IJNMR_36_18R42

Original Article
1 1
2 2
3 Effect of Nursing Intervention Integrating an Islamic Praying Program on 3
4 Labor Pain and Pain Behaviors in Primiparous Muslim Women 4
5 5
6 6
7 Abstract Desmawati1, AQ1
7
8 Background: Labor pain has always been a priority issue for primiparous women. Pain Waraporn 8
9 behaviors appear as a response to labor pain. This study aimed at examining the effect of nursing Kongsuwan2, 9
interventions integrating an Islamic praying  (NIIIP) program on labor pain and pain behavior.
10 Warangkana 10
Materials and Methods: In this experimental design, 42 women in the control group received the
11 usual care; 41 in the experimental group received the usual care and an NIIIP program from the Chatchawet2 11
12 32nd week of pregnancy. This was done by providing childbirth education which they then practiced 1
Department of 12
13 at home every day until they entered the labor room in the Bhinneka Bhakti Husada Hospital and Nursing‑Midwifery, University of 13
14 Community Health Center Pamulang, Indonesia. They conducted 30 min of reciting from the Quran, Pembangunan Nasional Veteran 14
15 stroking, positioning during their inter contractions, just breathing during contractions at the 1st, Jakarta, Indonesia, 1Faculty AQ8
15
of Nursing, Prince of Songkla
16 2nd, 3rd  h after cervical dilation of 3–4  cm. The visual analogue scale  (VAS) and pain behaviors University, Hatyai, Thailand 16
17 observation scale  (PBOS) were used to measure pain and pain behaviors. Repeated measures of the 17
18 ANOVA and t test were used to analyze the data. Results: There were significant differences in 18
experience of labor pain ([F = 113.07, df (1, 81), p < 0.001] and pain behavior ([F = 147,49 df
19 19
(1, 81), p <  0.001] between the control and experimental groups. There were significant statistical
20 differences of over four times at the points of pain [F = 82.84, df (2, 182), p < 0.001] and pain
20
21 behaviors  [F  =  165.55, df =  (2, 189), p < 0.001]. Conclusions: The program effectively resulted in 21
22 lower pain and increased pain behaviors. 22
23 23
24 Keywords: Intervention, Islamic praying, labor pain, nursing, pain behaviors, primiparous 24
25 25
26 Introduction and cultural factors makes a woman feel 26
27 that she is in an unfamiliar environment, 27
28 The majority of pregnant women are 28
which exacerbates the fear and pain that
29 worried about labor pain, especially the 29
influences their attitudes toward childbirth
30 first time mother  (primiparous).[1] Most 30
pain.[5,6]
31 primiparous women  (75%) reported that 31
32 their pain during childbirth was severe or Pain behaviors depend on the intensity 32
33 intolerable,[2] and other studies reported and frequency of pain.[7] Severe labor 33
34 a level of about 37%. This is higher than pains often lead to apparently uncontrolled 34
35 multiparous women of whom only 20.7% pain behaviors that may have a negative 35
36 felt severe pain.[1] impact on both the mother and fetus. This 36
37 is because they disturb the autonomic 37
Low fetal stations in primiparous women
38 maternal functions and cause a release of 38
were the cause of the stimulation of
39 catecholamine, which results in abnormal Address for correspondence: 39
pelvic and cervical pain by the fetal head,
40 labor and fetal distress.[8,9] Dr. Desmawati, 40
and thus, they had greater pain than the Department of AQ2
41 multiparous women.[3] In addition, the lack Analgesic medication and cesarean delivery 41
Nursing‑Midwifery, University
42 of prior experience has also been a cause are deemed the last option in Bhinneka of Pembangunan Nasional 42
43 of increased physiological pain caused Bhakti Husada (BBH) hospital because it Veteran Jakarta, Indonesia. 43
44 by contraction of the uterus. A lack of is an Islamic Hospital. In Islam, Muslims E‑mail: desmawati.campay@ 44
gmail.com
45 knowledge causes their minds to increase believe the Quran Surah  (QS) At‑taghabun, 45
46 their fear and anxiety than in turn causes 64:  11 that predestined matters (including 46
47 tension in the body, which in turn causes sustenance, illness, birth, death, and all Access this article online
47
48 more fear and pain.[4] A neglect of spiritual calamities and happenings in life) come 48
Website: www.ijnmrjournal.net
49 from Allah, or all that happens is by 49
50 DOI: 10.4103/ijnmr.IJNMR_36_18 50
51 This is an open access journal, and articles are
Quick Response Code: 51
52 distributed under the terms of the Creative Commons How to cite this article: Desmawati, Kongsuwan W, 52
Attribution‑NonCommercial‑ShareAlike 4.0 License, which Chatchawet W. Effect of nursing intervention integrating
53 allows others to remix, tweak, and build upon the work Islamic praying program on Labor Pain and Pain 53
54 non‑commercially, as long as appropriate credit is given and the Behavior in primiparous Muslim women. Iranian J 54
new creations are licensed under the identical terms.
55 Nursing Midwifery Res 2019;XX:XX-XX. 55
56 For reprints contact: reprints@medknow.com Received: March, 2018. Accepted: January, 2019 56

© 2019 Iranian Journal of Nursing and Midwifery Research | Published by Wolters Kluwer ‑ Medknow 1

 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 Allah’s permission. Thus, Muslim women do not perceive The sample size was calculated in accord with the effect the 1
2 labor pain as a form of punishment but rather as a way size had when a similar previous study was conducted.[18] 2
3 of atonement for one’s sins, and giving birth is glorious The effect size (d) of labor pain was 1.13 = 10–11 women 3
4 (jihad). However, Muslims are encouraged to seek care, to per group, and the effect size of the duration of labor was 4
5 be patient, and to pray and ask help from Allah when in 0.64  =  31 women per group, power = 0.80 and level of 5
6 pain.[10] significance = 0.05, was need at least 41 women for 6
7 each group. A total of 110 participants were recruitment 7
Women in labor are like mujahidin (in the Oxford
8 according to inclusion criteria at antenatal clinics. These 8
dictionary of Islam jihad is an Arabic word, which
9 criteria included mother and fetus without complications, 9
literally means striving or struggling and working hard
10 singleton pregnancy, 32 weeks of pregnancy, availability by 10
for something, especially something with a praiseworthy
11 phone to control interventions every day, and willingness to 11
aim such as crusades against drugs, smoking, and women
12 follow the research guidelines. The pregnant women who 12
in labor). Therefore, a woman does not usually ask for a
13 met the inclusion criteria and were willing to participate 13
cesarean section  (elective CS), except when it is the last
14 in this study needed to give their informed consent and 14
option if the woman has complications because labor in
15 their mobile telephone number. They were then randomly 15
childbirth is a natural or physiological process. Therefore,
16 assigned to either the EG (n = 55) or CG (n = 55) according 16
a non‑pharmacological pain relief method is considered a
17 to the specified sequence according to the formula for the 17
priority.
18 block randomization that was drawn up. The women who 18
19 Many non‑pharmacologic modes of labor pain management belonged to the EG, besides receiving the usual care during 19
20 have been dealt with in previous studies. Most of these pregnancy, also followed the NIIIP program. The women 20
21 studies have focused on physical care only. However, were given childbirth education at 32 weeks of pregnancy 21
22 nurses are also obliged to care for the psychological, about non‑pharmacological pain relief involving breathing, 22
23 emotional, cultural, and spiritual needs of each person to positioning, stroking, and Islamic praying. The content 23
24 decrease discomfort and pain.[11,12] It is absolutely necessary validity index  (CVI) of the childbirth education  (program) 24
25 to develop holistically new interventions to achieve this. was 0.83. They were given out leaflet as a guide for manual 25
26 practice at home at least once a day until delivery. 26
From existing studies, only zikr therapy (devotional
27 27
acts in Islam in which short phrases or prayers are The inclusion criteria of women at labor room
28 28
repeatedly recited silently within the mind or aloud included (1) normal gestation for birth; (2) not coming
29 29
such as Alhamdulillah, Subhanallah, Allahuakbar, to the labor room at >4 cm of cervical dilation (cd);
30 30
Astagfirullah, etc.) has been identified in adult and mental
31 (3) normal fetal heart rate; (3) latent phase no more than 31
health areas.[13,14] In maternity care, only listening to the
32 12 h; (4) cephalic presentation;  (5) estimated fetal weight 32
holy Quran and this make patients passive.[15,16] There
33 of 2,500 to 4,000 grams; (6) progress of labor not less than 33
is some scientific evidence regarding the efficiency and
34 3 h; (7) absence of health complications for the mother 34
effectiveness of active pray (reciting the Quran during
35 or fetus; (8) labor support from the family; and (9) have 35
pregnancy) on labor pain and not holistic interventions.[17]
36 no contraindication for vaginal delivery. The women who 36
37 This has encouraged the researcher to investigate this belonged to the EG were undertaking breathing during 37
38 problem. Developing the program as a holistic program had uterine contractions. Upright positions  (walking, standing, 38
39 the goals of reducing pain and increasing pain behaviors sitting, and squatting) were recommended if membrane 39
40 to make it indispensable to give birth by natural ways. was not to be ruptured and the family could helped. 40
41 This study is part of the nursing intervention integrating Positioning and stroking as much as the women can from 41
42 an Islamic praying  (NIIIP) program that deals with labor the active phase of labor until the baby was born (at least 42
43 pain, pain behaviors, the duration of labor, and neonatal 3  times). Islamic praying during inter‑contractions for 43
44 outcomes. approximately 30 min as much as three times at the 1st, 2nd, 44
45 and 3rd h after cd of 3–4 cm by involving of the family. 45
46 Materials and Methods The Islamic prayer recited included 14 verses of the Quran, 46
47 This experimental study used control group  (CG) and Surah:  (1) Al‑Mukminun 23: number 12‑14;  (2) As‑Sajdah 47
48 experimental group  (EG), and a pre‑test and post‑test 32: number 9;  (3) Al‑Hijr 15: number 29;  (4) Al‑Imran 3: 48
49 design. It was conducted at an antenatal clinic and labor unit number 6;  (5) Al‑A’raf 7: number 172;  (6) Al‑Qiyamah 49
50 at the BBH Hospital and Community Health Center (CHC) 75: number 39;  (7) Al‑Fathir 35: number 11;  (8) Ar‑Ra’d 50
51 Pamulang, Banten, Indonesia from June, 2016 to January, 13; number 8; (9) Al‑Furqan 25: number 54; (10) Az‑Zumar 51
52 2017. The research framework was according to Islamic 39: number 6;  (11) Al‑Imran   3: number 36;  (12) Ibrahim 52
53 philosophy  (IP), holistic nursing theory  (HNT), and labor 14: number 40; (13) ‘Abasa 80: number 20; and (14) 53
54 support. HNT is deemed congruent with IP and was used to An‑Nahl 16: number 78 by herself. Contemplating how 54
55 guide the study because labor pain is holistic; the women the human being created by Allah (Allah created man from 55
56 are holistic beings, and nursing is holistic. an extract of clay‑sperm‑into a clot of congealed blood‑a 56

2 Iranian Journal of Nursing and Midwifery Research  ¦  Volume 24  ¦  Issue 2  ¦  March-April 2019
 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 fetus lump‑wrapped by bones‑wrapped with flesh‑then Ethical considerations 1

2 Allah developed the creation to a human within three 2
Ethical approval of this study was obtained from ethical
3 trimesters. When 16 weeks of pregnancy, Allah made them 3
boards of review in Prince of Songkla University  (PSU)
4 testify concerning themselves, saying; Am I not your Lord 4
Thailand, University of Pembangunan Nasional Veteran
5 who cherishes and sustains you? they said; yes, we do 5
(UPNV) Jakarta, and BBH Hospital Indonesia. Pregnant
6 testify! There is no God but Allah. Then Allah breathed 6
women signed a consent form for the study, they were free
7 into the fetus of His spirit and gave you the hearing, sight, 7
to withdraw from the study at any time, and confidentiality
8 intelligence, and understanding that perhaps you would 8
of participants (data) was maintained. EQ1
9 be grateful, then Allah makes ease during childbirth), and 9
10 surrendering oneself to Allah by saying “laahawla walaa Results 10
11 quwwata illabillah” (there is no power and no strength 11
12 Of the 110 women and their family, since the 32 weeks of 12
except from Allah) made pregnant women to do active
13 pregnancy up to the finish of the study nine participants 13
prayer. After reciting these, they conducted the stroking
14 dropped out  (four women in the CG and five women in 14
of the mother abdomen themselves using “love” pattern.
15 the EG). They withdrew owing to some reasons; used 15
These nursing interventions were similar to the main steps
16 cesarean section with a variety of reasons, moved to their 16
of ruqyah syariah in Indonesia, which is the reciting of the
17 home town, active phase of labor was less than 3 h, and 17
verses of the Quran for people who are sick while stroking
18 came to delivery room at 7 cm of cd. During data analysis, 18
the sick area.
19 some outliers were found, and there were 41 women in the 19
20 The visual analogue scale  (VAS) was used to measure any EG and 42 women in the CG to be analyzed. All women in 20
21 changes in the severity of pain. Metric calculation was used the both groups met the assumption of the independent t test 21
22 using a ruler for the VAS in millimeters. The scale was and repeated measure of ANOVA. The normal distribution 22
23 from 0 to 100 mm (from no pain to the worst imaginable of data was assessed by skewness and kurtosis for pain and 23
24 pain) as developed by Maxwell (1978). The reliability of pain behaviors. Homogeneity was met by Levene’s test score 24
25 the VAS in the pilot study was. 69. In the other study, the of labor pain (p = 0.117) and pain behaviors (p = 0.87). No 25
26 reliability of the VAS was. 74.[19] The women were asked significant in demographic and obstetric data between the 26
27 to put a mark on the lines in the VAS scales to measure control and EG (mother age p = 0.732, occupation p = 0.314, 27
28 the labor pain by self‑reporting at the starting point with ethnic p = 0.748, educational level p = 0.961, painful 28
29 a cd 3–4  cm  (pre‑test), and the end of contractions after menstruation p = 0.694, gestational age at birth p = −446, 29
30 intervention at the 1st, 2nd, and 3rd h after a cd of 3–4 cm. mother weight p = 0.602, rupture membrane p = 0.967, 30
31 At the same time, the researcher or research assistants and characteristics of amniotic fluid p = 0.261) were found. 31
32 observed the behaviors that shown by the laboring women Thus, with fairly homogenous sample, randomization, and 32
33 by using the pain behavior observation scale  (PBOS) confounding factors were controlled. 33
34 instrument developed by Baosoung  (1983). The PBOS First hypothesis. There were significantly different degrees EQ2 34
35 consisted of five behaviors shown by the women during of labor pain between CG and EG  ([F  =  113.07, df (1, 81), 35
36 uterine contraction (vocalization, body movement, p < 0.001], and there were significant statistical different over 36
37 breathing control, facial expression, and communication) four times points of labor pain within group, [F = 82.84, 37
38 that were scored from 1 to 3 (1 = bad behavior, 2 = middle df (2, 182), p < 0.001]. It revealed that the pain was 38
39 behavior, and 3 = good behavior). The total score ranged significantly reduced after conducting the program [Table 1]. 39
40 from 5 to 15. A lower score indicated the women displayed 40
41 poor pain behaviors and vice versa. The reliability of the 41
42 Table 1: Comparison of labor pain of primiparous 42
PBOS in the pilot study was 0.8. In other research studies,
43 women during active phase of labor of the two 43
the reliability of the PBOS was 0.8.[19] The participation
44 groups (n=83) using repeated measure ANOVA 44
were excluded when (1) the mother had any adverse
45 Sources of Sum of df Mean F p Partial 45
medical diseases, psychological depression; (2) should
variance Squares Square Ƞ2
46 suddenly have a cesarean section; (3) arrived late at the 46
Between‑participants
47 labor room (more than 4 cm of cd) and active phase of 47
Group 2421099 1 2421099 55017.23 <0.001 0.99
48 labor <3 h. The statistical analysis used software IBM (intercept)
48
4975.87 1 4975.87 113.07 <0.001 0.58
49 Corporation released in 2012. The IBM SPSS Statistics 49
Group 3564.50 81 44.00
50 for Windows, Version 21.0. Armonk, New York and the 50
51 Error 51
significance level at p <  0.05  (two‑tailed) were used to
52 Within participants 52
analyze data. Repeated measures of ANOVA were used to
53 Time 254.75 2.25 112.97 9.28 <0.001 0.10 53
test the effects within groups of the program after receiving
54 Group x time 2272.70 2.25 1007.91 82.84 <0.001 0.50 54
the program. An independent t test was used to compare
55 the group effects of the program between the EG and CG. Error (time) 2222.14 182 12.16 55
56 56

Iranian Journal of Nursing and Midwifery Research  ¦  Volume 24  ¦  Issue 2  ¦  March-April 2019 3
 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 Second hypothesis that the program could reduce labor 9.29 (0.90), at 2nd  h was 9.75  (0.48), and at 3rd h was 1
2 pain was supported. The mean score of labor pain at the 1st, 10.21 (0.47) versus the CG scores: 7.54 (0.83), 7.45 (0.70), 2
3 2nd, and 3rd h from cd of 3–4 cm in the EG was lower than and 7.35 (0.61), respectively. It was found that a significant 3
4 CG. Independent t test demonstrated that the differences of difference across the 3 h of both groups  (t = −9.15, 4
5 mean and standard deviation of labor pain in the EG at 1st h p  <  0.001), (t = −17.32, p <  0.001), and  (t = −23.70, 5
6 of labor pain was 81.17 (4.83), at 2nd  h was 78.43  (5.16), p < 0.001), respectively. There was no significant difference 6
7 and at 3rd  h was 79.31  (6.30) versus the CG scores: of both of group at pre‑test (t = −0.33, p = 0.74). The mean 7
8 88.95  (1.39), 90.33  (2.03), and 91.42  (2.33), respectively. and standard deviation and p value of total score of pain 8
9 Independent t test of group differences at each data point behaviors in each time point of the EG and CG are shown 9
10 presented that EG had significantly less pain scores at first in Figure 2. 10
11 post‑test, t  =  9.91, p <  0.001; second post‑test, t  =  13.73, 11
12 p < 0.001; and third post‑test, t = 11.54, p < 0.001 compare Discussion 12
13 to the CG. Figure 1 shows the results indicated; there was This study proves the effectiveness of NIIIP program 13
14 a decreased labor pain in the EG, whereas the scores of 14
in order to reduce labor pain and improve score of pain
15 labor pain in the CG increased in the each time point. 15
behaviors. Although the labor pain is significantly lower
16 16
EQ2 Third hypothesis. There were significantly different degrees at the early of active phase of labor  (3–5  cm and 5–8  cm
17 17
of pain behaviors between CG and EG  ([F  =  147.49, of cd), it was not significantly lower at the transition time
18 18
df (1, 81), p <  0.001], and there were significant statistical (8–10  cm of cd). These findings were almost consistent
19 19
different over four times points of pain behaviors with the previous studies that found that reciting the Qur’an
20 20
score, [F = 165.55, df (2, 182), p < 0.001]. It revealed that at least 30 times during the third trimester of pregnancy
21 21
the score of pain behavior was significantly increased after significantly decreased labor pain at a cd of 3–5  cm,
22 22
conducting the program [Table 2]. 5–8 cm, and 8–10 cm.[17]
23 23
24
EQ2 Fourth hypothesis. The mean score of pain behaviors at One study in the Middle East used holistic care; the women 24
25 the 1st, 2nd, and 3rd  h from cd of 3–4  cm in the EG was who chose active ways for coping with labor pain reported 25
26 higher than CG. Independent t test demonstrated that that the pain was significantly less in the transitional 26
27 the differences of mean and standard deviation of pain stages  (8–10  cm of cd) and not significantly different 27
28 at 3–4 cm of cd and the second stage of labor,[21] which 28
behaviors score in the EG at 1st h of pain behaviors was
29 was different to this study. Current study showed that 29
30 labor pain was not significantly lower at transitional time 30
31 Table 2: Comparison of pain behavior scores of because at that time there was very severe labor pain. This 31
32 primiparous women during active phase of labor of the is natural pain that will increase along with the time until 32
33 two groups (n=83) using repeated measure ANOVA the baby is born. Moreover, this is possibly explained by 33
34 Sources of Sum of df Mean F p Partial the differences in race and ethnicity because labor pain is 34
35 variance Squares Square Ƞ2 35
subjective, unique, and influenced by cultural and spiritual
36 Between‑participants 36
factors. In Islamic beliefs, the mother who struggles against
37 Group 23366.93 1 23360.93 13648.90 <0.001 0.99 37
(intercept)
natural pain at that time deserves high appreciation from
38 252.50 1 252.50 147.49 <0.001 0.64 38
Allah (jihad), which gives them a glorious and great reward
39 Group 138.67 81 1.71 39
and they get to heaven.
40 Error 40
41 Within participants Regarding pain behaviors, the program significantly 41
42 Time 51.32 2.33 21.96 93.52 <0.001 0.53 improved score of pain behaviors in each time at 1st, 2nd, 42
43 Group x time 90.85 2.33 38.87 165.55 <0.001 0.67 and 3rd h after cd 3–4 cm. This is because of doing active 43
44 Error (time) 44.44 189 0.23
prayer and surrendering oneself to Allah should come 44
45 from in‑depth heart  (not negligent). The harmony between 45
46 46
47 47
48 48
49 49
50 50
51 51
52 52
53 53
54 54
55 55
56 Figure 1: Mean and standard deviation of labor pain Figure 2: Mean and standard deviation of pain behaviors 56

4 Iranian Journal of Nursing and Midwifery Research  ¦  Volume 24  ¦  Issue 2  ¦  March-April 2019
 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 heart, mind, speech, and action, then request attitude levels. Breathing can inhibit the ascending of nociceptors 1
2 wisdom, inner meticulousness, not being arrogant, patience, to the spinal cord and the brain. It can also increase blood 2
3 fortitude, and good prejudice to Allah as in QS Al‑Ghafir flow, oxygenation, and blood plasma melatonin, thus 3
4 40:  60. In that Surah, Allah says: “call on Me  (praying inhibiting the release of tachykinins or p substances in the 4
5 to Me): I will answer your prayer; but this who are too peripheral nervous system as a key protein involved in the 5
6 arrogant to serve Me will surely enter Hell abased”). transmission of pain, therefore, decreasing the awareness of 6
7 pain.[25‑27] 7
Moreover, Hadith Tirmidzi number 3479 (From Abu
8 8
Hurairah r. a, Prophet Muhammad  (peace be upon Islamic praying can distract that act to which the brain
9 9
him  =  pbuh) said “praying to Allah confidently will be responds to directly to close the gate, and inhibit the
10 10
granted, Allah does not answer prayer from a neglectful ascending of nociceptors to the brain, and then to relieve
11 11
heart.” Therefore, those praying for their pain were more pain.[26] Praying by focusing and concentrating on Allah,
12 12
likely to change positive in pain behaviors, because the produces changes in neural regulation in pituitary hormone
13 13
more pain, the more surrendering oneself to Allah. Those secretion by enhancing the endorphins hypothalamic and
14 14
are surrendering oneself to Allah thought that just Allah inhibit GABA  (chemical substance) in CNS can increase
15 15
has the power for everything (include to reduce pain) and serotonin to increase production of the neuro hormone
16 16
as a source of calm in the life as in QS Asy‑syuara 26:217. melatonin. The melatonin has been shown to depress the
17 17
In that Surah, Allah says, put your trust in Allah, the CNS modulate autonomic, metabolic, endocrine, and immune
18 18
Exalted in Mighty, the Merciful. In QS Ghafir 40:  44 and functions, and thus, mediate global regulatory changes in
19 19
20 QS At‑thalaq 65: 3, Allah says… my own affair I surrender various behavioral states including producing a state of calm 20
21 to Allah; for Allah (always) watches over His servants. to reduce labor pain and increase pain behaviors. 21
22 The study results support the founder of HNT,[12] who Islamic praying in this study used 14 verses of Quran about 22
23 reported that praying was one of components of the holistic how the human being is created by Allah, focuses on Allah 23
24 nursing and was a good medicine for pain and healing. to remember their agreement with Allah when in the womb 24
25 Interrelation between all of the components of holistic at 16–18 weeks of pregnancy “When Allah drew forth from 25
26 nursing is very helpful for women during the perinatal the children of Adam from their descendants, and made 26
27 period. The implementation of holistic nursing results them testify concerning themselves,  (saying): “Am I not 27
28 in the optimal harmonization of body, mind, and spirit, your God  (who cherishes and sustains you)? “They said:” 28
29 which enhances psychological, social, cultural, spiritual, Yes! We do testify!” this, lest you should say on the Day of 29
30 and physical health status.[12] Another study reported that Judgment: “Of this we were never mindful”  (QS Al‑A’raf, 30
31 massage, position, comforting, encouraging, reassuring, 7: 172), surrendering oneself on Allah, can be distracted 31
32 and relaxation for 30 min strongly brings about alleviation from pain by making the large fibers reach the brain and 32
33 of pain.[21] This is also similar to earlier studies reporting directly close the gate, and also inhibit the ascending of the 33
34 nociceptor to the spinal cord and brain. By concentrating 34
that the breathing, massage, mindfulness, position, and
35 on Allah, the women can release endogenous opioids, 35
involving significant partners brought about an overall
36 which can relieve pain. The Prophet Muhammad  (pbuh) 36
significantly lower labor pain and unpleasantness.[22] That
37 said that Allahs saying in hadith qudsi “I depend on my 37
passive praying have more robust effects to stop pain
38 servant’s supposition to Me, I with them when they are 38
than does catastrophizing.[23] All distract attention from
39 praying to Me. 39
pain by providing substitute activities, catastrophizing and
40 40
hope quest (prayer) during labor.[24] Passive prayer is a Religious spiritual interventions play an important role
41 41
commonly used among Muslim women to relieve pain and as some of non‑pharmacological pain management
42 42
create the best situation for women and her unborn child, techniques for reducing pain and improve score of pain
43 43
such as when listening to 78 verses of QS Ar‑Rahman,[15] behaviors. Pain behavior is how pain is expressed by a
44 44
or to listening 98 verses of QS Maryam.[16] Different with person when labor pain occurs. Pain behaviors depend on
45 45
46 this study that used active praying together with nursing the intensity and frequency of pain. It was noted that in 46
47 interventions (stroking and breathing) could make positive this study if the women had severe labor pain, they tended 47
48 behaviors to face labor pain. to have inappropriate  (non‑adaptive behaviors), such as 48
49 The stroking can stimulate large nerve endings and close restlessness, crying out, sobbing, uncontrolled breathing, 49
50 the gate, so nociceptive responses are not sent to the grimacing, showing desperation, and often asking for help. 50
51 brain. The stroking can also distract from pain by focusing In the group of low to moderate labor pain, the behaviors 51
52 were more controlled, such as normal talking, grunting, 52
on the fetus by touching the fundus uterine, which helps
53 moaning, and sighing. 53
relaxation, stimulates and increases the endorphins in the
54 central nervous system  (CNS) that inhibit the release of Nowadays, there is respect for prayer or spiritual healing 54
55 glutamate‑aminobutyric acid  (GABA) resulting in the practices and complementary therapies, and that these are 55
56 production of dopamine (pleasure), thus relieving pain increasingly needed within all health care settings.[28] The 56

Iranian Journal of Nursing and Midwifery Research  ¦  Volume 24  ¦  Issue 2  ¦  March-April 2019 5
 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 pain is reduced by the use of prayer over time.[29] This is 7. Ebirim  LN, Buowari  OY, Ghosh  S. Physical and psychological 1
2 especially so for Muslims, as prayer is very important for aspects of pain in obstetrics, Chapter  9; 2012. p.  219‑36. 2
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The limitations in this study were subjects using a manual
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on self‑practice at home cannot be controlled directly
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9 9
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11 program in the latent phase until third stage of labor, a analysis of nursing based on Islamic sources: Seeking remedy. 11
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12
as well as high risk pregnancies with normal labor. 11. Burkhardt MA, Nagai‑Jacobson M. Holistic nursing: A handbook
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Conclusion Health. Sudbury, MS: Jones and Bartlett; 2009. p. 618.
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16 The NIIIP program can create harmonization of mind, global. In: Dossey  BM, Keegan  L, editors. Holistic Nursing: 16
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19 non‑pharmacological pain management in maternal nursing 13. Mardiyono  M, Songwathana  P, Petpichetchian  W. Spirituality 19
intervention and outcomes: Corner stone of holistic nursing
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practice. Nurse Media J Nurs 2011;1:117‑27. AQ6
21 significant benefits to women and their infants without 21
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25 all of antenatal clinics and delivery rooms in Indonesia. 15. Bayrami R, Ebrahimipour H. Effect of the Quran sound on labor 25
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Acknowledgments women. J Res Health Social 2014;4:898‑902. AQ6
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28 16. Forouhari  S, Honarvaran  R, Masoomi  R, Robati  M, Zadeh  IH, 28
The researchers would like to thank the participating
Setayesh  Y. Evaluation of the auditory effects of the sound of
29 mothers and their family, research assistants, and staff Quran e karim on labor pain. Quran Med 2011;1:14‑8.
29
30 members who cooperated with the study. 17. Mohammaditabar  S, Rahnama  P, Kiani  A, Heidari  M. Effect of 30
31 Qur’an citation during third semester of pregnancy on severity 31
Financial support and sponsorship
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AQ6
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34 18. Gallo  RBS, Santana  LS, Ferreire  CHJ, Marcolina  AC, 34
Conflicts of interest PoliNetto OB, Duarte G, et al. Massage reduced severity of pain
35 35
during labour: A randomised trial. J Physiother 2013;59:109‑16.
36 Nothing to declare. 36
19. Chuntharapat  S, Petpichetchian  W, Hatthakit  U. Yoga during
37 pregnancy: Effects on maternal comfort, labor pain and birth
37
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 Desmawati, et al.: Nursing program on labor pain, pain behavior

1 for Midwives and Women. 2nd  ed. Oxford: John Wiley & Sons; healing as adjuncts to conventional care: A crosssectional 1
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