Health Notions, Volume 1 Issue 2 (April-June 2017) ISSN 2580-4936

RESEARCH ARTICLE
URL of this article: http://heanoti.com/index.php/hn/article/view/hn1211

The Effectiveness of Physical Exercise, Prenatal Yoga and Pregnancy Gymnastics in

Primigravida on Childbirth Duration

Irma Linda*, Rismahara Lubis*, Yusniar Siregar*

*Department of Midwifery, Health Polytecnic of Ministry of Health in Medan, Indonesia
Email: irmalinda65@gmail.com

ABSTRACT

One of the physical exercises favored by pregnant women is pregnancy gymnastics. It is a kind of exercise for
strengthening and maintaining the elasticity of abdominal wall muscles, ligaments, and basic muscles of pelvis
which are related to the process of childbirth. The objective of this research was to find out the effectiveness of
physical exercise method between prenatal yoga and pregnancy exercise in primigravida on childbirth duration
so that it could provide information which could increase the knowledge of midwives and midwifery students in
providing midwifery care for pregnant women in facing the process of childbirth. This quasi experiment study
was conducted in July to September 2016. The subjects was 40 pregnant women. The respondents were all
primigravida pregnant women of trimester III who had the pregnancy examined in the Practice of Independent
Midwife, Medan Johor. T-test was used for statistical analysis. The result of T-test showed that p-value=0.002
which indicated that there was the difference in the effectiveness of physical exercise method between prenatal
yoga and pregnancy gymnastics in primigravida on the duration of normal childbirth. Prenatal yoga was more
effective than pregnancy gymnastics in shortening the duration of normal childbirth.

Keywords: Prenatal yoga, Pregnancy gymnastics, Childbirth

INTRODUCTION

Background

Every pregnant woman must have wanted a healthy and perfect baby; therefore, she also has to be
physically and mentally healthy. It means that she has to be in normal condition either physically or mentally,
without undergoing disturbances, and can function well as what a pregnant woman usually is (Solihah, 2010)
One of the purposes of prenatal care is physiological childbirth with healthy mother and her baby. A
natural and normal childbirth can be achieved when uterus has good, rhythmical, and strong contraction with its
segment is below the womb, cervix, and basic muscles of pelvic is in a relaxing condition so that the baby can
easily pass the canal. This condition can be achieved by the efforts of the pregnant woman herself in a complete
bodily composer and relaxation (Setyorini, et. al, 2007).
In a primipara (the first childbirth), the duration of childbirth in Phase I has longer than that of multipara
(many childbirths) in which the duration of childbirth Phase I in primipara is in the neighborhood of 13 to 14
hours, while in multipara it is in the neighborhood of 7 hours (Wiknjosastro, 2008). The long duration of
childbirth Phase I in primipara can bring about long duration of pain so that the childbirth woman undergoes
severe exhaustion; in consequence, she will have emotional response such as anxious, tense, scared, and
panicky. It is indicated that in primipara, there is long duration of parturition and the risk for the infant death is
more possible than that in multipara. Cheng, et. al. (2010) in Budiarti (2011) points out that long duration of
parturition in Phase I of childbirth has the risk for the incidence of post-parturition bleeding, chorioamnionitis,
and the increase in intensive care in neonatal.
Most of pregnant women must have undergone anxiety in facing the process of childbirth. Exercises
which can be done by pregnant women in order to expedite the process of childbirth are pregnancy gymnastics,
pregnancy yoga, and relaxation. One of the exercises which is favored by pregnant women is pregnancy
gymnastics. The aims of pregnancy gymnastics are to strengthen and to maintain the elasticity of abdominal
wall muscles, ligaments, and basic muscles of pelvic which are related to the process of childbirth. By doing
pregnancy gymnastics regularly, a preganant woman can maintain the condition of muscles and joints which

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play their role in expediting the process of childbirth. Pregnancy gymnastics can also establish prime bodily
attitude so that it can help solve any complaints during pregnancy which will eventually help solve any
complaints during pregnancy, arrange the position of fetus, help out breathlessness, control respiration technique
in childbirth, and provide comfort for women during the process of childbirth so that childbirth can be carried
out smoothly (Yuliarti, 2010)
There are several types of physical exercises in pregnancy such as pregnancy gymnastics, pilates, yoga,
and kegel and yophita exercises. Physical exercises which are favored by pregnant women are pregnancy
gymnastics and pregnancy yoga. Pregnancy gymnastics constitutes a therapy of movement exercise to maintain
women’s stamina and fitness during their pregnancy and to prepare them physically and mentally in facing the
process of childbirth optimally. Viewed from its movements, pregnancy gymnastics is merely a kind of common
gymnastics which makes the body fresh and fit; however, it also has another benefit, helping the smoothness in
the process of childbirth. Its difference from pregnancy yoga lies on “respiration.” Yoga exercise is always
referred to respiration.In yoga exercise, pregnant women are clearly guided when they have to inhale and when
they have to exhale (Wiadnyana, 2011). Shindu (2009) points out that yoga regular exercise can help maintain
health and the smoothness in the process of childbirth because it will make the body flexible, especially in the
muscles of canal. These flexible muscles are highly needed because pregnant women usually feel anxiety and
panicky during childbirth.
Yoga is a kind of exercises of the body, mind, and mentality which help a pregnant woman make her
joints more flexible and sooothe her mind, especially in the trimester III. Pregnancy yoga exercise has five
methods: yoga physical exercise, pranayama (respiration), mudra (positions), meditation, and deep relaxation.
They can be very beneficial during pregnancy since they can help the smoothness in pregnancy and normal
childbirth, and they can also make sure that the new-born baby will be healthy (Indiarti, 2009).
Several researches have been done to find out the influence of pregnancy gymnasticss and pregnancy
yoga exercise on the duration of childbirth. The research conducted by Rusmita (2011) on pregnant women in
trimester III in the Mother and Child Limijati Hospital, Bandung, about the influence of pregnancy yoga
exercise during pregnancy on physical and psychological preparation in facing childbirth showed significant
result (p=0.014). The research with the same topic was also conducted by Hariyanto (2015) in the Practice of
Independent Midwife, Boyolali Regency, found that there was the influence of pregnancy yoga exercise on the
level of anxiety in pregnant women in trimester III in the treatment group (p < 0.05), there was no influence of
yoga exercise on the level of anxiety in pregannt women in trimester III in the control group (p > 0.05), and
there was the difference in the level of anxiety in pregant women with the age of pregnancy more than 32 weeks
in the pre and post yoga exercise (p < 0.002).
Martini, et. al, (2008) points out that pregnancy gymnastics has the influence on the childbirth duration
of Phase I and Phase II at p = 0.001. The research conducted by Ekayanthi, et. al, (2014) on the influence of
pregancy gymnastics on childbirth duration in primigravida in the Klinik Ibunda, Denpasar, found that there was
the significant influence at p-value of 0.000, less than α = 0.05 (p<0.05) of pregnancy gymnastics on duration of
childbirth in primigravida and duration of childbirth in the treatment group; 11 respondents (73.3%) were in the
category of speed duration of childbirth.
Based on the explanation above, it is recommended that research should be done to analyze the
effectiveness of physical exercise method, pregnancy prenatal yoga and pregnancy gymnasticss, in primigravida
on childbirth duration in the Practice of Independent Midwife, Medan Johor, Medan.

Formulation of the Problems

Which of the physical exercise method is more effective, prenatal yoga or pregnancy gymnastics, in
primigravida on the duration of childbirth?

Objective

This study amimed to find out the effectiveness of physical exercises, prenatal yoga and pregnancy
gymnastics in primigravida on the duration of childbirth in the Practice of Independent Midwife, Medan Johor,
Medan.

Hypothesis

1. Prenatal yoga in primigravida was more effective than pregnancy gymnastics in shortening the duration of
childbirth phase I, phase II, and phase III.
2. There was the difference in the effectiveness of physical exercises between prenatal yoga and pregnancy
gymnastics on the total duration of childbirth

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Significances of The Study

1. It could strengthen research material on physical exercises in pregnancy which was effective to shorthern
childbirth duration and could be used as the reference for the next researches;
2. There would be the standard of measured gymnastics or physical exercise for pregnant women and it could
increase the quality of antenatal care, minimize the incidence of anxiety in facing childbirth, prepare a safe
and comfortable childbirth, and decrease the risk for the incidence of long and complicated duration of
childbirth.

METHODS

The research used pre-experimental method with one-shot case study design. It measured the difference
in the effectiveness of physical exercises between prenatal yoga and pregnancy gymnastics in primigravida
pregnant women of trimester III on childbirth duration. The population was 40 primigravida pregnant women
with the pregnancy age of 28-32 weeks. They were divided into two groups: group 1 was all respondents who
participated in Prenatal Yoga class and group 2 was all respondents who participated in Pregnacy Gymnastics
class in the Practice of Independent Miwife, Medan Johor, Medan, from July until September, 2016. The
samples were the total population: 40 respondents that were divided into two groups with 20 respondents each.
They were taken by using purposive sampling technique in which the whole population had met inclusive
criteria. The research was conducted in the Practice Independent Midwife Suryani and the Practice of
Independent Midwife Sumiariani at Medan Johor from July until September, 2016. T-test was used for statistic
test which was aimed to analyze the difference between pregnancy gymnastics and prenatal yoga in
primigravida pregnant women of trimester III on duration of childbirth.

RESULTS

Result I

The analysis on the duration of childbirth and the difference in the effectiveness of physical exercise
method between prenatal yoga and pregnancy gymnastics in primigravida pregnant women on the total duration
of normal childbirth in the Practice of Independent Midwife, Medan Johor, Medan, could be seen in Table 1
below.

Table 1. Childbirth duration and difference in physical exercise method between prenatal yoga and pregnancy
gymnastics in primigravida on the total duration of childbirth in the practice of independent midwife, Medan
Johor, Medan.

No Childbirth Duration Time (minute) 95% CI P value

A. Prenatal Yoga -106.540 0.002
-24.860
1 Phase I Childbirth 770
2 Phase II Childbirth 12.75
3 Phase III Childbirth 8.00
Total Childbirth Duration 790.75
B. Pregnancy Gymnastics
1 Phase I Childbirth 813
2 Phase II Childbirth 25.85
3 Phase III Childbirth 10.7
Total Childbirth Duration 849.55

Based on the Table 1, it was found that the average duration of normal childbirth Phase I in primigravida
pregnant women who participated in Prenatal Yoga class in the Practice of Indepndent Midwife, Medan Johor,
Medan, was 12 hours and 50 minutes, while the average duration of those who participated in Pregnancy
Gymnastics class was 13 hours and 33 minutes (mean difference of 17 minutes). The average duration of normal
childbirth phase II in primigravida pregnant women who participated in Prenatal Yoga class was 12 hours and
75 minutes, while the average duration of those who participated in Pregnancy Gymnastics class was 25 hours
and 85 minutes (mean difference of 13 hours and 1 minute). The average duration of normal childbirth Phase III
in primigravida pregnant women who participated in Prenatal Yoga class was 8 hours, while the average

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duration of those who participated in Pregnancy Gymnastics class was 10 hours and 70 minutes (mean
difference of 2 hours and 70 minutes). Therefore, physical exercise method which was more effective between
prenatal yoga and pregnancy gymnastics for the total duration of normal childbirth was those who participated
in Prenatal Yoga class with the mean difference in Phase I was 17 minutes, in Phase II was 13 hours and 1
minute, and in Phase III was 2 hours and 70 minutes.
Meanwhile, the difference in the effectiveness of physical exercise method between prenatal yoga and
pregnancy gymnastics tested by independent t-test showed that p-value=0.002 (<0.05) which indicated that there
was the difference in the effectiveness of physical exercise method between prenatal yoga and pregnancy
gymnastics in primigravida on the total duration of childbirth in the Practice of Independent
Midwife, Medan Johor, Medan.

DISCUSSION

The result of the research showed that the duration of childbirth Phase I in primigravida in the Practice of
Independent Midwife, Medan Johor, Medan, for those who participated in Prenatal Yoga class on duration of
childbirth, the average duration of normal childbirth Phase I in primigravida pregnant women who participated
in Prenatal Yoga class was 12 hours and 50 minutes (770 minutes). The average duration of childbirth Phase II
in primigravida pregnant women who participated in Prenatal Yoga class was 12 hours and 75 minutes. The
average duration of normal childbirth Phase III in primigravida pregnant women who participated in Prenatal
Yoga class was 8 hours. This was in accordance with the result of the research conducted by Berliana (2015) on
physical and psychological preparation in facing childbirth in pregnant women who participated in Yoga
gymnastics in Do The Beauty & Fresh, Sidoarjo, which stated that 10 respondents (66.7%) were physically
ready to face childbirth, while 11 respondents (73.3%) were psychologically ready to face childbirth.
The result of the research also showed that the duration of childbirth Phase I in primigravida in the
Practice of Independent Midwife, Medan Johor, Medan, for those who participated in Pregnancy Gymnastics
class on duration of childbirth, the average duration of normal childbirth Phase I in primigravida pregnant
women who participated in Pregnancy Gymnastics class was 13 hours and 33 minutes (813 minutes). The
average duration of childbirth Phase II in primigravida pregnant women who participated in Pregnancy
Gymnastics class was 25 hours and 85 minutes. The average duration of normal childbirth Phase III in
primigravida pregnant women who participated in Pregnancy Gymnastics class was 10 hours and 70 minutes.
This was in accordance with the result of the research conducted by Mintarsih (2014) on the
effectiveness of pregnancy gymnastics on duration of childbirth Phase I primapara in Mawar I Ward of RSUD
Dr. Moewardi, Surakarta, which stated that there was the difference in the inflluence of pregnancy gymnastics
on duration of childbirth Phase I in the spontaneous post-parturition primapara in RSUD Dr. Moewardi,
Surakarta. The result of the research conducted by Septaningtia (2015) on the correlation of pregnancy
gymnastics with the duration of childbirth process phase II in primigravida women in RSKIA Sadewa,
Yogyakarta, in 2015 found that there was the correlation of pregnancy gymnastics with the duration of
childbirth process phase II.
The result indicated that there was the difference in the effectiveness of physical exercise method
between prenatal yoga and pregnancy gymnastics in primigravida on the total duration of normal childbirth in
the Practice of Independent Midwife, Medan Johor, Medan. Referring to the result of the test above, it could be
explained that physical exercise method of prenatal yoga was more effective than that of pregnancy gymnastics
in shortening the total duration of normal childbirth.
From the result of the research, it was found that physical exercise method of prenatal yoga in
primigravida was more effective in shortening the duration of normal childbirth. This condition could easily be
seen in the phase I childbirth in primipara women who participated in Prenatal Yoga class: the childbirth
duration was ≤ 12 hours and 5 minutes (770 minutes) at the percentage of 55%, while those who participated in
Pregancy Gymnastics class had longer duration of childbirth (<12 hours and 5 minutes at the percentage of
80%). In phase III, those who participated in Prenatal Yoga class had childbirth duration of ≤ 10 minutes at the
percentage of 90%, while those who participated in Pregnancy Gymnastics class had only 75%. Nevertheless, if
it was viewed from child birth duration of phase II in primipara, both methods were effective enough to shorten
childbirth duration. According to Rukiyah (2009), duration of childbirth for primigravida in phase I was 12
hours and 5 minutes, in phase II was 60 minutes, in phase III was 10 minutes, and phase IV was 2 hours.
Prenatal yoga is beneficial to train and master respiration technique which plays its role in pregnancy and
in the proccess of childbirth. The use of basic training of respiration was to train tense, expedite blood
circulation, and meet the needs of oxygen for pregnant women and their fetuses. No less important than its
benefit, it can strengthen and maintain the elasticity of abdominal wall muscles, ligament, basic muscles of
pelvic, and muscles in inner part of hips so that the process of childbirth can be carried out smoothly.
According to Yuliarti (2010), by doing pregnancy gymnastics regularly the condition of muscles and
joints which plasy their role in expediting the process of childbirth can be maintained. Pregnancy gymnastics

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Health Notions, Volume 1 Issue 2 (April-June 2017) ISSN 2580-4936

can also establish prime bodily attitude so that it can help sole any complaints during pregnancy, arrange
position of fetus, help out breathlessness, master respiration technique in childbirth, and provide comfort for
childbirth women so that the process of childbirth can take place smoothly. Meanwhile, doing yoga gymnastics
regularly, according to Shindu (2009), is also very beneficial to maintain health and the smoothness of the
process of childbirth because it will make the body, especially muscles of the canal, flexible. The flexibility of
muscles is highly needed because during the childbirth, pregnant women usually undergo anxiety and panic. The
difference between pregnancy gymnastics and yoga exercise lies on ‘respiration.” Yoga exercise is always
referred to respiration. In yoga exercise, pregnant women pregnant women are clearly directed when they have
to inhale and when they have to exhale (Wiadnyana, 2011).
This research which was in accordance with the research conducted by Rusmita (2011) in pregnant
women in trimester III in the Mother and Child Hospital Limijati, Bandung, about the influence of yoga
gymnastics during pregnancy on physical and psychological preparation in facing childbirth showed significant
result. Another research by Hariyanto (2015) in the practice of Independent Midwife, Boyolali Regency, found
that there was the influence of yoga gymnastics on the level of anxiety in pregnant women in trimester III, and
there was the difference in the level of anxiety in pregnant women with pregnancy age more than 32 weeks in
pre and post yoga gymnastics.

CONCLUSION

There was the difference in the effectiveness of physical exercise method between prenatal yoga and
pregnancy gymnastics in primigravida on the total duration of normal childbirth in the Practice of Independent
Midwife, Medan Johor, Medan. Physical exercise method of prenatal yoga was more effective than that of
pregnancy gymnastics in shortening the total duration of normasl childbirth;

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