IMPLEMENTATION OF PREGNANT MASSAGE AT THE BL40
(WEIZHONG) ACUPRESSURE POINT TO REDUCE LOWER BACK PAIN IN
PREGNANT WOMEN IN THE 2ND AND 3RD TRIMESER
Naning Puji Suryantini Universitas Bina Sehat PPNI Mojokerto Corresponding Email: naning.
bidan82@gmail.
ABSTRACT
Keywords Lower back pain is the most common form of discomfort during pregnancy experienced by mothers, especially in the second and third trimesters.
Hormonal changes, weight gain, and biomechanical adaptations of the body are the main factors causing this complaint.
The impact is not only pain but also disrupts daily activities, sleep quality, and increases stress.
Pharmacological management is not always safe, so non-pharmacological interventions are more recommended.
One potential method is pregnancy massage with stimulation of the BL40 (Weizhon.
acupressure point, which works to relax muscles, improve circulation, and stimulate the release of This study used a quasi-experimental design with a pretestAe posttest without a control group.
The sample consisted of 30 pregnant women in their second and third trimesters who experienced lower back pain and received antenatal care at the Sujiati Nur Elys TPMB.
Dlanggu District.
Mojokerto Regency.
The intervention was given three times a week, with pain measured using the Numeric Rating Scale (NRS).
The results showed that before the intervention, the majority of respondents experienced severe pain .
3%), while after the intervention, none experienced severe pain.
A total of 7% of respondents had no pain, 53.
3% had mild pain, and 20% had moderate pain.
The Wilcoxon test showed p = 0.
< 0.
, indicating a significant difference before and after the intervention.
Thus, pregnancy massage at the BL40 point has been proven effective in reducing lower back pain in pregnant women.
Pregnant
Acupressure BL40
Lower back
Pregnant
INTRODUCTION
Pregnancy is a crucial period that begins with conception and continues until the fetus develops in the womb.
This period lasts approximately 280 days, or 40 weeks, calculated from the first day of the last menstrual period .
(Handayani et al.
During this period, the pregnant physiological, psychological, and hormonal These adaptations often lead to physical and emotional discomfort, which International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 can impact the mother's quality of life.
One of the most common physical complaints is musculoskeletal discomfort.
This condition primarily occurs in the second and third trimesters due to changes in posture due to the enlarging uterus, weight gain, and the effects of the hormone relaxin, which affects the ligaments and muscles of the back, leading to lower back pain ( LBP).
(Almanda et al.
, 2.
Globally, the WHO .
reports that low back pain (LBP) is estimated to affect 40Ae70% of pregnant women (Salari et , 2023.
Huang et al.
, 2.
LBP not only impacts physical health but also affects daily activities and reduces the mother's quality of In Indonesia, the prevalence of back pain in pregnant women ranges from 60Ae 80%, mostly with mild to moderate intensity (Widiyastika et al.
, 2.
Data from East Java shows a prevalence rate of around 65%, meaning more than half of pregnant women experience LBP (Handayani & Wardiyah.
In Mojokerto Regency, a 2023 maternal health survey reported that 65% of pregnant women in the second and third trimesters experienced LBP, but only 30% received optimal non-pharmacological interventions (Mojokerto Regency Health Office, 2.
Initial interviews at one of the TPMB in Mojokerto in August 2025 showed that all 30 pregnant women in their secondAe third trimester complained of lower back pain with varying intensity from mild to The discomfort caused by back pain affects the mother physically and Excessive stress impacts the hormonal system, such as increased levels of adrenaline and noradrenaline, as well as muscle tension.
This can lead to biochemical dysregulation, which impacts the well-being of pregnant women.
In fact, stress and anxiety are known to trigger increased corticotropin levels, which interact with oxytocin, causing premature contractions and potentially leading to premature labor (Nurbaiti & Tiwi, 2.
Managing lower back pain in pregnant women is crucial and can be achieved through pharmacological and nonpharmacological therapies.
Pharmacological approaches involve the use of opioids, non- anti-inflammatory (NSAID.
, and other analgesics (Resmi & Tyarini.
Non-pharmacological interventions are preferred because they are considered safer and have fewer side effects.
One example is pregnancy massage with stimulation of the BL40 (Weizhon.
acupressure point.
Pregnant massage is a massage technique specifically for pregnant women that aims to promote relaxation, improve circulation, reduce cramps, lower back pain, and lower stress levels.
Acupressure works by applying pressure to specific points to stimulate the release of transmission to the spinal cord and brain while increasing blood and oxygen supply to the affected area, thereby reducing symptoms (Ministry of Health of the Republic of Indonesia, 2.
The BL40 point itself is known to be effective in reducing lower back pain due to its strategic position along major nerve and muscle pathways (Chan, 2.
Several effectiveness of this method.
Research at the Sumbersari Community Health Center (Puskesma.
showed that prenatal massage significantly reduced lower back pain in pregnant women in their third trimester.
Using a sample of 30 respondents and measured using the NRS scale, the Wilcoxon test demonstrated a significant difference before and after the intervention .
< 0.
(Pratiwi, 2.
Another study by Robaniyah et al.
at the Karang Rejo Community Health Center in Tarakan City also demonstrated that acupressure at points BL23.
GV3.
GV4, and BL40 effectively reduced the intensity of lower back pain in 34 pregnant women in their third trimester with significant results .
< 0.
(Robaniyah et al.
, 2.
Non-pharmacological interventions for lower back pain, such as yoga, prenatal exercises, and warm compresses, have been widely studied.
However, studies focusing on prenatal massage with BL40 (Weizhon.
point stimulation are still limited.
Therefore, researchers are interested in conducting a study entitled "Implementation of Pregnant Massage at the BL40 (Weizhon.
Acupressure Point to Reduce Lower Back International Journal of Nursing and Midwifery Science (IJNMS).
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Issue 3.
December 2025 Pain in Pregnant Women in the Second and Third Trimesters at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency.
pharmacological therapy alternative in reducing lower back pain in pregnant women and supporting improvements in the quality of antenatal care (ANC) services.
METHOD
RESULT
This study used a quantitative method with a quasi-experimental design .
using a pretest-posttest design without a control group .
The study was conducted to determine the effect of pregnancy massage with stimulation of the BL40 (Weizhon.
acupressure point on reducing lower back pain in pregnant women in the second and third trimesters The intervention was carried out three times a week , with pain levels measured using the Numeric Rating Scale (NRS) before and after the procedure.
General Data Respondent Characteristics Based on Age The independent variable of this study is the implementation of pregnant massage at the BL40 (Weizhon.
acupressure point , while the dependent variable is the intensity of lower back pain in pregnant women.
The subjects of this study consisted of 30 pregnant women in their second and third trimesters who experienced low back pain and underwent antenatal care at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency , who were selected through a total sampling method .
Data collection was carried out using an observation sheet to record changes in the pain scale according to the research The research procedures included: .
selecting and providing informed consent to respondents, .
measuring the initial pain level ( pretest ), .
providing pregnant massage intervention at point BL40 three times a week, and .
measuring the final pain level ( posttest ).
Data analysis used the Wilcoxon Signed Rank Test to examine differences in pain levels before and after the intervention.
The results were used to assess the effectiveness of pregnancy massage at the BL40 Table 1Frequency Distribution Respondents Based on Age at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Age <20 years 20-35 years >35 years Amount Respondents Source: Primary Research Data, 2025 Table 1 shows that based on age characteristics, almost all respondents were aged 20-35 years, namely 28 respondents .
3%).
2 Respondent Characteristics Based on Education Table 2Frequency Distribution Respondents Based on Education at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Education Respondent F % Elementary .
lementary, middle 0 0 Middle School (SMA) Higher Education (Colleg.
Amount Source: Primary Research Data, 2025 Based on Table 2, it is known that the majority of respondents had secondary education .
igh schoo.
, namely 22 respondents .
3%), and 8 respondents .
7%) had tertiary education.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 3 Respondent Characteristics Based on Occupation Table 3Frequency Distribution of Respondents Based on Occupation at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Respondents Work Work Doesn't work Amount Source: Primary Research Data, 2025 Based on table 3, it is known that the majority of respondents are working, namely 18 respondents .
%), and 12 respondents .
%) are not working.
4 Respondent Characteristics Based on Parity Table 4Frequency Distribution Respondents Based on Parity at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Parity Primigravida Multigravida Grandemultigravida Amount Intervention Group Source: Primary Research Data, 2025 Table 4 shows that the parity of primigravidas and multigravidas.
The majority of respondents were primigravidas, at 16 .
3%).
5 Respondent Characteristics Based on Pregnancy Trimester Table Trimester Respondents Second Trimester Third Trimester Amount Source: Primary Research Data, 2025 Based on Table 5, the majority of respondents were pregnant women in their third trimester, namely 21 respondents .
%).
Nine respondents .
%) were pregnant women in their second trimester.
Special Data 1 Distribution of Pain Scale Based on Numeric Rating Scale (NRS ) Before Intervention Table 6Distribution of Pain Scale Based on the Numeric Rating Scale (NRS) Before Intervention at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Lower Back Pain Before Respondents Intervention No Pain Mild Pain .
Moderate Pain .
Severe Pain .
Amount Source: Primary Research Data, 2025 Based on Table 6, before the intervention, most respondents experienced severe lower back pain .
3%).
Nearly half of the respondents experienced moderate pain .
3%), and a small proportion experienced mild pain .
3%).
5Frequency Distribution Respondents Based Trimester of Pregnancy at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency International Journal of Nursing and Midwifery Science (IJNMS).
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Issue 3.
December 2025 2 Distribution of Pain Scale Based on Numeric Rating Scale (NRS ) After Intervention Table 7Distribution of Pain Scale Based on the Numeric Rating Scale (NRS) After Intervention at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency Lower Back Pain After Respondents Intervention No Pain Mild Pain .
Moderate Pain .
Severe Pain .
Amount Source: Primary Research Data, 2025 Based on Table 7 after the intervention, the majority of respondents experienced mild pain, namely 16 respondents .
3%).
Eight respondents .
7%) experienced no pain, and six respondents .
%) experienced moderate pain.
No patients experienced severe pain.
4 Differences in Lower Back Pain Levels Before and After Intervention Table 8Differences in Lower Back Pain Levels Before and After Intervention Before Intervention After Intervention No Pain Mild Moderate Pain .
Severe Pain Amount Lower Back Pain Pain Willcoxon Statistical Test : p-value 0.
000 < yu Source: Primary Data, 2025 Table 8 shows a comparison of lower back pain levels before and after the intervention.
There was a decrease in lower back pain levels before and after the intervention, from 100% of respondents experiencing lower back pain to 8 respondents .
experiencing no pain.
The results of the statistical test with Willcoxon showed a p-value of 000 < yu 0.
05 so that H1 was accepted, which means there was a difference in the level of lower back pain between before and after the intervention at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency.
DISCUSSION
Lower Back Pain Before Intervention The results showed that before the intervention, all 30 respondents ( 100%) experienced lower back pain, with the majority in the severe pain category .
3%), followed by moderate pain .
3%), and mild pain .
3%).
respondents experienced no pain.
Risk factors that cause pregnant women to experience lower back pain include age, parity, occupation, physical activity, and a previous history of low back pain (Daneau et , 2.
The research results showed that the majority of respondents were in the 20Ae35 age group .
3%), while the remainder were over 35 years old .
7%).
The age of 20Ae35 is considered a healthy reproductive age, where reproductive organs function optimally and the risk of pregnancy complications is relatively low (Maryana et , 2.
However, even at a healthy International Journal of Nursing and Midwifery Science (IJNMS).
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December 2025 complaints can still arise due to the physiological and biomechanical changes typical during pregnancy, especially in the later trimesters (Leung, 2.
This reinforces the idea that the main factor causing low back pain is not only age, but also the body's adaptation to the ongoing pregnancy (Daneau et al.
, 2.
In terms of education level, the majority of respondents had secondary education .
3%), while the remainder had tertiary education .
7%).
Educational level influences mothers' understanding of health information and their ability to manage complaints during pregnancy (Handayani et al.
, 2025.
Mothers with higher education tend to more quickly understand the benefits of complementary therapies and be proactive in seeking solutions to pain complaints, while mothers with secondary education still require basic education to practice therapy appropriately (Prameswari et al.
, 2.
Based on occupation, 60% of respondents were employed and 40% were Strenuous physical activity such as prolonged standing, bending, or carrying excessive weight can increase the risk of lower back pain by increasing mechanical stress on the spine (Pisoh et al.
This is consistent with the theory that pregnant women who work high-activity jobs are at higher risk of experiencing low back pain (Daneau et al.
, 2.
In terms of parity, the majority of respondents were primigravidas .
3%),
7% were multigravidas, and there were no grandemultigravidas.
According to Pisoh et al.
, primigravidas are more susceptible to discomfort during pregnancy because their bodies are adapting to hormonal and biomechanical changes for the first time.
Meanwhile, multigravidas are usually more accustomed to it, although they are still at risk of experiencing back pain due to repeated musculoskeletal strain from previous pregnancies.
Based on gestational age, the majority of respondents were in their third trimester .
%), with the remainder in their second trimester .
%).
According to Leung .
, lower back pain is more common in the final trimester due to the increasingly significant enlargement of the uterus, a forward shift in the center of gravity, and increased lumbar lordosis, which puts excessive pressure on the back muscles and Furthermore, the hormone relaxin, which peaks in the second and third trimesters, also contributes to sacroiliac joint instability, further exacerbating pain (Bertucci et al.
, 2.
Pathophysiologically, the primary cause of low back pain during pregnancy is a combination of hormonal and mechanical The hormones relaxin and progesterone cause pelvic ligaments to loosen, thereby reducing joint stability and triggering pain (Bertucci et al.
, 2.
Furthermore, the enlarging uterus shifts the center of gravity forward, increasing lumbar lordosis and increasing the mechanical load on the spine (Daneau et al.
, 2.
This condition is exacerbated by significant weight gain during pregnancy, averaging 10Ae16 kg, which increases pressure on the intervertebral discs (Ahmadi et al.
, 2.
Besides psychological aspects also play a role.
According to Nurbaiti & Tiwi .
, excessive stress during pregnancy can increase corticotropin and adrenaline hormones, which contribute to muscle tension and heighten pain perception.
This explains why most respondents in this study experienced severe pain before the This demonstrates a clear gap between existing facts and theories.
Lower Back Pain After Intervention The results of this study indicate that changes in lower back pain in respondents were very significant after pregnancy massage with stimulation of the BL40 acupressure point.
Before the intervention.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 the majority of respondents were in the severe pain category .
3%) , followed by moderate pain .
3%) , and only a small proportion experienced mild pain .
3%) ,
with no respondents being pain-free.
After the intervention, there was a significant change, namely 26.
7% of respondents no longer felt pain , 53.
3% only experienced mild pain , and the rest 20% still experienced moderate pain , with no respondents remaining in the severe pain This change is not merely a statistical decrease, but rather represents a significant clinical transformation.
pregnant women.
This means that this therapy successfully shifted the pain profile of the respondents from one that disrupted daily activities to a much milder, even painfree, condition.
This decrease is consistent with the therapy's mechanism of action.
Pregnant massage can improve blood circulation, reduce muscle spasms, lower cortisol levels, and increase the release of endorphins, which function as the body's natural analgesics (Nurbaiti & Tiwi, 2.
Meanwhile, acupressure at the BL40 point works through the gate control theory, providing non-noxious sensory stimulation that closes the pain transmission gate in the spinal cord (Daneau et al.
, 2.
Pressure at this point also increases the release of endorphins and serotonin, and improves lumbar tissue metabolism (Pisoh et al.
This research supports the results of Pratiwi's .
study, which demonstrated that prenatal massage effectively reduces lower back pain in pregnant women in the third trimester.
Similarly.
Robaniyah et al.
study showed that acupressure on the BL40 musculoskeletal pain in pregnant women.
Effectiveness of Implementing Pregnant Massage Point BL40 Analysis using the Wilcoxon test showed a p-value of 0.
000 < 0.
indicating a significant difference between pain levels before and after the intervention.
Thus, pregnancy massage at the BL40 point has been shown to be effective in reducing lower back pain in pregnant women in their second and third trimesters.
This effectiveness can be explained from two perspectives.
First, prenatal massage promotes muscle relaxation, improves circulation, and reduces stress hormones (Simiati et al.
, 2.
Second, stimulation of the BL40 point provides an neurophysiological mechanism, namely the release of endorphins (Bertucci et al.
, 2.
The combination of the two produces a synergistic effect, resulting in faster and more significant pain relief than either intervention alone.
This therapy is also relatively safe, affordable, and easily performed by trained healthcare professionals, making it suitable for integration into antenatal care services at primary healthcare facilities.
This aligns with the Indonesian Ministry of Health's 2021 recommendation, which encourages the implementation of complementary therapies in obstetric care to improve the well-being of pregnant women.
Pregnant massage at the BL40 point has the dual benefit of reducing the intensity of lower back pain physiologically while providing psychological comfort.
The gentle touch of the massage can enhance the emotional bond between mother and fetus, reduce anxiety, and improve sleep quality (Friska & Masliyah, 2.
Therefore, prenatal massage at the BL40 point should be included in comprehensive antenatal care , especially for pregnant women in the second and third trimesters who are prone to musculoskeletal complaints such as low back pain (LBP).
CONCLUSION
Based on the results of research on the implementation of pregnant massage at the BL40 (Weizhon.
acupressure point at TPMB Sujiati Nur Elys.
Dlanggu District.
Mojokerto Regency, it can be concluded International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 Before the intervention, all respondents .
%) experienced lower back pain, with the majority of respondents experiencing severe pain, namely 16 respondents .
3%).
After receiving pregnancy massage intervention using the BL40 ( Weizhong ) acupressure point three times a week, there was an increase in the number of respondents .
7%) who did not experience pain.
No respondents experienced severe pain.
Based on the statistical test with Willcoxon , the p-value results were 000, which means there was a significant difference so that the implementation of pregnant massage at acupressure points BL40 ( Weizhong ) is effective in reducing the level of lower back pain in pregnant women in the second and third trimesters.
REFERENCES