E:\2021\NERS APRIL 2021\14-jurn 94 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 94–100 Solus Per Aqua (SPA) Massage to Reduce Complaints During the Period Postpartum at Mombykids Village Sambong Dukuh District Jombang Regency Jombang Henny Sulistyawati Midwifery Departement, STIKes ICME Jombang, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 07/10/2020 Accepted, 26/02/2021 Published, 05/04/2021 Keywords: Solus Per Aqua (SPA), Massage, Complaints during Postpartum Article Information Abstract The mother’s struggle after giving birth takes a long time. One of them is to restore a fresher and more relaxed body shape.Because it cannot be denied, after birth the body will feel weak because of the energy released.The muscles that feel are usually tense, especially for women who give birth normally.This condition is of course intolerable, special care is needed to restore the mother’s body to recovery.Solus Per Aqua (SPA) postpartum is one way to restore body shape.Solus Per Aqua (SPA) massage can be useful to improve blood circulation and restore the body to be firmer and make the body more comfortable and relaxed.This study aims to determine the Solus Per Aqua (SPA) Massage in mothers can reduce complaints during postpartum.The type of this research is quasi-experimental using a pretest and posttest de- sign by treating the research subject.The samples in this study were 20 mothers who came to Mombykids from day 2 to 14.The sampling technique used simple random sampling.The variables in this study were spa massage and complaints during postpartum.Data collection was carried out using checklist and questionnaire.Data processing was performed using the “Wilcoxon” statistical test with a significance level of 0.05.The results of this study showed that complaints of mothers before spa massaging experienced complaints during the postpartum period including postpartum pain 25 %, non-smooth milk production 60%, stress 15%, and almost 75% of mothers felt relaxed / comfortable after spa massaging.This study concluded that there is a significant effect of spa massage in reducing complaints during the postpartum period.For the next researchers, because of the limitations in conducting this research, the variables were studied in general,it is expected that next research can expand the research into the variables studied, for example those related to uterine involution, lactation, or postpartum exercise and there may be new findings that need to be reexamined. 94 Correspondence Address: STIKes ICME Jombang – East Java, Indonesia P-ISSN : 2355-052X Email: henny.gadang@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i1.ART.p094–100 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) © 2021 Journal of Ners and Midwifery https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i1.ART.p094-100&domain=pdf&date_stamp=2021-04-15 https://doi.org/10.26699/JNK.V8I1.ART.P094-100 95Sulistyawati, Solus Per Aqua (SPA) Massage to Reduce Complaints During the ... INTRODUCTION T he postpa rtum is a cr itica l period for postpartum mothers. Physical, psychological, mental, and spiritual unpreparedness in facing this period will cause mother s to experience problems related to involution and lactation(Kusbandiyah & Puspadewi, 2020). The postpartum period is still a vulnerable period for the health of new mothers (Lowdermilk DL, Perry SE, Cashion, MC, 2016). There are many things to be risk factors for postpartum discomfort. These factors include lactation, stress, postpartum pain.Some treatments that can be done to make the process run well include exercise, oxytocin ma ssage, and postpartum massage (Wahyuni & Nurlatifah, 2017).If the postpartum discomfort is not well organized, the postpartum mother may experience postpartum blues.The number of postpartum blues incidents in Indonesia varies widely. According to (Post et al., 2008), the incidence of postpartum blues in Indonesia reaches 50- 70%. Accor ding to Ma ha mpa ng, 2010 a nd Fa tma wa ti 2015, this number is higher in primiparous which reaches 88%.In Jombang Regency in 2017, the maternal mortality rate was 149.68 live birth per 100,000 live birth. This figure is based on data on maternal mortality as many as 28 cases from 18,707 live births.The details of the maternal mortality during pregnancy were 10 people, at the time of giving birth were 3 people, and at the postpar tum per iode wer e 15 people. (Dina s Kesehatan Jombang, 2017) The postpartum period is the peak of a mother’s physical exhaustion after a long pregnancy and tiring labor.Fatigue is usually caused by the pain the mother feels in all parts of body as a result of childbirth.Pain due to childbirth is usually not felt during the delivery process and will only be felt after the completion of the labor process.Physical fatigue will cause the mother to feel stressed so that the breastfeeding process does not run optimally.Fatigue also affects the mother’s activities so that it will indirectly affect the involution process (Kusbandiyah & Puspadewi, 2020). Massage can be important and beneficial because it is known to promote relaxation, reduce pain and stress, and have many other health benefits. Postpartum massage accelerates recovery and improves hormonal balance effectively. The prolactin and oxytocin levels multiply to make breastfeeding easier (Metzger S, 2013). Massage has been known that has many health benefits. Ma ssa ge per for med with the r ight technique during the postpartum period allows it to improve the recovery of maternal health and to increase breast milk production. Massage on the mother’s back after giving birth can increase the levels of oxytocin and prolactin so that breast milk will be produced a nd excreted more quickly (Palembang et al., 2018). So it is necessary to do research on Solus Per Aqua (SPA) Massage to Reduce Complaints during the Postpartum Period in Mombykids Village, Sambong Dukuh District, Jombang Regency. RESEARCH METHODS The research design used in this study is a Quasi Experiment using “Pre-test - Pot test Design” how to provide intervention to mothers by doing spa massage for 3 months and evaluated whether the intensity / level of complaints can be reduced or not. In this study, the treatment was analyzed using the Wilcoxon statistical test.If the complaints during the postpartum period decrease after massaging, the massage given has significant effect.This research was conducted in Mombykids, Sambong Dukuh Village, Jombang District, Jombang Regency from April to July 2019. The variable in this study, the independent variable was spa massage and the dependent variable was reducing complaints during the postpartum period.The population in this study were postpartum mothers on day 2-14 who came to Mombykids, Sambong Dukuh Village, Jombang District, Jombang Regency.The sample in this study wer e 20 postpa r tum mother s who ca me to Mombykids using simple r a ndom sa mpling technique.All postpartum mothers who come and experience complaints during postpartum period were given massage (mother spa) once a week and re-evaluated after 1 week. The materials needed in this study were the Spa room, aromatherapy and VCO (Virgin Coconut Oil) or coconut oil. The instrument in this study was a checklist. RESEARCH RESULTS 1. General Data a. Age Frequency distribution of respondents’ charac- teristics based on age grouped into 3 groups showed in the Table below: 96 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 94–100 From Table 1 obtained the results of respon- dents’ characteristics based on the age of post- partum mothers mostly 15 (75%) 20-35 years old. b. Parity No Age (Year) Frequency (f) Persentage (%) 1 < 20 year 1 5 2 20-35 year 15 75 3 > 35 year 4 20 Jumlah 20 100 Source : Primary Data 2019 Table 1 Distribution of Respondents based on the age of postpartum mothers in Momby Kids Village Sambong Dukuh District Jombang Regency. Jombang year 2019 Table 2 Distribution of Respondents based on Parity of postpartum mothers in Mombykids Village Sambong Dukuh District Jombang Regency in 2019 No Parity Frequency Percentage (%) 1 Primipara 8 40 2 Multipara 7 35 3 Grandemulti 5 25 Jumlah 20 100 Source : Primary Data 2019 Based on Table 2 obtained the results of respondent characteristics based on postpartum maternal parity obtained almost half 8 (40%) respondents are primipara. 1. Special Data a. Complaints of postpartum mothers before SPA Massaging Distribution of characteristic frequency based on complaints of postpartum mothers before spa massaging Based on Table 3 and a half 12 (60%) obtained compla ints felt by postpa r tum mother s The production of breast milk is not smooth and the other complaint is postpartum pain 5(25%) and stress 3(15%). b. Mother’s complaint postpartum after spa massaging Distribution of characteristic frequency based on postpartum maternal complaints after spa massaging. Based on Table 4 obtained data most of 15 (75%) after a spa massaging postpartum mother relaxed/comfortable condition, complaints of postpartum pain, the production of breast milk is not smooth and stress is also reduced. No Complaints of postpartum mothers before SPA Massaging Frequency (f) Percentage (%) 1 Postpartum pain 5 25 2 Production of breast milk is not smooth 12 60 3 Stress 3 15 4 Relax/ Comfortable 0 0 Jumlah 20 100 Source: Primary Data 2019 Table 3 Distribution of Respondents based on complaints of postpartum mothers before spa massaging in MombyKids Village Sambong Dukuh Jombang District Jombang Regency in 2019 Source: Primary data 2019 No Complaints of postpartum mothers after SPA Massage Frequency (f) Percentage (%) 1 Pospartum Pain 2 10 2 Production of breast milk is not smooth 2 10 3 Stress 1 5 4 Relax/ Comfortable 15 75 Jumlah 20 100 Table 4 Distribution of Respondents based on complaints to postpartum mothers after spa massaging in MombyKids Village Sambong Dukuh Jombang District Jombang Regency in 2019 97Sulistyawati, Solus Per Aqua (SPA) Massage to Reduce Complaints During the ... years and over 35 years are at an increased risk of complaints. The age under 16 years, the organs ar e not ready for the process of pregna ncy, childbirth, and postpartum.As a result, when the uterus has to contract for the return of the uterus to its original state, it will experience difficulties.The mindset and ability to make decisions at an early age are still unstable, so there will be many influences from thinking from the surrounding environment which can be positive or negative towards discomfort during the postpartum period (Mayasari et al., 2015). This is follows (Hidayati & Sulistyoningtyas, 2017), the results of statistical calculations on the Chi-Square test with ñ-value 0.01, which means that there is a relationship between age and type of delivery with the incidence of postpa r tum blues a t Puskesma s II Jetis Bantul.According to researchers, aged 20-35 years who are mature or productive, it will certainly affect their view of new things that come from outside so that knowledge increases.The older a person is, the more rational thinking and the better his knowledge and experience and also as a result of mental experience and maturity, age also greatly influences a person to think. c. Differences In Complaints Of Postpartum Mothers Before and After spa massaging in Mombykids Village Sambong Dukuh Jombang District Jombang Regency Based on Table 5 it ilustrated that the test result obtained the value  = 0.01 means that this value is lower than the value of meaning 0.05. This is No Postpartum mother complaints Changes in complaints of postpartum mothers Sebelum Sesudah f % f % 1 Postpartum pain 5 25 2 10 2 Production of breast milk is not smooth 12 60 2 10 3 Stress 3 15 1 5 4 Relax/ Comfortable 0 0 15 75 Total 20 100 100 100 Wilcoxon test p:0.01 Source: Primary data 2019 Table 5 Distribution of Respondents based on Differences in complaints to mothers before and after a massage spa at MombyKids Village Sambong Dukuh Jombang District Jombang Regency in 2019 evidenced a fter the spa ma ssage in mothers postpartum complaints reduced, postpartum pain complaints from 25% to 10%, the production of breast milk is not smooth from 60% reduced to 10%, Stress 15% to 5% while relax / comfortable that was initially 0% increased by 100% after the spa massage in mothers postpartum. DISSCUSSION 1. General Data a. A g e The first factor that influences someone to do something new (spa massage) is the age of the mother. Based on Table 1, the results obtained from the characteristics of respondents based on the age of the mother, which were analyzed in terms of age of the respondents, were mostly in the productive age range or low risk age between 20-35 years as much a s 75%. Minimum a ge is a t r isk of experiencing subinvolution because the reproductive organs are still working optimally. it is different from the age under 20 years and over 35 years. According to (Notoatmojo, 2010), a person’s arrest and mindset.As you get older, the more you develop your ca tch a nd mindset, the mor e knowledge you get.At this age, individuals will play an active role in social life and prepare more for successful efforts to adjust to old age, and middle- aged people will spend more time to read. Intel- lectual abilities, problem solving, and verbal abilities are reported not to decline from an early age. In some studies, age correlates with complaints experienced during the postpartum. Ages under 16 98 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 94–100 b. Parity The second factor that influences a person to do something new is Parity.Based on Table 2, the results of the characteristics of respondents based on maternal parity determined that almost half of them were 8 respondents (40%) primiparous. According to (Notoatmojo, 2012), the number of children is a source of knowledge or way of obtaining truth and knowledge. It is done by repeating the experience gained in solving problems faced in the past. According to (Rahmaningtyas et al., 2019), showed p-value of 0.027 which means there is a relationship between maternal parity and anxiety disorders in postpartum mothers in Semarang.The same research (Lestari, 2017) stated that the parity of postpartum mothers had a relationship (p-value) of 0.020. Mothers who have given birth more than once will have more experience caring for babies than primiparous.Mothers who have recently given birth to their first child with a lifeless condition tend to have a greater risk of experiencing anxiety. According to researchers, mothers who have just given birth to their first child have more curiosity than second or third mothers. They tend to do everything new about motherhood after giving birth. The current mother ’s age makes it easier for mothers to care for their babies and accept the fact that the mother already has a baby and has more knowledge on how to be a single mother who also needs to be able to care for her baby properly and access various information related to complaints that often occur in the past and how to handle these complaints. 2. Special Data a. Complaints of Postpartum Mother Before doing Spa Massage The results showed that 5 respondents (25%) had complaints of postpartum pain before the spa massage, 12 respondents (60%) complained about not smooth in breast milk production, 3 respondents (15%) experienced complaints of stress / anxiety during the postpartum period. And 0% of no one feels relaxed / comfortable during childbirth.From the data, it can be concluded that before the average massage spa has a complaint during the postpartum period and most of the complaints felt during the postpartum period is the production of breast milk is not smooth.According toIslami et al (2012), there are some discomforts during the puerperium, namely, pain after childbirth, excessive sweating, perineal pain, br east enla rgement, constipa tion, and hemorrhoids.According to researchers, complaints during the postpartum are a common disorder, and almost all mothers who have given birth ever experienced them.If the complaint during the postpartum does not interfere with the activities of caring for the baby, it may still be considered normal. But if the discomfort is disturbing the activities of the postpartum mother, it is necessary to consult with the health worker. b. Complaints of postpartum mothers after doing Spa Massage From the results of the study, it was found that complaints of postpar tum mothers a fter spa massaging, namely complaints of postpartum pain decreased up to 10%. According to (Ambarwati et al., 2013) multiparous postpartum mothers often feel pain due to simultaneous decrease in uterine muscles. It causes intermittent relaxation (pauses). Whereas in breastfeeding women, baby suction stimulates oxytocin production which not only triggers the let down reflex (breast milk production) but also causes uterine contractions.Uterine pain will go away if the uterus continues to contract properly and the bladder is empty, and will feel great during breastfeeding.This is in accordance with research (Irda Novrida Ashar et al., 2018), The results of the Mann-Whitney test of the intervention group sig. 0.0001 (p <0.05) indicated that the intervention group experienced a decrease in pain so that there was a significant effect.The difference between the control and intervention groups in pain reduction in postpartum mothers can be concluded that there is an effect of effleurage massage on pa in r eduction in multipa r ous postpa r tum mothers.The results of this study are in line with (Siahaan, PG., 2017) with the title “The Effect of Endorphin Massage On Back Pain In Mothers Primigravida Kala I Active Phase In Citra Medan Maternity Clinic” supports pain can be reduced by massage.The results obtained on average pain scale in respondents before and after massaging was significantly different.The average pain scale of respondents before massaging (12.31) was higher than that of respondents after massaging (4.69). Complaints about the production of breast milk not smoothly decreased up to 10%, The result of Research from(“Nurul Isnaini, Rahma Diyanti,” 2015) indicated relationship between oxytocin 99Sulistyawati, Solus Per Aqua (SPA) Massage to Reduce Complaints During the ... massage and breast milk production. it is because oxytocin massage is a n action performed on breastfeeding mothersin the form of massage on the mother’s back to increase the production of the hormone oxytocin. Oxytocin massage will provide comfort to the mother so that it will provide comfort to the breastfed baby. Physiologically, the hormone oxytocin increases which is passed to the brain so that the oxytocin hormone is secreted and flows into the blood, then enters the mother ’s breast causing the muscles around the alveoli to contract and make milk flow in the milk ducts.The oxytocin also makes the breast milk ducts wider, so that breast milk can be passed out more smoothly.Stress complaints decreased to 5%, the results of the study found that respondents who did endorphin massage mostly had mild anxiety levels, because endorphin massage is one of the non-pha rma cologica l therapies to reduce or relieve pain in mothers who are about to give birth.So that the reduction of pain will be able to reduce maternal anxiety during childbirth (Sukmaningtyas & Windiarti, n.d.). Feeling Relaxed / comfortable Feeling increases 100% after spa massage according to (Sukmaningtyas & Windiarti, n.d.) 2016 endorphin massage helps mothers feel fresher, relaxed and comfortable after delivery.From the data it can be concluded that the number of postpartum complaints decreased after massage and an increase in feeling relaxed / comfortable in postpartum mothers.The number of complaints that occur during the puerperium makes the mother exper ience discomfort during the postpartum so that it often interferes with activities and rest in the postpartum mother. One of the things that can be done to reduce these complaints is to do a spa massage. Massage in mothers is very useful to give relaxing effect on the body and relax tense muscles after birthing.As long as the treatment is carried out properly and appropriately and handled by professionals. CONCLUSION This study concluded that there is a significant effect of spa massage in reducing complaints during the postpartum period. SUGGESTION For the next researchers, beca use of the limitations in conducting this research, the variables were studied in general, it is expected that next research can expand the research into the variables studied, for example those related to uterine involution, lactation, or postpartum exercise and ther e ma y be new findings tha t need to be reexamined. REFFERENCE Ambarwati, R., Muis, S. F., &Susantini, P. (2013). The effect of int en si ve la ct at ion counsel in g on breastfeeding ( breast milk) exclusively up to 3 months. 2(1), 16–23. Hidayati, Y., & Sulistyoningtyas, S. (2017). The Relationship of Age and Type of Childbirth with The Incidence of Postpartum Blues in Post Partum Mothers in the Region of PuskesmasJetis II Bantul Regency. University of Aisyiyah Yogyakarta. Kusbandiyah, J., &Puspadewi, Y. A. 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