng et al. BMC Pregnancy and Childbirth (2019)
19:168 https://doi.org/10.1186/s12884-019-2311-x
 Major/ Minor subject (Key Words) Labour pain relief method(s), Non-
drug technique(s), Phenomenology, Maternity care provider(s), Africa
 Abstract.
Latar Belakang:Intervensi non-farmakologis menjanjikan pengurangan
nyeri persalinan, dengan dampak minimal atau tanpa bahaya bagi ibu,
janin dan kemajuan persalinan serta sederhana dan hemat biaya. Namun
penggunaannya belum dieksplorasi secara memadai dalam pengaturan
klinis, terutama di Afrika sub-Sahara.Metode: Penelitian ini merupakan
penelitian deskriptif fenomenologi. Lima belas (15) orang perawat dan
bidan yang bekerja dalam proses persalinan bangsal dua rumah sakit di
Ghana diwawancarai. Analisis data dipandu oleh prinsip pengkodean oleh
Bailey dan pendekatan komparatif konstan untuk menghasilkan tema.
Persetujuan etika diperoleh dari Dewan Peninjau Kelembagaan Rumah
Sakit Pendidikan Militer 37 di Ghana.
Hasil: Tiga tema utama diidentifikasi yang menggambarkan pengalaman
perawat dan bidan mengenai penggunaan intervensi non-farmakologis
dalam menangani nyeri persalinan. Hal-hal tersebut adalah pengetahuan
mengenai intervensi non-farmakologis, manfaat yang dirasakan dari
intervensi non-farmakologis, dan hambatan dalam penggunaan intervensi
non-farmakologis dalam penatalaksanaan nyeri persalinan.
Kesimpulan: Meskipun beberapa intervensi manajemen nyeri non-
farmakologis telah diketahui dan digunakan oleh perawat dan bidan,
mereka belum memahami sebagian besar intervensi tersebut. Perawat dan
bidan menganggap intervensi ini bermanfaat, namun ada sejumlah
hambatan yang menghambat pemanfaatannya.
 Tanggal Publikasi:1 Oktober 2019

3.2 Deskripsi penelitian berdasarkan metode PICO:

a. Tujuan Penelitian
Untuk mengetahui beberapa intervensi manajemen nyeri non-farmakologis
yang dapat mengurangi nyeri saat persalinan berdasarkan pengalaman
bidan dan perawat dengan metode kualitatif.
b. Desain Penelitian
Partisipan dan prosedur pengumpulan data ini adalah penelitian
fenomenologis deskriptif, dan laporannya dipandu oleh Kriteria
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 4 of 36

Konsolidasi untuk Pelaporan Penelitian Kualitatif . Lima belas (15) orang

perawat dan bidan yang pernah bekerja di bangsal bersalin kedua rumah
sakit untuk jangka waktu minimal 6 bulan diambil sampelnya secara
sengaja antara bulan Mei dan Oktober 2016. Setelah mendapat persetujuan
etika, LOK mendekati peserta yang memenuhi syarat. Tujuan penelitian,
manfaat, risiko dan sifat sukarela dari partisipasi dijelaskan kepada mereka
sebelum mereka mendapatkan persetujuan tertulis. Semua peserta yang
memenuhi syarat yang didekati setuju untuk menjadi bagian dari
penelitian ini. Pertemuan kemudian diatur dengan peserta yang
menandatangani formulir persetujuan berdasarkan ketersediaan dan
preferensi mereka. Karakteristik peserta telah disajikan pada Tabel 1
termasuk pangkat dan pengalaman klinis mereka selama bertahun-tahun.
Nama samaran telah digunakan untuk memastikan anonimitas peserta.
Wawancara individu mendalam dilakukan dengan menggunakan panduan
wawancara semi terstruktur (file tambahan 1) dan direkam secara audio
setelah mendapat izin peserta. Semua wawancara individu dilakukan
dalam bahasa Inggris dan di ruang pribadi yang tenang di setiap rumah
sakit, difasilitasi oleh salah satu peneliti (LOK). Tidak ada orang lain yang
hadir di ruangan tersebut selain LOK dan partisipan pada setiap sesi
wawancara. Tidak ada wawancara berulang. Pertanyaan-pertanyaan
tersebut disusun berdasarkan tujuan penelitian, literatur yang ada,
pendapat ahli dan umpan balik dari pra-tes dengan 5 bidan di rumah sakit
yang sama. Catatan lapangan ditulis setelah setiap wawancara untuk
merinci pengamatan yang tidak dapat ditangkap melalui rekaman audio.
Durasi sesi wawancara berkisar antara 27 dan 56 menit.
c. Populasi/ sample and problem
1. Populasi / sampel
Sampel yang diambil dari penelitian yang berjudul “Nurses and
midwives’ experiences of using non-pharmacological interventions for
labour pain management: a qualitative study in Ghana” ini adalah
Lima belas (15) orang perawat dan bidan yang pernah bekerja di ruang
bersalin di dua rumah sakit yang ada di Ghana, yang terdiri dari staff
midwife 9 orang, senior nursing officer 2 orang, rotation midwife 1
orang, dan senior staff midwife 3 orang. Penelitian ini dilakukan pada
jangka waktu minimal 6 bulan dan diambil sampelnya antara bulan
Mei dan Oktober 2016 dengan cara wawancara perawat dan bidan.
Karakteristik dari peserta meliputi pangkat dan pengalaman klinis
mereka selama bertahun-tahun.
2. Problem
Permasalahannya yaitu penggunaan intervensi non-farmakologis
dalam pengelolaan nyeri persalinan yang belum dieksplorasi secara
memadai dalam pengaturan klinis, terutama di Afrika sub-Sahara.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 5 of 36

Meskipun beberapa intervensi manajemen nyeri non-farmakologis

diketahui dan digunakan oleh perawat dan bidan, mereka belum
mengetahui banyak mengenai intervensi ini dan menganggap
intervensi ini bermanfaat namun sejumlah hambatan menghalangi
pemanfaatannya dengan mudah.

d. Intervention/ Perlakuan oleh peneliti terhadap samplenya *(jika ada)

e. Comparator/ intervensi yang berbeda *(jika ada)

f. Outcomes/ Findings/ Hasil Penelitian

Analisa data mengidentifikasi 3 (tiga) tematik besar area yang menggambarkan

pengalaman perawat dan bidan dengan penggunaan intervensi non-farmakologis
untuk manajemen nyeri persalinan di rumah sakit terpilih. Ini adalah keakraban
dengan intervensi non-farmakologis, manfaat intervensi non-farmakologis, dan
hambatan penggunaan intervensi non-farmakologis dalam penatalaksanaan nyeri
persalinan.

Peserta Ungkapan Hasil Analisis

Konsta Itu (intervensi non-
n, SM farmakologis) adalah cara
untuk meredakan nyeri
persalinan tanpa obat yang
digunakan.
Vicky, Menggunakan cara lain untuk Dapat
SSM menghilangkan rasa sakit digantikan
selain obat-obatan dengan non-
farmako seperti
pijat,
pernafasan
dalam dan
terapi
pengalihan.
Joyce, Saya belajar (tentang) Banyak
SM sebagian besar metode (non- alternative yang
farmakologis) ini dibangsal dapat
terutama di tempat saya digunakan
bekerja sebelumnya… dan untuk
saya tahu ada banyak hal meredakan
yang bahkan tidak saya nyeri yang
ketahui. efektif tanpa
penggunaan
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 6 of 36

obat.
Consta Saya mengikuti lokakarya
nce, keterampilan penyelamatan
SM jiwa beberapa waktu lalu dan
terapi non-farmakologis
adalah salah satu topiknya.
Pat, Saya diajar disekolah dan
RM penanggungjawab saya disini
mendorong saya
menggunakan metode
tersebut.
Hanna
h, SM Anda juga dapat menciptakan
lingkungan yang tepat
dengan memberikan terapi
pengalihan… Anda dapat
meminta klien untuk menarik
dan membuang napas, Anda
juga dapat memberikan
pijatan sakral.”
Elizab
eth, “Anda [dapat] menyemangati
RM pasien selama persalinan dan
memberikan pijatan sakral.
Anda dapat melibatkan
pasien dalam percakapan
yang mirip dengan terapi
pengalih perhatian yang akan
mengalihkan pikirannya dari
rasa sakitnya.”
Debbie
, SM “... ambulasi …dia harus
berjalan; kami biasanya
memberi tahu klien bahwa,
dia akan lebih merasakan
sakit jika dia berbaring
miring atau di satu tempat…”
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 7 of 36

Joyce,
SM “…latihan pernafasan dalam,
dianjurkan untuk berjalan-
jalan, mendengarkan musik
pilihannya atau menonton
televisi… Kemudian handuk
hangat atau dingin dapat
digunakan pada tubuh klien
perut, dahi atau dimanapun
dia merasa nyaman terutama
saat dia berkeringat.”
Rhoda,
SM Di sini [di bangsal bersalin]
kami menggunakan metode

[non-farmakologis] ini setiap

hari, maksud saya sangat
sering”
Elizab
eth, “Kami sebenarnya
RM menggunakannya di sini,
sebagian besar klien kami
biasanya menggunakan
metode ini; terapi non-
farmakologis”
Nyony
a, “Tidak ada efek samping.
SMO Jika Anda, misalnya, akan
melahirkan dan saya
mengizinkan Anda menonton
film misalnya, setidaknya

hal itu akan mengalihkan

pikiran Anda dari rasa sakit
tanpa membahayakan Anda
atau bayi Anda…”
Wendy
, SSM “…karena tidak ada efek
samping dan dapat digunakan
kapan saja…”
Elizab
eth, “[Intervensi non-
RM farmakologis] sangat
membantu secara psikologis,
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 8 of 36

bandingkan dengan
penatalaksanaan
farmakologis, misalnya
petidin [yang] terkadang
mempengaruhi detak jantung
janin”
Rhoda,
SM “Itu membuat klien rileks…
klien biasanya tetap tenang
dan yang lain tetap nyaman.”
Elizab
eth, Melibatkan klien dalam
RM percakapan sebenarnya
mengalihkan pikiran klien
dari rasa sakitnya. Anda
melakukan itu [berbicara]

dan Anda menyadari bahwa

bahkan ketika klien tertular,
dia tidak benar-benar
menunjukkan rasa sakit
seperti ketika tidak ada terapi

pengalihan. Membuat klien

merasa nyaman dan
mengurangi kecemasan,
menenangkan dan
melancarkan proses
persalinan.”
Joyce,
SM “Ini benar-benar
menenangkan klien,
membuatnya nyaman dan

mengalihkan pikiran dari rasa

sakit sehingga
memungkinkan proses
persalinan berjalan lancar. Ini
sangat membantu dan
menenangkan klien.”
Nyony
a, “…itu membuat klien merasa
bahwa Anda dekat
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 9 of 36

SMO
dengannya jadi apa pun yang
Anda minta dia lakukan,
tentu saja dia akan
melakukannya.”Akibatnya,
perawat dan bidan tidak
selalu siap untuk menerapkan

beberapa intervensi non-

farmakologis yang
disebutkan di atas pada
wanita yang mengalami nyeri
persalinan namun lebih
memilih untuk memberikan
terapi farmakologis pada
sebagian besar kasus.
Agarth
a, SNO …dan itu melegakan karena
saat mau keluar klien dia
berkata

seperti ‘bidan bidan, jangan

pergi, silakan kembali,
datang dan

lakukan lagi”
Vicky,
SSM “…tentu saja, karena bersifat
non-farmakologis, efek
sampingnya

tidak banyak dibandingkan

dengan obat pereda nyeri
farmakologis. Ini adalah
pereda nyeri termudah yang
dapat Anda berikan karena
Anda tidak perlu
menggunakan prosedur
invasif apa pun, dan tidak
memiliki efek samping. Itu
hanya fisik, tidak ada invasi;
tidak ada apa-apa dan tidak
terjual.”
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 10 of 36

g. Kelebihan-Kelemahan penelitian / Strength-Limitation of the study *(jika

ada)

h. Manfaat Hasil Penelitian Bagi Keperawatan

 Manfaat Praktis:
Manfaat intervensi non-farmakologis untuk manajemen nyeri
1. persalinan berkontribusi terhadap penggunaannya oleh perawat
dan bidan.
2. Dapat memberikan informasi dalam mengurangi nyeri persalinan,
dengan sedikit atau tanpa membahayakan ibu, janin dan kemajuan
persalinan serta sederhana dan hemat biaya.
3. Di penelitian menggambarkan pengalaman dan bidan dapat
dilakukan untuk teknik non farmakologis dengan kegiatan pijat
sakral, latihan pernapasan dalam, dan terapi pengalihatan,
ambulasi, mandi air dingin, kompres dingin atau hangat dapat
diaplikasikan menjadi inovasi di praktik keperawat.
4. Ada beberapa pendekatan manajemen nyeri persalinan non-
farmakologis, perawat dan bidan tersebut dapat dilakukan
Intervensi non-farmakologis seperti perendaman dalam air citra
terbimbing, aromaterapi, terapi warna, homoeopati, akupunktur,
stimulasi saraf listrik transkutan (TENS), terapi bunga, dan
dukungan tingkat energi telah terbukti dapat membantu berhasil
dalam mengurangi nyeri persalinan.
 Manfaat Teoritis:
1. Hasil penelitian ini secara teori dapat memperkaya wawasan
perawat dan bidan dalam tingkat manajemen nyeri persalinan
terutama padaefektitas pemberian intervensi non farmakologis
untuk sebagai cara untuk menenangkan ibu bersalin dan
membuatnya lebih nyaman selama proses.
2. Untuk meningkatkan sistem pelayanan kesehatan yangberkualitas
terutama dalamstruktur sistem layanan kesehatan serta desain fisik
bangsal bersalin dan terbatasnya jumlah perawat dan bidan di
fasilitas kesehatan per shift karena beberapa intervensi mungkin
memerlukan kehadiran terusmenerus dari penyedia layanan
bersalin agar efektif.
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 11 of 36

3. Untuk menggambarkan efektivitas non-farmakologis dan

memungkinkan metode tersebut untuk mendukung
pengembangan pelayanan kesehatan.
4. Untuk menyusun program dalam menyusun strategi agar tidak
hambatan dalam intervensi manajemen nyeri non-farmakologis
dikarenakan di penelitian ini perawat dan bidan menganggap
intervensi ini bermanfaat namun sejumlah hambatan menghalangi
pemanfaatan nya.
5. Hasil penelitian dapat dijadikan bahan kajian untuk mencari sebab
akibat masalah kesehatan terutama dalam berbagai metode non
farmakologis dengan berbagai pandangan tenaga kesehatan dalam
pelayanan kesehatan sehingga dapat dijadikan acuan solusi atau
alternatif penyelesaian masalah.
6. Manfaat intervensi non-farmakologis dalam penatalaksanaan nyeri
persalinan Penelitian ini juga mengeksplorasi perspektif partisipan
mengenai manfaat yang terkait dengan penggunaan intervensi
non-farmakologis dalam penatalaksanaan nyeri persalinan.

BAB 4

PENUTUP

4.1 Kesimpulan

4.2 Saran

1. Bagi perawat dan bidan diharapkan mampu melakukan teknik

manajemen nyeri persalinan non-farmakologis

2. Bagi peneliti selanjutnya diharapkan meneliti lebih lanjut teknik

manajemen nyeri persalinan non-farmakologis
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 12 of 36

DAFTAR PUSTAKA
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 13 of 36

LEMBAR KONSULTASI JURNAL MATERNITAS

KELOMPOK 2

JUDUL JURNAL:

NO. HARI/ MATERI KONSULTASI TTD

TANGGAL FASILITATOR
KONSULTASI

1. Selasa, 28 Contemporary patterns of spontaneous

November 2023 labor with normal neonatal outcomes

The effect of hypnobrithing relaxation

on the scale pain in labor during the
active phase 1
Boateng et al. BMC Pregnancy and Childbirth (2019) 19:168 Page 14 of 36

Waterbirth: current knowledge and

medico-legal issue

2. Rabu, 29 The perceptions and experiences of

November 2023 women who achieved and did not
achieve waterbirth

Labor characteristic and intrapurtum

intervention in women with vaginal
birth after caesarean section

Massage, refleoxogy and other manual

methods for pain management labour
(Review)

Nurses and midwives’ experiences of

using non-pharmacological
interventionsn for labour pain
management: a qualitative study in
Ghana

TTD ACC PRESENTASI JURNAL