The Effectiveness of Combine Endophin Massage and The Aman Mobile Health Application in Reducing Maternal Anxiety and Labor Pain During The Active Phase of Labor at Tempat Praktik Bidan Mandiri in Tanjungpinang, Indonesia

Abstract

Labor anxiety and pain in the active phase remain prevalent challenges in Indonesian midwifery care, yet integrated non‑pharmacological interventions are underexplored. To evaluate the effectiveness of combined endorphin massage (EM) and the AMAN (Aplikasi Mobile Android Nyeri) mobile health application for reducing maternal anxiety and labor pain during the active phase of labor. A qualitative action‑research design was employed with 32 purposively selected women in spontaneous labor at two independent midwifery practices in Tanjungpinang. The intervention comprised standardized endorphin massage delivered by trained midwives and simultaneous use of the AMAN application. Quantitative data were collected using the Hamilton Anxiety Rating Scale (HARS) and Visual Analog Scale (VAS); qualitative data were obtained through in‑depth interviews, participant observation, and field notes. Results: HARS scores decreased from 30.9 ± 5.2 (moderate‑severe anxiety) to 14.1 ± 4.8 (mild anxiety) after the intervention (p<0.001). VAS pain scores declined from 7.8 ± 1.3 to 4.6 ± 1.7 (p<0.001). Four core qualitative themes emerged: (1) tangibility of pain relief, (2) amplified self‑efficacy, (3) emotional anchoring through the digital companion, and (4) preservation of human‑centered care. The combined EM‑AMAN intervention effectively reduced anxiety and pain, fostered maternal empowerment, and was highly acceptable. This integrative, technology‑assisted, non‑pharmacological strategy offers a scalable model for Indonesian midwifery practice.