Hypnoprenatal reduces anxiety and stress in high-risk pregnancy in North Tapanuli District

Background: High-risk pregnancies can cause more complications for the mother and fetus during pregnancy, childbirth


INTRODUCTION
Methods: This research method used a pre-experimental method with a one group pretest post-test design. Samples were taken by the purposive sampling method, which, based on the inclusion criteria, obtained as many as 36 high-risk pregnant women who experience anxiety and stress. Hypnoprenatal intervention was carried out for 3 days, twice a day, and then observations and interviews were carried out using the DAS 42 questionnaire. Data analysis used a paired t-test. The results showed that the characteristics of the respondents based on the age of the majority were >35 years (44.7%), secondary education (33.3%), farmer's work (52.8%), primigravidas (17%), high-risk pregnancies (72.7%), and low risk (27.8%). Results : The results of the statistical tests showed differences and decreased levels of anxiety and stress in pregnant women at risk before and after the hypnoprenatal intervention, with a p-value of 0.000 (p<0.05). Conclusions: hypnoprenatal has a significant effect on the level of anxiety and stress among pregnant women at risk. It is recommended that pregnant women use hypnoprenatal techniques to help reduce anxiety and stress during pregnancy, which affects the mother's psychological condition. A high-risk pregnancy increases the risk of prenatal illness or infant death for both the mother and the unborn child (1). Factors that cause pregnancy risk that is not treated immediately in the mother can threaten safety, and even the worst thing can happen, namely the death of the mother and baby - (2).
Pregnancy is a period of growth and development of the intrauterine fetus, which starts at conception and lasts until labor starts.
During pregnancy, many physiological changes occur in the body of pregnant women as a form of maternal adaptation, namely physical changes, organ function, changes in the hormonal system, metabolism, and psychological conditions such as anxiety, fear, stress, and depression - (3).
Research shows that about 7% of pregnant women experience depression during pregnancy. This incidence increases in low-and middle-income countries (4 Anxiety or depressive disorders, as well a s g e n e r a l s t r e s s , c a n o c c u r d u r i n g pregnancy. However, anxiety that occurs continuously can make you uncomfortable, causing difficulty sleeping, headaches, a loss of appetite, or excessive eating behavior. Related to the condition of pregnancy, anxiety in pregnant women can increase stress, which affects the growth and development of the fetus in the womb. High levels of stress can stay for a long time and lead to various health problems, such as high blood pressure and heart disease. When you are pregnant, stress can increase your risk of having a premature or low-birth-weight baby. Babies born too soon or too small have a higher risk of health problems than babies born normally. The effect of stress on pregnant women does not only occur in the fetus but can continue and hurt children from infancy to school age. An epidemiological study shows that the stress of p r e g n a n c y c a n i n c r e a s e t h e r a t e o f spontaneous abortion, fetal malformations, and preterm birth. Toddlers born to mothers with stressful conditions have worse intellectual and language abilities (5) (6).
Psychosocial research on stress during pregnancy conducted on Asian, African, and white races stated that 6% of pregnant women experienced mild stress, 78% experienced severe stress, and 16% experienced no stress at all. Stress during pregnancy is significantly caused by factors such as economic difficulties, household problems, physical violence, medical problems, busy activities, work, and history of complicated pregnancies (7). The level of stress and anxiety increases in a t -r i s k p r e g n a n c i e s , w h e r e a t -r i s k pregnancies are pregnancies that can cause harm or complications to the mother and fetus during pregnancy, childbirth, and the puerperium when compared to normal pregnancies. The prevalence of COVID-19 and the nature of the epidemic also increase worry and anxiety in pregnant women, making them vulnerable to mental and psychological disorders (8 experienced an increase in anxiety, and 19% experienced insomnia, which was higher than that of non-pregnant women (9).
During pregnancy, mothers must also manage their emotional levels effectively, one of which is by using prenatal hypnosis techniques, also known as hypnoprenatal.
Hypnosis can be defined as "an animated,

RESULTS
Based on tracing data on pregnant women at the Situmeang and Sitada-tada Health Centers, it was found that 68 third-trimester pregnant women were at high risk. Based on the inclusion criteria, some did not meet the sample criteria, so the total sample of at-risk pregnant women who met the sample criteria and became respondents in this study was 36 high-risk pregnant women who were then observed and assessed for anxiety and stress levels before and after hypnoprenatal. The research data are presented in the table as follows:

Characteristics of Respondents
The characteristics of the respondents studied were age, education, occupation, parity, and risk assessment of pregnancy.

Anxiety Level of At-Risk Pregnant Women Given Hypnoprenatal
To measure the level of anxiety, the DASS questionnaire is used, and the level of anxiety is known as follows:  Regency.

Stress Levels in At-Risk Pregnant Women Who Received Hypnoprenatal Care
To measure the stress level, the DASS questionnaire is used, and it is known that the stress level of pregnant women at risk is as follows:

Anxiety and Stress Levels in High-Risk P r e g n a n t W o m e n B e f o r e a n d A f t e r
Hypnoprenatal Intervention The following table shows the differences in the outcomes of hypnoprenatal intervention before and after in pregnant women at risk for anxiety and stress:

Characteristics Of High-Risk Pregnant Women With Anxiety And Stress
Based on the results of this study, the The results of the study in Table 2  indicates that the pregnancy experienced by primigravida mothers is their first experience, so the third trimester is felt to be even more anxious because it is getting closer to the delivery process (11). Mothers will tend to feel anxious about their pregnancy and afraid of facing childbirth, considering that ignorance is a contributing factor to anxiety (14). Among mothers who have been pregnant before (multigravida), maybe their anxiety is related to past experiences they have had (4). In general, the anxiety that occurs in women who are about to give birth is caused by the fact that pregnant women have to adjust to physical and psychological changes.

The Anxiety Level of High-Risk Pregnant Women
Based on Table 2, it can be seen that after

Stress Levels in At-Risk Pregnant Women
In which function to provide energy to the mother a n d p r e p a r e h e r p h y s i c a l l y a n d The effect of stress on pregnant women does not only occur in the fetus but can continue and hurt children from infancy to school age. An epidemiological study shows that the stress of p r e g n a n c y c a n i n c r e a s e t h e r a t e o f spontaneous abortion, fetal malformations, and preterm birth. Toddlers born to mothers with stressful conditions have worse intellectual and language abilities (5,6).

Differences in Stress and Anxiety Levels of Pregnant Women at Risk Before and After
Hypnoprenatal Intervention Based on the results of data analysis using the paired t-test, it was found that the p- Hypnoprenatal therapy improves the mood during pregnancy so that the mother is more relaxed, and comfortable in her pregnancy, and prepares for labor. Anxiety and stress issues are common in pregnant women, especially if they have risk factors; therefore, these anxiety issues must be addressed. One way that can be done is with hypnoprenatal. Hypnoprenatal is an activity that can help a person relax and calm, and the effects of this condition will affect the mother and her environment. Hypnoprenatal techniques are external actions that can influence an individual's internal response.
The hypnoprenatal technique is a relaxation technique that originates from oneself in the form of words, short sentences, or thoughts t h a t c a n m a k e t h e m i n d p e a c e f u l .
Hypnoprenatal is done by imagining yourself in a state of peace and calm and focusing on regulating your breath and heartbeat.
Hypnoprenatal therapy for pregnant women aims to be a diversion, reduce anxiety and pressure, calm the mind, improve sleep quality, help reduce constipation, and make the mother more relaxed. Hypnoprenatal helps mothers relax due to the formation of endorphins, which have a calming effect.
Hypnoprenatal affects reducing the level of anxiety in at-risk pregnant women because when doing hypnoprenatal there is an increase in concentration, which makes it easier to regulate breathing, increases oxygen in the blood, decreases the hormone adrenaline, stimulates endorphins and enkephalins to provide a sense of calm, reduces heart rate, and lowers blood pressure, thereby lowering levels of anxiety.

CONCLUSION AND RECOMMENDATION
There were significant differences in the anxiety and stress levels of high-risk pregnant women before and after being given hypnoprenatal (ρ<0,05) so it can be concluded that hypnoprenatal can reduce anxiety and stress levels in high-risk pregnant women in North Tapanuli Regency. It is hoped that pregnant women can use prenatal hypnosis as an alternative therapy to deal with stress and anxiety during pregnancy.