International Journal of Research in Medical Sciences
Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175710
Original Research Article
The effectiveness of yogic breathing to comfort level of first trimester
pregnant mothers at community health center of Kragilan district
working area, Serang, Banten, Indonesia
Fifi Musfirowati*, Adi Fahrudin, Irna Nursanti
Faculty of Nursing Student, Muhammadiyah Jakarta University, Jakarta, Indonesia
Received: 08 November 2017
Accepted: 09 December 2017
*Correspondence:
Mrs. Fifi Musfirowati,
E-mail: fifi_musfirowati@yahoo.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Pregnancy is a natural and physiological process. During the process, women will get some
physiological, psychological, and social changes which cause discomfort. Techniques of yogic breathing are able to
control respiration and mind. The mechanism of physical change is started by conscious relaxation which happens
systematically in the body, which then leads into a deeper relaxation. The study intends to examine the effectiveness
of yogic breathing to comfort level of pregnant mothers in first trimester.
Methods: The study is a quantitative research with quasi experimental design. It employs pre-test and post-test
without control group. The samples are 42 pregnant mothers who were selected by purposive sampling technique
which is a type of non-probability sampling. The instrument for measuring comfort level was adopted from GCQ
(General Comfort Questionnaire). For the analysis of statistical data, McNemar Test is used.
Results: The univariate analysis shows proportional data of respondents’ comfort level frequency before the
intervention of yogic breathing was given. Most of the respondents (64.3%) were in discomfort category level of their
first trimester pregnancy. Meanwhile, the comfort level after getting yogic breathing intervention is increased. Most
of the respondents (66.7%) are in comfort level toward their first trimester pregnancy. From bivariate analysis, the
researchers obtained difference in the comfort level proportion of first trimester pregnant mothers before and after
getting yogic breathing intervention, with p value 0.007.
Conclusions: The study suggests that yogic breathing should be continued as an applied intervention in nursing
service especially for pregnant mothers who get discomfort within first trimester.
Keywords: Comfort, First trimester, Pregnant mothers, Yogic breathing
INTRODUCTION neurological, digestive, and endocrinal system.
Meanwhile, psychological change is an emotional
Pregnancy is a sustainable physiological process, a unity response as the result of body alteration and increased
of conception, implantation, and mother’s adaptation to responsibility relating to pregnancy. Moreover, social
it, the care, and hormonal change as preparation in change is resulted by the automatic alteration of mother’s
welcoming the baby delivery.1 During pregnancy process, role in which she previously has no child in her life.2,3
a woman will get some physiological, psychological, and
social changes. Physiological change occurs not only in Due to the changes during pregnancy, women are
reproduction organs but also in cardiovascular, required to adapt with them. Generally, the changes are
respiration, kidneys, integument, musculoskeletal, able to cause discomfort and anxiety for most of pregnant
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Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
mothers. Percentage of discomfort in first trimester (2- and rejuvenation process. Sympathetic nervous system
8weeks) of pregnancy occurs to 50-75% of pregnant which is always ready for receiving messages is safe to
mothers due to nausea and vomit which often cause a do relaxation; meanwhile, parasympathetic nervous
shock.4 States in her research journal that the discomfort system will respond to do it. Besides sympathetic nerves,
felt by pregnant mothers is less acceptable by their messages for doing relaxation is also received by
physical condition. The discomfort caused by physical endocrinal gland which is responsible in almost whole
and physiological condition of pregnant mothers is a emotional and physical condition.12,13
problem existed during pregnancy.5 A previous study
which involves 49 respondents as the samples identifies Breathing exercise that can be done is yogic breathing
that the discomfort often happens within first trimester. It exercise (Pranayama). Worby explains that Pranayama is
is signed by nausea and vomit until 85.71%. a technique of breathing slowly and deeply, using
diaphragm muscles, so abdomen is able to be lifted
The discomfort felt during pregnancy process basically is slowly and chest blows fully. The relaxed situation
a physiological condition of pregnant mother. However, created will erase sounds in mind; thus, body is able to
argues that although it is a natural physiological release muscles tension.14 The study focuses on the effect
condition, it needs prevention and treatment.6 Nausea and of the intervention to the comfort level of first trimester
vomit are the most frequent discomfort during first pregnant mothers, in which mothers in some areas
trimester. If the symptoms become more awful, pregnant including Kragilan District never applied one of yoga
mother may have a pregnancy disorder which is called techniques. Moreover, not all nurses and midwives
hiperemesis gravidarum. Discomfort during pregnancy is working in the District knew that yogic breathing is
a substance of physiological condition in which women existed since the technique needs specific skills.
suffer from physiological changes which happen not only Therefore, the researchers are interested to examine the
within reproduction system and breasts but also within effects of yogic breathing to comfort level of first
other organs, including digestive system, respiratory trimester pregnant mothers.
system, tractus urinarius, blood system and blood
circulation.2 METHODS
Some women are very happy and proud of their Design
pregnancy, while some of them are worried and
depressed.7 A previous study supports the argument, The study is a quantitative research with quasi
finding that 57.3% of women who have their first time of experimental design. It uses pre-test and post-test without
pregnancy only know a little bit about what happens in control group.
their body either physically or psychologically.8 It may
cause discomfort for women during pregnancy. Sample
Therefore, nurses, especially maternity nurses, play a role
in solving the discomfort by assimilating their knowledge The research samples are first trimester pregnant mothers
to develop nursing techniques, fulfilling basic needs of who actively visited Community Health Center of
patients, and collaborating in a team to give Kragilan District working center. The sampling technique
pharmacological and non-pharmacological therapies.9 As used is nonprobability sampling, specifically purposive
with what has been stated by that Nurses who are able to sampling technique. The respondents are 42 first
integrate their theoretical knowledge and evaluate the trimester pregnant mothers who were selected after
nursing care process provided, will be able to identify calculating a formula of sample size and based on the
potential problems or potential errors especially of purpose of research data analysis.
patients in lowering the level of anxiety and discomfort.10
Data collection
Mind, body and spiritual therapies include relaxation,
meditation, hypnosis, and yoga. They are a group of The data collection was conducted from May to June
Complementary and Alternative Therapies (CATs) which 2017 at Community Health Center of Kragilan District
can be given by nurses to improve, maintain, keep working area, Serang, Banten. In collecting the data, the
patient’s health and prosperity, prevent them from researchers were helped by 2 facilitators who were
diseases and release any symptoms, such as discomfort previously taught about yogic breathing. In first day, the
caused by anxiety, headache, and sleeping disorder.11 researchers selected and gathered respondents based on
inclusion criteria. Then, they explained the research
Yogic breathing technique can control respiration and objectives, benefits, time schedule, respondent rights,
mind. The mechanism of physical change through yogic time contract of research process, and asked for
breathing is initialed by creating relaxing situation on respondents’ consent. In the same day, the researchers
conscious mind, which systematically leads body to a conducted pre-test by giving questionnaire for examining
deeper relaxation.12 The condition will make body comfort level of first trimester pregnant mothers and
relaxed, breath slower, and give positive effect on whole calculated the result directly before applying the
circulation system and heart, that is good for taking a rest intervention. After that, still in Day-1, yogic breathing
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Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
intervention was started by giving information about intervention. The statistical data were analyzed by
what it is through leaflet and teaching about the technique McNemar test formula with α significance of 5%.
and how to do yogic breathing I. In day-3, according to
the agreement contract, the respondents were invited and RESULTS
taught about the techniques and how to do yogic
breathing II. The researchers and the respondents made Univariate analysis
contract and agreement to do yogic breathing exercise
twice a day. To control the consistency of the The univariate analysis administered was intended to
intervention, the researchers made the schedule of yogic examine the frequency distribution of each research
breathing exercise which is suited to the agreement. The variable, namely comfort level before and after yogic
researchers also created a whatsapp group to monitor and breathing intervention and demographic data including
remind the respondents to do yogic breathing exercise age, parity status, education, occupation, and ethnic
routinely. 3weeks after applying the intervention, the origin.
researchers invited the pregnant mothers to fill the
questionnaire of comfort level during pregnancy as post- Table 1: Comfort level of respondents before and
test. after yogic breathing intervention.
Instruments Before After
Comfort level intervention intervention
General Comfort Questionnare (GCQ) F % F %
Uncomfortable 27 64.3 14 33.3
The questionnaire used in this study is General Comfort Comfortable 15 35.7 28 66.7
Questionnare (GCQ) developed from theory of Kolcaba
(Comfort Theory) which has been modified. The Table 1 shows that the frequency data proportion of
questionnaire consists of 48 questions and the answers respondents’ comfort level before getting yogic breathing
are optional in form of Likert scale scored among 1 to 4. intervention is 64.3%. It means that most of respondents
4 means very agree, 3 means agree, 2 is for not agree, and felt uncomfortable with their pregnancy in first trimester.
1 is very not agree. The respondents answered based on Meanwhile, the comfort level after getting the
what they feel on each question item. Formerly, the intervention is increased. 66.7% of respondents felt
questionnaire was ever utilized in Spain by involving 600 comfortable with their first trimester pregnancy.
nurses who worked in 8 hospitals in Valencia and
Murcia.15 The researchers tested the questionnaire Table 2: Demographic data of respondents including
validity and reliability and used cronbach alpha to age, parity status, education, occupation, and ethnic
analyze the statistical data and got score 0.90. origin at community health center of Kragilan district
working area, Serang, Banten.
Validity and reliability test
Demographic data Frequency (n) (%)
After conducting validity test in Community Health Age
Center of Kragilan District working area, Serang, Banten < 20 years 7 16.7
by involving 25 respondents, the researchers determined > 20 years 35 83.3
the score of r table is 0.396. Among 27 questions, 24 Parity status
questions show calculated r is higher than r table. Thus, Primipara 22 52.4
the 24 questions are valid. Nevertheless, 3 questions are Multipara 20 47.6
not valid since their calculated r is lower than r table. Education
They are question number 6, 8, and 23. Therefore, the Low (SD-SMP) 25 59.5
total numbers of questions used in this research are 24 in High (sma-pt) 17 40.5
which the cronbach’s alpha value is 0.911. Occupation
Unemployed 26 61.9
Data analysis
Employed 16 38.1
The analysis of research data was done to prove the Ethnic origin
hypothesis and answer the research question “Does yogic Javanese 32 76.2
breathing give effects on comfort level of first trimester Sundanese 10 23.8
pregnant mothers.
Table 2 shows the proportion of respondents’
The dependent variable namely comfort level is demographic data. Most of respondents (35
nominal/binary response by using cross tabulation 2x2. people/83.3%) are more than 20 years old. Based on
The research was designed as one group pre-test and parity status, most of them (52.4%) are in the category of
post-test, in which the samples were tested twice to prove primipara. The respondents were identified mostly to
whether there are some changes after getting the have a low educational background (59.5%) including
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Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
elementary school and junior high school. Based on after getting yogic breathing intervention. The
occupation, most of respondents are unemployed (26 researchers identified some changes in 17 respondents
people/59.3%). In addition, almost respondents (76.2%) (40.5%) who previously felt uncomfortable with their
are Javanese. first trimester pregnancy but then felt comfortable after
getting yogic breathing intervention.
Bivariate analysis
The result of statistical test by using McNemar Test
The bivariate analysis of pre-test and post-test in this shows p value is 0.007 at α = 0.05 (p<α), which
study uses statistical method through non-parametric statistically means that the proportion difference of
statistical approach, namely McNemar Test. comfort level is existed before and after giving yogic
breathing intervention to first trimester pregnant mothers
Table 3 shows the proportion data of comfort level at Community Health Center of Kragilan District, Serang,
difference of first trimester pregnant mothers before and Banten.
Table 3: Proportion difference of comfort level of first trimester pregnant mothers before and after getting yogic
breathing intervention.
Comfort level before Comfort level after intervention
Total (%) P value
intervention Uncomfortable (%) Comfortable (%)
Discomfort 10 (23.8) 17 (40.5) 27 (64.3)
Comfort 4 (9.5) 11 (26.) 15 (35.) 0.007
Total 14 (33.3) 28 (66.7) 42 (100.0)
Statisticed Analysis with McNemar Test
DISCUSSION natural symptoms and often occur in first trimester.
Nausea usually happens in morning, but it also can occur
Depiction of comfort level of first trimester pregnant every time and in night. The symptoms usually occur in
mothers before and after getting yogic breathing the 6th weeks after last day period and happen around 10
intervention weeks. Nausea and vomit occur to 60-80% of
primigravida and 40-60% of multigravida. In addition,
The research result shows that most of respondents one of one thousand pregnancies have heavier
(64.3%) felt uncomfortable with their first trimester symptoms.17
pregnancy before getting yogic breathing intervention.5 In
other hand, the comfort level is increased after they The research results and previous studies support what
received the intervention (66.7% respondents). The has been explained by Ummah that during pregnancy a
results parallel previous study which involves 49 woman will experience some changes in which they are
respondents as samples and identifies that discomfort is a required to be able to adapt.5 The alteration often
frequent problem which mothers suffer from in their first experienced by women during their pregnancy is
trimester pregnancy. The discomfort is signed by nausea discomfort.
and vomit up to 85.71%.
Effects of yogic breathing to comfort level of first
The researchers explained in detail that the uncomfortable trimester pregnant mothers
feeling which occurs to the respondents was measured
through several symptoms including: frequently feeling The research results show some changes to 17
nauseous and vomiting, unsmooth defecation, feeling respondents or 40.5% of the total samples. Previously
anxious about what will happen during her pregnancy, they were uncomfortable with their pregnancy in first
loss of appetite, and easily feeling tired when doing trimester but then able to feel comfort with it after getting
activities. Moreover, pregnant mothers feel tired and yogic breathing intervention. According to the data, the
dizzy more than usual due to hormones in their body researchers identified different proportion in comfort
actively adapt to pregnancy, causing physical and level of first trimester pregnant mothers before and after
emotional alteration. giving yogic breathing intervention.
Pregnant mothers need to do urination more often The statistical result of McNemar Test shows p value is
because of two causes: their womb is growing, which 0.007 at α = 0.05 (p<α). It means that there is proportion
pushes bladder and due to hormonal factor.16 Nausea and difference in comfort level of first trimester pregnant
vomiting are known as the results of chaos in normal mothers before and after giving yogic breathing
body activity due to the effect of chorionic gonadotropin intervention at Community Health Center of Kragilan
hormone. Nausea and vomit (emesis gravidarum) are District working area, Serang, Banten.
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Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
The research result parallels the findings of Mediarti’s Yogic breathing is a breathing exercise by inhaling and
study which uses quasi experimental research design with exhaling alternately and slowly with one nostril and
one group pre-test and post-test.18 The study obtains p diaphragm muscles, enabling abdomen lifted slowly and
value 0.005 which means there is a significant difference chest blooming fully; it also includes spirituality elements
in pregnant mothers’ complaints before and after ante- in the end of exercise.25,14 Yogic breathing techniques can
natal yoga exercise at Merdeka Community Health control respiration and mind. The mechanism of physical
Center. Another study conducted by Beddoe and change is started by the creation of relaxation atmosphere
colleagues proves that yoga and meditation are able to in consciousness, systematically leading body to a deep
release psychological stress and physical injury during relaxing condition.12 The creation of relaxation
the process of pregnancy and labor, to increase comfort, atmosphere will erase sounds in mind; thus, body will be
and to decrease anxiety and pain.19 able to release muscles tension. Relaxing atmosphere will
make body relaxed, breath slower, and give positive
Other similar findings can be read in several studies influence on whole circulation system and heart for
including, the researchers stated that yoga gives some resting and rejuvenation. Sympathetic nervous system
benefits for pregnant mothers, women in labor process which is always ready to receive messages is safe to do
and after giving childbirth, including alleviating edema relaxation; meanwhile, parasympathetic nervous system
and cramp which often occur in last months of will respond to relaxation. Besides sympathetic nerves, a
pregnancy, facilitating baby position and movement, message for relaxation is also received by endocrinal
increasing digestive system and appetite, increasing gland which is responsible for almost all emotional and
energy, slowing metabolism, recovering calmness and physical condition.12,13
focus, releasing nausea, morning sickness and negative
feeling, reducing tension around cervix and birth canal by The limitation of the research is unavailability of control
focusing on opening pelvis to ease labor process, group when implementing yogic breathing intervention.
facilitating post-partum treatment by recovering uterus, Moreover, the effectiveness of the intervention cannot be
abdomen, and pelvic floor, reducing discomfort and identified due to the very limited scope of research
depression during pregnancy.20-23 location. Another limitation is the condition in which not
every pregnant mother as respondent used smartphone
Basically, uncomfortable feeling during pregnancy is a and social media application. It made the researchers
physiological condition which happens to pregnant cannot control and observe directly each respondent
mothers. However, prevention and treatment are required. daily. Therefore, they cooperated with several cadres to
Nausea and vomiting often occur during first trimester. If do controlling and observation to the respondents in
the symptoms become heavier, pregnancy disorder called doing yogic breathing intervention.
hyperemesis gravidarum may occur.6 Excessive nausea
and vomiting may cause body solution of first trimester CONCLUSION
pregnant mothers diminished, impacting on blood
coagulation (hemoconcentration) and reduced blood The analysis result shows that comfort level of first
circulation to body tissues. Oxygen and nutrition trimester pregnant mothers before getting yogic breathing
deficiency in body tissues will make damage in it, intervention is low. 64.3% of respondents are in
impacting on the health decrease of mother and her fetus, discomfort category. In other hand, their comfort level is
which require a serious treatment.24 increased after getting the intervention. 66.7% of the
respondents felt comfortable with their first trimester
The discomfort which occurs to pregnant mothers as pregnancy. The result of bivariate analysis shows a
respondents can be minimized by applying yoga different proportion of comfort level of first trimester
technique. Yoga is a technique which connects human pregnant mothers before and after getting yogic breathing
physic, mental, and spiritual for achieving comprehensive intervention, in which p value is 0.007 at α = 0.05 (p< α).
health.22 Yoga technique applied for first trimester
pregnant mothers is a mild technique, such as relaxation Recommendations
and yogic breathing, and able to help the respondents take
a rest. An example of yogic breathing technique is dhirga Based on the research results, the researchers suggest
swasam which can optimize lungs capacity of taking nurses and other health workers who have responsibility
more oxygen to be absorbed by body. Another technique in providing health service to be educated about yogic
is anuloma viloma which is useful to balance mind breathing and the benefits for decreasing women’s
activities, to eliminate anxiety, to calm the mind, and to discomfort in their first trimester either formally or non-
improve concentration and balance of body and mind. formally, such as joining trainings and seminars which
The next techniques are sitali and sitakri. They are useful can upgrade their knowledge and improve their skills on
to provide coolness on the body, to calm the mind, to the issue. Yogic breathing is the intervention studied in
alleviate heartburn, to overcome heatiness, and to reduce the research to examine the effects on comfort level of
nausea during pregnancy. The last technique is Brahmari first trimester pregnant mothers. For further studies, the
which is useful to eliminate anxiety, to calm the mind, subject can be selected as one of interventions to be
and to overcome insomnia.
International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 55
Musfirowati F et al. Int J Res Med Sci. 2018 Jan;6(1):51-56
implemented in nursing service for women who feel 12. Sindhu P. Panduan lengkap Yoga: Untuk hidup
uncomfortable with their first trimester pregnancy. sehat dan seimbang. Mizan Qanita; 2015.
13. Sani R. Yoga Untuk Kesehatan. Semarang: Dahara
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14. Worby C. Memahami segalanya tentang yoga:
Authors would like to thank Mr. Lukmanulhakim for his Tingkat kekuatan, kelenturan, dan kesehatan anda
assistance in data collection, data filter, statistical (SC Simanjuntak, trans). Yoga: Everything yoga
measurement and analysis. We also thank Mrs. Solis book. Jakarta: Karisma Publishing Group. 2007:
Setiani for her assistance in study administration. 351-375.
15. Ferrandiz, E.F dan Baena, D.M. Translation and
Funding: No funding sources Validation of a Spanish version of the Kolcaba's
Conflict of interest: None declared General Comfort Questionnaire in Hospital Nurses.
Ethical approval: The study was approved by the Inter J Nur. 2015;2(1):113-19.
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