The Influence of Birth Ball Exercise and Lemon Aromatherapy on Cortisol Levels in Pregnant Women
DOI:
10.29303/jppipa.v12i3.14741Published:
2026-03-25Downloads
Abstract
Pregnancy is a natural and physiological condition. During pregnancy, various changes occur in the body due to the hormones estrogen and progesterone, which affect both the physical and psychological conditions of the mother. Anxiety during pregnancy is an emotional reaction related to the mother's concerns about her baby. Persistent anxiety can affect the sympathetic nervous system and the release of the stress hormone cortisol. The purpose of this study is to examine the effect of birth ball exercise and lemon aromatherapy on cortisol levels in pregnant women. This study employed a posttest-only control group approach in a quasi-experimental design. Thirty third-trimester pregnant women who engaged in pregnancy exercises made up the study sample; they were chosen using purposive sampling. For four weeks, the respondents in the intervention group received the lemon aromatherapy and birth ball exercise twice a week for forty-five minutes each. A questionnaire with respondent characteristics and a cortisol level column were part of the research tool. The non-parametric Mann-Whitney test was used for data analysis. The average cortisol levels in the intervention group and the control group differed significantly, as indicated by the results, which showed p = 0.000. This indicates that cortisol levels in third-trimester pregnant women are considerably impacted by lemon aromatherapy and birth ball exercise. cortisol levels are lowered by the physiological and psychological effects of the birth ball exercise and lemon aromatherapy, which relax the body and calm the mind. Pregnant women may benefit from combining lemon aromatherapy with birth ball exercise to lower anxiety levels and avoid excessive cortisol elevation.
Keywords:
Birth ball Cortisol Exercise Lemon aromatherapy PregnancyReferences
Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. M. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191, 62–77. https://doi.org/10.1016/j.jad.2015.11.014 DOI: https://doi.org/10.1016/j.jad.2015.11.014
Bjelanović, V., Babić, D., Hodžić, D., Bjelanović, A., Krešić, T., Dugandžić-Šimić, A., & Orešković, S. (2016). Correlation of psychological symptoms with cortisol and CRP levels in pregnant women with metabolic syndrome. Psychiatria Danubina, 27 Suppl 2, 578–585. Retrieved from https://hrcak.srce.hr/file/384235
Bleker, L. S., Roseboom, T. J., Vrijkotte, T. G., Reynolds, R. M., & de Rooij, S. R. (2017). Determinants of cortisol during pregnancy – The ABCD cohort. Psychoneuroendocrinology, 83, 172–181. https://doi.org/https://doi.org/10.1016/j.psyneuen.2017.05.026 DOI: https://doi.org/10.1016/j.psyneuen.2017.05.026
Chourpiliadi, C., & Paparodis, R. (2023). Physiology, Pituitary Issues During Pregnancy. Retrieved from https://www.ncbi.nlm.nih.gov/books/nbk551724/.
Claudia, J. G., & Rasyid, P. S. (2021). The Effect Of Giving Lemon Aromatherapy And Health Education On Pregnancy Anxienty Covid 19 Pandemic At Dungingi Health Center and Kota Barat Health. Science Midwifery, 10(1), 217–222. Retrieved from https://shorturl.asia/5rOoP
Darvishpor, S., Hosseini, A., Davoodi, A., Salehifar, E., Akbari, J., & Azadbakht, M. (2018). A Review on Medicinal Plants used for Nausea and Vomiting in Persian Medicine AReviewonMedicinalPlantsusedforNauseaandVomitinginPersianMedicine. Global Journal of Medical Research: B Pharma, Drug Discovery, Toxicology & Medicine, 18(January). Retrieved from https://www.academia.edu/download/121130914/4-A-Review-on-Medicinal-Plants.pdf
De Nys, L., Anderson, K., Ofosu, E. F., Ryde, G. C., Connelly, J., & Whittaker, A. C. (2022). The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. Psychoneuroendocrinology, 143, 105843. https://doi.org/10.1016/j.psyneuen.2022.105843 DOI: https://doi.org/10.1016/j.psyneuen.2022.105843
Dinkes RI. (2024). Laporan Kesga 2024. Retrieved from https://kemkes.go.id/id/laporan-keuangan-kemenkes-ta-2024
García-Blanco, A., Monferrer, A., Grimaldos, J., Hervás, D., Balanzá-Martínez, V., Diago, V., Vento, M., & Cháfer-Pericás, C. (2017). A preliminary study to assess the impact of maternal age on stress-related variables in healthy nulliparous women. Psychoneuroendocrinology, 78, 97–104. https://doi.org/10.1016/j.psyneuen.2017.01.018 DOI: https://doi.org/10.1016/j.psyneuen.2017.01.018
Gonzalez, R. A. C., Lynn, F., Alderdice, F., & Peralta-Ramirez, M. I. (2022). Cortisol levels versus self-report stress measures during pregnancy as predictors of adverse infant outcomes: a systematic review. Stress (Amsterdam, Netherlands), 25(1), 189–212. https://doi.org/10.1080/10253890.2022.2059348 DOI: https://doi.org/10.1080/10253890.2022.2059348
Heuvel, M. I. van den, van Assen, M. A. L. M., Glover, V., Claes, S., & Van den Bergh, B. R. H. (2018). Associations between maternal psychological distress and salivary cortisol during pregnancy: A mixed-models approach. Psychoneuroendocrinology, 96, 52–60. https://doi.org/10.1016/j.psyneuen.2018.06.005 DOI: https://doi.org/10.1016/j.psyneuen.2018.06.005
Jesica, F., & Friadi, A. (2019). Hubungan Kadar Kortisol Dan Prostaglandin Maternal Dengan Persalinan Preterm Dan Aterm. Jurnal Ilmu Keperawatan Dan Kebidanan, 10, 21. https://doi.org/10.26751/jikk.v10i1.540 DOI: https://doi.org/10.26751/jikk.v10i1.540
Kane, H. S., Dunkel Schetter, C., Glynn, L. M., Hobel, C. J., & Sandman, C. A. (2019). Pregnancy anxiety and prenatal cortisol trajectories. Biological Psychology, 100, 13–19. https://doi.org/10.1016/j.biopsycho.2014.04.003 DOI: https://doi.org/10.1016/j.biopsycho.2014.04.003
Kowshihan & Ravikumar, R. (2023). Estimation Of Lemon Inhalation Aromatherapy On Salivary Cortisol Levels And Dental Fear & Anxiety In Children. European Journal of Molecular & Clinical Medicine, 10(06), 181–192. Retrieved from https://shorturl.asia/IpKC3
Li, J., Tang, S., Liu, M., Liu, W., Cheng, C., Li, Y., Sun, M., & Qin, C. (2019). The relationship between salivary cortisol and perinatal depression in women undergoing termination of pregnancy for fetal anomaly: A prospective cohort study. Midwifery, 75, 103–109. https://doi.org/10.1016/j.midw.2019.04.010 DOI: https://doi.org/10.1016/j.midw.2019.04.010
Mardliyana, N. E. (2022). Peningkatan Pengetahuan Ibu Hamil Tentang Penanganan Keluhan Fisiologis Dengan Media Video Pakbuto (Penanganan Keluhan Ibu Hamil Tanpa Obat) Di Kelurahan Sutorejo Kecamatan Mulyorejo Surabaya. Jurnal Pengabdian Masyarakat Kebidanan, 4(1), 11. https://doi.org/10.26714/jpmk.v4i1.8894 DOI: https://doi.org/10.26714/jpmk.v4i1.8894
Miranda, J., Benitez, L., Macías-Redondo, S., Paules, C., Gomez-Gomez, A., Basso, A., Crovetto, F., Youssef, L., Pozo, O. J., Schoorlemmer, J., Crispi, F., & Gratacós, E. (2025). Maternal stress and fetoplacental cortisol regulation in small-for-gestational-age newborns. Ultrasound in Obstetrics & Gynecology, 65(6), 738–748. https://doi.org/10.1002/uog.29238 DOI: https://doi.org/10.1002/uog.29238
Mirzakhani, K., Hejazinia, Z., Golmakani, N., Mirteimouri, M., Sardar, M. A., & Shakeri, M. T. (2016). The effect of execution of exercise program with birth ball during pregnancy on anxiety rate in nulliparous women. The Iranian Journal of Obstetrics, Gynecology and Infertility, 17(117), 8–16. https://doi.org/10.22038/ijogi.2014.3474
Octhaviany, R. (2016). Pengaruh Aromaterapi Terhadap Penurunan Kelelahan Kerja di Rumah. Universitas Sumatera Utara.
Peterson, A. K., Toledo-Corral, C. M., Chavez, T. A., Naya, C. H., Johnson, M., Eckel, S. P., Lerner, D., Grubbs, B. H., Farzan, S. F., Dunton, G. F., Bastain, T. M., & Breton, C. V. (2020). Prenatal Maternal Cortisol Levels and Infant Birth Weight in a Predominately Low-Income Hispanic Cohort. International Journal of Environmental Research and Public Health, 17(18). https://doi.org/10.3390/ijerph17186896 DOI: https://doi.org/10.3390/ijerph17186896
Sari, W. I. P. E., & Kurniyati. (2021). Pengaruh Senam Hamil Birth Ball dengan Muatan Edukasi Persiapan Persalinan terhadap Kecemasan Ibu Hamil. Medikes (Media Informasi Kesehatan), 8(2), 223–236. https://doi.org/10.36743/medikes.v8i2.251 DOI: https://doi.org/10.36743/medikes.v8i2.251
Sari, W. I. P. E., Kurniyati, & Esmianti, F. (2023). Penerapan Asuhan Kebidanan Tradisional Komplementer untuk Mengurangi Keluhan Mual Muntah pada Ibu Hamil. Penerbit NEM.
Sari, W. I. P. E., Kurniyati, Yusniarita, & Mardalena, I. (2024). Perubahan Psikofisiologis Pada Ibu Hamil Trimester III:Penelitian Deskriptif. Jurnal Medikes (Media Informasi Kesehatan), 11(2), 135–152. https://doi.org/10.36743/medikes.v11i2.778 DOI: https://doi.org/10.36743/medikes.v11i2.778
Sartika, Y., Harahap, D. A., Rahmi, J., & Hindratni, F. (2023). Primigravid Patients ’ Cortisol Level And Anxiety Level Toward Childbirth With Pregnancy Exercises And Healing Touch. 14(03), 3207–3216. https://doi.org/10.47750/pnr.2023.14.03.402
Septiani, L. (2017). Pengaruh Senam Hamil Teratur pada Primigravida terhadap Perubahan Psikofisiologis Ibu dan Berat Badan Lahir Bayi. Jurnal Sehat Masada, XI(1), 109–120. Retrieved from https://ejurnal.stikesdhb.ac.id/index.php/Jsm/article/view/245 DOI: https://doi.org/10.24198/ijemc.v2i3.69
Stiles, K. G. (2017). The Essential Oils Complete Reference Guide: Over 250 Recipes for Natural Wholesome Aromatherapy. Page Street Publishing.
Suyani, S. (2020). Hubungan Tingkat Pendidikan Dan Status Pekerjaan Dengan Kecemasan Pada Ibu Hamil Trimester Iii. JKM (Jurnal Kesehatan Masyarakat) Cendekia Utama, 8(1), 19. https://doi.org/10.31596/jkm.v8i1.563 DOI: https://doi.org/10.31596/jkm.v8i1.563
Usman, A. S. H. H., Sunarno, I., & Syamsuddin, S. (2021). Risiko Peningkatan Hormon Kortisol Pada Hipertensi Gestasional. Jurnal Ilmiah Ilmu Kebidanan & Kandungan, 13(4), 182–192. https://doi.org/10.36089/job.v13i4.650
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