Journal of Positive School Psychology http://journalppw.

com
2022, Vol. 6, No. 8, 6820-6848

Effect Of Benson Relaxation Technique On Reducing

Pain And Stress Among Post Cesarean Section
Mothers
1Shaimaa Hassan Mohamady, 2 Somaya Ouda Abd Elmoniem, 3 Ola Abdel-
Wahab Afifi Araby, 4 Samah Ramadan Elrefaeys, 5 Shaimaa Mohamed Nageeb

1
Assistant Professor Maternal and Newborn Health Nursing, Faculty of Nursing, Helwan University,
Egypt.
2
Assistant Professor Obstetrics & Gynecology Nursing, Faculty of Nursing, Benha University, Egypt.
3
Lecturer of Obstetrics & Gynecology Nursing, Faculty of Nursing, Benha University, Egypt.
4
Assistant Professor of Psychiatric and Mental Health Nursing, Faculty of Nursing, Benha University,
Egypt.
5
Lecturer of Psychiatric Nursing and Mental Health, Faculty of Nursing, Zagazig University, Egypt.
Email: dr_shaimaa_2007@yahoo.com

Abstract

Context: Cesarean section patients were experienced discomfort and worry. Benson’s
relaxation technique is a good strategy to alleviate pain and stress. Mothers are the major
symptoms that influence comfort and well-being. Aim: The study aimed to see how Benson’s
relaxation technique effectively decreased pain and tension in post-cesarean section mothers.
Design: It was decided to utilize a quasi-experimental design. The study was performed at
Benha University Hospitals’ post-partum recovery unit in the obstetrics and gynecology
department.
Sample: A total of 170 moms were chosen at random and split into two equivalent groups:
study and control.
Tools: For data collecting, three main tools were used. The visual analog scale for pain, and
the perceived stress scale were used in a structured interviewing questionnaire.
Results: Following the application of Benson’s relaxation technique, the two groups had
statistically significant differences in their pain intensity and perceived stress scale ratings.
Meanwhile, no statistically significant difference in pain intensity or perceived stress scale
ratings existed between the study and control groups before administering Benson’s relaxing
approach.
Conclusion: Benson’s relaxation technique was shown to be useful in decreasing pain levels
in post-cesarean section moms in study groups, who also lowered their stress levels.
Recommendation: To further generalize the results, a similar study utilizing a large
representative probability sampling technique is highly recommended in various maternity
facilities.

KEYWORDS: Benson’s relaxation technique; Stress; Pain; Post cesarean section mothers

I. Introduction A Cesarean section (CS) can save a life

when conducted in a reasonable timeframe
6821 Journal of Positive School Psychology

to avoid dystocia or further difficulties. It is exacerbated. Within six weeks of

a traumatic experience that could lead to childbirth, these stresses include physical
stress disorder (Chen et al., 2020). Post- changes, maternal role attainment, and
cesarean moms’ pain and stress make societal support and action (Horasanlı &
healing difficult, and it affects the mother’s NUR DEMIRBAS, 2020).
relationship with her newborns. Early
recovery is extremely crucial for a patient Recently, several strategies for
who will be responsible for her newborn managing post-cesarean section pain have
shortly after surgery. Poorly treated pain been explored, including pharmaceutical
after a cesarean section has been linked to and non-pharmacological therapies.
an elevated prevalence of chronic pain and Relaxation is a non-pharmacological
post-traumatic stress syndrome, according method for reducing pain severity.
to proof from research conducted on high- Relaxation seeks to alleviate muscle
income features (Kintu et al., 2019). tension, anxiety, and bone discomfort, and
Extensive management of pain and stress is also relieve tension and pain associated
necessary to make the woman reasonably with the body’s natural functions (Raj &
comfortable throughout the duration of the Pillai 2021).
post-delivery. Benson’s relaxation
medication is a basic technique for Benson’s relaxation treatment
reducing pain and tension (Raj & Pillai (BRT) is a non-pharmacological method
2021). that attempts breathing consciousness to
Pain is a complicated phenomenon induce relaxation in the body. It can
that has been described differently by alleviate pain, increase hunger, improve
physicians, researchers, and individuals. sleep, boost energy levels, decrease stress,
The pain was known as an unpleasant make you feel relaxed, and help you bond
emotional sensation or experience related with your child indirectly. A typical BRT
to potential or actual tissue harm, as per the session series of steps: Mothers who have
international correlation for the study of had a cesarean section should sit
pain. Patients can suffer from physical and comfortably in a relaxed position, shut their
psychological effects as a result of poorly eyes, gradually breathe in and out via their
controlled pain (Mahama et al., 2019). C- nose, and silently utter the word “one”
sections have several disadvantages for when breathing out. Five minutes in the
women, including pain, which necessitates morning and evening, two times a day, are
using a lot of pain medication, and a spent practicing the procedure, with the
lengthier recovery time than vaginal birth. duration eventually increasing to 10-20
Women frequently suffer from pain in the minutes (Riddhi and Tiwari, 2020).
wound (where the stitches are) and Benson’s relaxation is also dependent on
abdominal discomfort following a C- four key aspects that contribute to détente
section delivery. Abdominal discomfort (stress release), including a peaceful
might continue for up to a month in some atmosphere, an appropriate state, a mental
cases (Lee et al., 2020). device consisting of a single word to
concentrate on, and a passive attitude
Birth is stressful for women, and a C- (Fateme et al., 2019).
section adds to that stress because it is
major abdominal surgery with the Benson’s relaxation technique
possibility of critical situations. Post- reduces sympathetic nervous system
partum stress is a restricting force caused activity and endogenous catecholamine
by post-partum stressors and can be levels. It causes muscle relaxation and
Shaimaa Hassan Mohamady 6822

decreased tension, anxiety, and sadness. is lowered inducing a postponement in

Benson’s relaxation approach has also been breastfeeding from the start. However, it
linked to an increase in self-esteem. People also impacts breastfeeding initiation (IMD)
may control their breathing, lower their (Marfuah et al., 2019).
heart rate and blood pressure, and avoid
many harmful physiologic responses to Benson’s relaxation treatment
stress by concentrating (Jourabchi et al., seeks to decrease stress, anxiety, muscular
2020). tension, and bone strain, and also it relieves
pain and tension associated with the body’s
Nurses play an important role as physiological status indirectly. Benson’s
educators by providing support for mothers relaxation has been demonstrated to be
and providing information, education, useful in lowering post-operative pain in a
psychological monitoring, and giving number of trials (Priya et al., 2017).
practical advice to women. Nursing Nurses play an essential part in a woman’s
management of post-cesarean pain is pregnancy and birthing experience as
unique in that mothers are expected to educators, organizers, and supporters of
reclaim their maternal role for the neonates women’s health. After a cesarean birth,
shortly after the surgical birth. Short post- most women were endured postsurgical
cesarean healing time decreases many other discomfort and administered painkillers.
somatic and emotional issues that impede Because opioid exposure increases the
cost reserves and a good delivery chance of developing a persistent
experience (Basyouni et al., 2018). For the postsurgical opioid addiction, opioid-
obstetric nurse, non-pharmacological pain reduction therapies are necessary
treatment methods are an excellent choice (Villadiego & Baker, 2021). The
for managing post-cesarean discomfort. relaxation technique developed by Benson
Massage, relaxation techniques, relaxing was efficient in decreasing pain and stress
music, mind-body practices, herbal in post-cesarean moms. Nurse educators
medicines, mentalism, and therapeutic should keep up to speed on complementary
touch are examples of these therapies. and substituted medicine for pain and stress
These methods are efficient in decreasing relief, as well as develop specialized skills
pain levels (Thomson et al., 2019). in delivering Benson’s relaxation treatment
(Radha et al., 2019).
2. Significance of the Study
Despite efforts to reduce the number of
primary caesareans, cesarean birth remains 3. Aim of the study
the most popular abdominal operation in The purpose of this study was to see how
North America. The third-greatest cesarean effective Benson’s relaxation method is at
section incidence in the world is in Egypt lowering pain and tension in mothers who
(54%) (Jadoo et al., 2020). Physical and have had a cesarean section. This goal was
psychological concerns plague post-CS achieved by:
women. (Ogunkua& Duryea 2021). ▪ In both the research and
Furthermore, pain from abdominal control groups, the
and uterine surgery that does not go away concentration of pain and
in a day has consequences such as limited stress among post-
mobilization, disturbed/unfulfilled bonding cesarean moms was
attachments (bonding affection), disruption assessed prior
of the mother’s activity of daily living to interventions.
(ADL), and, as a result, the baby’s nutrition
6823 Journal of Positive School Psychology

▪ Analyzing Benson’s 3.2. Research hypotheses

relaxation technique H1: After using Benson’s relaxation methods, post-
affects stress and pain cesarean moms will experience a significant
reduction in post-c- decrease in discomfort.
section moms in the H2. After using Benson’s relaxation methods, post-
study group following cesarean moms will experience a significant
the intervention. decrease in stress.

3.1. Operational definitions 4. Subjects & Methods

Planned or elective cesarean: Cesareans
are often planned before the birth for a 4.1. Research design: To accomplish this
medical reason or because it is the mother’s study objective, a quasi-experimental
decision. approach was adopted (two groups: control
Emergency C-section: is one that occurs and study).
very rapidly as a result of imminent anxiety
for the mother’s and/or baby’s health. The 4.2. Research setting
goal is for the time between the The current study is being performed on
determination to do an emergency C- post-cesarean moms who are admitted to
section and delivery to be less than 30 Benha University Hospital’s post-partum
minutes, although it can take up to 75 recovery room. This hospital is in the
minutes. Qalioubia Governorate, in Benha City,
Effectiveness: It is defined as the degree Egypt.
to which Benson’s relaxation treatment has
resulted in the anticipated transformation in 4.3. Subjects
stress and pain decrease among post-c-
section women. Sample type: A Purposive sampling
Benson’s Relaxation approach: It is a
non-pharmacological pain management Sample size:
approach that is based on breathing in post- This was a time-based study of six months,
cesarean section mothers in this study. which were 170 post-cesarean section
Mothers will be asked to attend quietly and mothers: 85 for each group of the study
with their eyes closed comfortably. The group and the control group, in a previously
mothers will be instructed to breathe slowly mentioned setting with the following
and through their nostrils. The mothers are inclusion and exclusion criteria: immediate
forced to utter the word “one” when they post-operative of cesarean section mothers
exhale discreetly. The approach is first who were alert, conscious, aware and
practiced for five minutes twice a day, in willing to enroll in the study, primipara
the mornings and afternoons, before with single baby, not using analgesic or
progressively increasing to 10-20 minutes. sedative therapy, free from any obstetrical
Stress: It alludes to an unfavorable state of disorders, free from post-cesarean
feeling disappointed, furious, complication, free from mental, psychiatric
apprehensive, or anxious due to surgery and cognitive disorders, free from chronic
and a newly assumed parental role in this medical diseases (i.e., hypertension,
study. cardiac diseases, and diabetes mellitus),
Pain: In this study, pain refers to a post- stable labor without complication, and had
cesarean mother’s discomfort at the a telephone number for contact.
surgical site.
4.4. Sample technique:
Shaimaa Hassan Mohamady 6824

The sample was 170 mothers split into two Part 1: Data about the mothers’ socio-
equal groups: a control group (85 mothers), demographics. It included five questions
and a study group (85 mothers). To elimi- (age, religion, educational concentration,
nate bias in data collection, the control residence, occupation, and social demand).
group included the post-cesarean mothers Part 2: The mothers’ obstetrical histories
who were admitted to the post-partum re- were examined. There were six questions in
covery room during the first three months all (abortion, gestational age, frequency of
and met the eligibility requirements from abortion, type of cesarean section, kind of
the start of data gathering. In contrast, the anesthesia, and type of surgical incision).
study group included other post-cesarean Part 3: This part has calculated the
mothers who met the same criteria but were beginning of mobility after the cesarean
conceded during the third and fourth section.
months of data analysis. Part 4: Factors that affect the severity of
pain. It consisted of two items which are
4.5. Tools of the study (drinking tea, drinking coffee).
The preceding three instruments were used
to collect pertinent data on the study indi- 4.5.2. Visual analog scale for pain:
viduals: Bain et al. (2005) used this measure to
validate the severity of pain among post-
4.5.1. A structured interviewing cesarean women based on a scale. It is a
questionnaire: The researchers created it specific tool that uses a scale of 0 to 10 to
after reading related material, and it was rate the severity of pain. On this scale, 0
written in plain Arabic. It was divided into represents no pain, 1-4 represents mild
four sections: pain, 4-7 represents moderate pain, and 7-
10 implies severe pain.

4.5.3. Perceived Stress Scale [PSS- Sometimes (2), Fairly often (3), and very
14]: often (4).
The perceived stress scale Ajitha, (2012)
was utilized to evaluate the stress degree The overall score of the perceived stress
experienced by the post-cesarean moms. It scale (PSS) is 0-56. Mild stress was given a
consists of 14 statements varying from score from 0-18; a score of 19-37 was given
never to very often. All of these are related for moderate stress, and a score of 38-56
to stress appraisal in post-cesarean moms. was given for severe stress.
The stress of post-cesarean mothers who
were assessed utilizing PSS, was classified 4.6. Ethical Considerations:
as follows: Never (0), Almost never (1),
6825 Journal of Positive School Psychology

There were no ethical concerns. Before who enrolled in the pilot study was
beginning the data collection, each mother removed from the study.
was informed of the study’s goal and given
an oral agreement. Throughout the study, 4.9. Procedure:
the women were told that their information The following steps were used to achieve
would be kept private and would only be the current study’s goal: preparatory,
used for research purposes. Each mother evaluation, preparation, implementation,
was told that involvement in the survey is assessment, and follow-up. These phases
completely voluntary, and that she could were conducted over a six-month
opt-out at any moment. timeframe from the beginning of August
2020 to the end of January 2021.
4.7. Tools Validity & Reliability:
An expert list comprised of five 1-Preparatory phase:
generations, gynecological health nursing The study’s first phase was the preparatory
and psychiatric, nursing of mental health phase, which was performed by the
professionals, obstetricians, and researcher through a survey of local and
psychiatrists, was thoroughly assessed the international relevant literature on many
tools for comprehensiveness, components of the research subject. This
appropriateness, and intelligibility. The gave the researchers a better understanding
expert group next verified the tools’ face of the scope and gravity of the issues, and
and content correctness. The tools’ guidance on how to build the necessary
dependability was tested to ensure that they data-gathering instruments.
were consistent. The retest reliability of the
scale was investigated, and it was found Approvals:
that the visual analog pain scale indicated After elucidating the research’s objective
an increased test-retest reliability (r = 0.84). and obtaining annual statistics of the post-
Previous studies (r=0.9) have validated the cesarean section of women participating
reliability of the perceived stress scale. As within the hospital, official permission to
a result, the tool was judged to be quite perform the research was secured by
trustworthy. The equation was used to uploading official paperwork from the
determine the reliability “r” =( Karl Benha University’s Faculty of Nursing’s
Pearson correlation co-efficient formula). Dean to the head of Benha University
Hospital in Egypt.
4.8. The Pilot study:
The pilot study enrolled 10% (18) of the 2-Assessment phase:
mothers and lasted three weeks. It was To acquire baseline data, researchers have
carried out to assess the advanced tools’ interrogated the post-cesarean section
simplicity, feasibility, clarity, applicability, moms in the post-partum recovery room
validity, and reliability. Moreover, it was (both control and study groups). The
done to consider potential hurdles or researchers welcomed every woman,
challenges that may develop for the described the aim and duration of the study,
researchers, block data gathering, and acted, and received their moms’ approval
calculate the time required for data before beginning the interview. The
collecting. As per the pilot study findings, researchers interviewed the post-cesarean
necessary changes were performed by section mothers to complete and fulfill the
adding or deleting questions and then structured interviewing questionnaire.
rephrasing some queries. Because some Then, the pre-test was performed to
adjustments were implemented, the mother validate women’s level of pain utilizing (a
Shaimaa Hassan Mohamady 6826

visual analog scale for pain), and evaluate which was aimed to reduce stress and pain
the level of stress utilizing (the perceived among the post-cesarean section mothers.
stress scale). The collected data during this
phase served as a baseline against Benson’s Implementation Phase:
relaxation method efficiency in lowering The duration of the study was 24 weeks pe-
pain and tension in the post-cesarean riod (3-4 mothers /day). The researchers
section mothers. The mean time for the went to previously indicated the location
completion of each woman’s structured twice a week (Mondays, Tuesdays, and
interviewing questionnaire was around (10- Wednesdays) from 9 AM to 3 PM.
15 minutes), the average time needed to The steps of the procedure were instructed
assess women’s level of pain was around and repeated to each mother to be imple-
(10-15 minutes), as well as the average time mented as follows Bommi, (2016):
needed to assess women’ level of stress was ▪ Sit calmly in a relaxed position.
approximately (20-25 minutes). Routine ▪ Shut your eyes.
post-operative care was given by hospital ▪ Starting with your feet and work-
staff for both groups. Routine post- ing your way up to your face,
operative care was given by hospital staff completely relax every muscle in
for both groups. To prevent information your body ( Relax your tongue,
from becoming contaminated between the and your thoughts will stop).
two groups, the control group was ▪ Be conscious of your breathing
evaluated initially. as you inhale and exhale. As your
mother is exhaling, quietly utter
2) Planning phase: the phrase “my God” or “my Al-
The researchers momentarily discussed the lah” to yourself (breathe
purpose of Benson’s relaxation technique smoothly and normally).
to the mothers, which is a physical ▪ Continue to breathe for another
condition of profound relaxation that alters 10 to 20 minutes. Open your eyes
the mental and physical reactions to stress to check the time, but do not set
and pain, based on baseline data gathered the alarm. When you are finished,
during the evaluation phase. Furthermore, sit quietly for a few minutes, first
after reviewing relevant literature, with your eyes closed, then with
researchers gradually found the benefits of your eyes open. For a few
this relaxation technique, including the fact minutes, do not stand up.
that consistent relaxation practice is an ▪ Do not be concerned about if or
appropriate medication for a broad range of not mom can achieve a deep state
stress-related issues. Moreover, the of relaxation. Keep a pleasant
researchers were prepared to implement the mindset and allow yourself to re-
Benson relaxation technique as follows: lax at your speed. When distract-
▪ Clarify the phases of pro- ing ideas arise, try to disregard
tocol to the mothers. them rather than lingering on
▪ Obtain oral consent to them, and return to the task at
guarantee co-operation. hand (my God or my Allah).
▪ Arrange the surrounding ▪ There should be little effort re-
environment to be quiet quired to respond after some ex-
and peaceful. perience. There should be no
The implementation phase was meals within two hours of using
designed to meet the study’s objective, the technique, because the diges-
tive process tends to obstruct the
6827 Journal of Positive School Psychology

elicitation of the relaxation re- telephone follow up a (twice daily7 a.m.

sponse. The technique should be and 7 PM).
done twice daily at 7 AM and 7
PM. For the control group: The impact of
Benson’s relaxation approach was assessed
▪ Practice the relaxed state for 10- using the same set of instruments that were
20 minutes in the morning to used prior to the intervention to validate the
avoid the stress reaction and amount of stress and pain experienced by
achieve substantial inner peace the post-cesarean section mothers.
and relaxation.
▪ Select any calming, mellifluous- Statistical Analysis
sounding word, ideally one that In the days before computers, data had to
has no meaning or association, to be double-checked before being entered
prevent needless cognitive acti- electronically. The Statistical Package for
vation. the Social Sciences (SPSS) was used (SPSS
version 20). In this investigation,
3) Follow up and Validation Phase: descriptive statistics were employed, such
For the study group: The influence of as mean, standard deviation, percentages,
Benson’s relaxation technique was and frequency. Statistical significance tests
assessed utilizing the same set of were utilized to assess the study hypothesis
instruments that were used prior to the (chi-square and paired independent t-test).
intervention to validate the amount of pain A p-value of less than or equivalent to 0.05
and stress experienced by the post-cesarean was regarded statistically significant, while
section mothers. Follow up, and evaluation a p-value of less than 0.001 was regarded
of the level of pain (tool II) and level of statistically extremely significant, and a p-
stress (tool III) were scheduled four times, value of more than 0.05 was regarded
two hours after the operation and on the statistically non-significant.
first, second and third day after the
operation through a home visit or by Results:

Table (1): The studied sample distribution (study and control groups) as per their socio-demo-
graphic features (n=170)

Groups Study group Control group

Socio- (n=85) (n=85)
demographic X2 p-value
characteristics No % No %
Age (years) 2.20
<25 46 54.1 53 62.4 0.33
25-30 34 40.0 25 29.4
>30 5 5.9 7 8.2

Mean ±SD ( years ) 23.31 ±3.96 22. 91 ±3.96

Religious
Muslim 77 90.6 69 81.2
Christian 8 9.4 16 18.8 3.10 0.07
 Shaimaa Hassan Mohamady 6828

Educational level
Read and write 9 10.6 13 15.3
Basic education 8 9.4 16 18.8
Secondary education 32 37.6 31 36.5 5.39 0.14
University education 36 42.4 25 29.4

Occupation
Work 19 22.4 23 27.1 0.50 0.47
Housewife 66 77.6 62 72.9
Residence
Rural 40 47.1 31 36.5
Urban 1.95 0.16
45 52.9 54 63.5
Present social support*
Mother 46 54.1 53 62.4
Mother in law 16 18.8 14 16.5 1.23 0.53
Sister 23 27.1 18 21.2

This table (Table 1) reveals the that the two groups were not differ much.
demographic features of the sample that is Homemakers made up more than two-
being studied. There was no statistically thirds of both the control and study groups
significant difference between the control in terms of occupation. Nevertheless, the
and study groups as per age, with a mean of majority of both the control and study
23.31±3.96 and 22.91±3.96 years, groups were Muslims. Both the control and
respectively, for the study and control study groups received social assistance
groups. Around two-thirds of urban from their mothers, with more than half and
residents in the study group and more than about two-thirds were received it from their
half were. mothers, respectively. The two groups had
Furthermore, only about a third of no statistically significant differences in the
the study group had a university degree, socio-demographic parameters, indicating
while only about half of the control group that they were homogeneous.
had a secondary education, demonstrating

Table (2): Frequency distribution of studied specimen (study and control groups) as per their past
and current obstetrical history (n=170)
Groups Study group Control group
Obstetric (n=85) (n=85)
X2 p-value
History No % No %
Abortion
1.85
Yes 28 31.8 20 23.5
0.17
No 57 68.2 65 76.5
Frequency of abortion N =28 N = 20
One 25 89.3 16 80.0
2.64 0.26
Two 0 0.0 4 20.0
Three 3 10.7 0 0.0
Gestational age 5.23 0.15
 6829 Journal of Positive School Psychology

37 weeks 19 22.4 15 17.6

38 weeks 28 32.9 38 44.7
39 weeks 15 17.6 19 22.4
40 weeks 23 27.1 13 15.3

Mean +SD 38.51 ± 1.12 38.35 ±0.94

Type of cesarean section

Planned cesarean section 66 77.6 75 88.2 3.36
0.06
Emergency cesarean section 19 22.4 10 11.8
Type of anesthesia
General 78 91.8 71 83.5
2.66 0.10
Regional 7 8.2 14 16.5

Type of incision
Transverse LSCS. 51 100.0 51 100.0
- -

Table (2) shows that 32.9% of general anesthetic (91.8 percent and 83.5
those in the research group and 44.7% of percent, respectively). For both the
those in the control group were both 38 research and control groups, all participants
weeks, with a mean gestational age of had transverse LSCS. To conclude, there
38.51±1.12 weeks and 38.35±0.94 weeks, were no statistically significant differences
respectively. About 31.8% of the study in the two groups’ prior obstetrical
participants and 23.5% of the control histories.
groups had abortions, respectively.
Additionally, the anticipated CS was Figure (1): proportional distribution of
received by more than three-quarters of studied specimen as per their history of
both study and control groups, respectively factors impacting on pain reliving ap-
(76.6 percent and 84.2 percent). Both study proach (tea and coffee intake) (n=170)
and control groups were anesthetized by
 Shaimaa Hassan Mohamady 6830

Figure (1) demonstrates the factors that Meanwhile, one-fifth of the study group
affected relieving pain in the study sample. (21.2%) and one-eighth (12.9%) of the
About two-fifths (40%) of the study group control group consumed more than four
and one-third (32.9%) of the control groups cups each day.
did not consume tea or coffee, respectively.

Table (3): Mean ratings of pain intensity in both control and study groups prior to
intervention and four stages after intervention (n=170)

Study group Control group

Time of intervention n=85 n=85 t-test p-value
Mean ±SD Mean ±SD
Immediately after ce-
Pre-intervention 6.30 ±2.20 6.22 ±2.31 0.23 0.81
sarean section

After2 hours 5.14 ±1.56 6.04 ±1.37 4.01 0.000**

Post-intervention

After4 hours 3.72 ±1.29 5.00 ±1.33 6.29 0.000**

Second day 1.71 ±1.32 3.23 ±1.82 6.20 0.000**

Third day 0.82±0.67 ±1.351.34 3.91 0.000**

*An extremely statistically significant p ≤ 0.001

Table (3): Before administering Benson’s relaxation methods, there are

Benson’s relaxation technique, no statistically significant variations in pain
statistically significant difference in pain intensity were noticed between the two
intensity was identified between the control groups (p-values less than 0.001).
and study groups. However, after using
 6831 Journal of Positive School Psychology

Table (4): Correlation coefficient between pain and socio-demographic characteristics among studied specimens before and four phases after intervention
(n=170)

Study period Pre-intervention Post-intervention

Pain immediately Pain during
Pain After 2 Pain After 4 Pain during the
after cesarean the second
Groups hours hours third day
Socio- section day
demographic charac- p- p- p- p-
teristics r p-value r r r r
value value value value
Study group 0.53 0.02* 0.19 0.06 0.08 0.12 0.25 0.51 0.21 0.91
Age
Control group 0.43 0.03* 0.34 0.02* 0.21 0.01* 0.21 0.06 0.07 0.21
Study group 0.62 0.04* 0.28 0.05* 0.51 0.31 0.61 0.71 0.51 0.84
Education
Control group 0.41 0.07 0.17 0.02* 0.24 0.03* 0.42 0.08 0.08 0.12
Study group 0.54 0.05* 0.68 0.05* 0.61 0.51 0.81 0.61 0.86 0.81
Residence
Control group 0.24 0.05* 0.57 0.02* 0.41 0.01* 0.52 0.07 0.02 0.31
Study group 0.91 0.02* 0.61 0.03* 0.24 0.68 0.59 0.01* 0.86 0.01*
Occupation
Control group 0.82 0.04* 0.42 0.01* 0.53 0.02* 0.50 0.03* 0.02 0.03*
A Statistical significant p-value less than or equal to 0.05

Table (4) demonstrates a statistically significant association between pain assessment with socio-demographic characteristics in both study and
and socio-demographic characteristics in both control and study groups, control groups except in occupation, where a significant correlation is found
after cesarean section, except for education in the control group. Moreover, in both control and study groups.
a significant association was observed after 2 hours in both study and
control groups, except for age in the study group. Meanwhile, after 4 hours,
a significant correlation is found in the control group compared to an
insignificant correlation in the study group. Moreover, there is an
insignificant correlation during the second-day and third-day pain
Shaimaa Hassan Mohamady 6832

Table (5): Correlation between pain and selected items of obstetrical history and factors affecting pain reliving method among studied sample before and
four phases after intervention (n=170)

Pre-intervention Post-intervention
Study period Immediately af-
during Sec- during the
ter the cesarean After 2 hours After 4 hours
ond day third day
Groups section
Obstetrical history
p- p- p- p-
and factors affecting pain reliv- r r r p-value R r
value value value value
ing method
Study group 0.61 0.006 0.71 0.000* 0.43 0.008 0.91 0.01* 0.72 0.01*
Type of anesthesia
Control group 0.52 0.01* 0.82 0.01* 0.23 0.002* 0.65 0.03* 0.62 0.03*
Study group 0.60 0.006 0.71 0.000* 0.43 0.008 0.91 0.01* 0.72 0.01*
Type of CS
Control group 0.51 0.01* 0.80 0.01* 0.28 0.002* 0.61 0.03* 0.65 0.03*
Study group 0.61 0.006 0.70 0.000* 0.45 0.008 0.82 0.01* 0.71 0.01*
Tea and coffee intake
Control group 0.52 0.01* 0.82 0.01* 0.23 0.002* 0.65 0.03* 0.69 0.03*
*A Statistical significant p ≤ 0.05
affecting pain reliving method (Tea and coffee intake) in the control group
at the pre and post-intervention stages. Meanwhile, a highly significant
Table (5) illustrates that there was a significant relationship between pain correlation was observed after 2 hours in the study group.
and obstetrical history (type of anesthesia and type of CS) and factors
6833 Journal of Positive School Psychology

Table (6): Distribution of studied sample as per their resumption of mobility among both study
and control groups after cesarean section (n=170)

Study group Control group

Resumption of mo- n = 85 n= 85
bility
No % No %

<10 hours 76 89.4 57 67.1

≥10 hours 9 10.6 28 32.9
X2 12.47
p-value P< 0.001
*A Statistical significant p ≤ 0.05 **An extremely Statistical significant p ≤ 0.001

Table (6) illustrates that the majority of the cesarean section, with an extremely
study group (89.4%) and more than two- significant difference among both control
thirds (67.1%) of the control group were and study groups.
resumed mobility before 10 hours after the

Table (7): Mean score of perceived stress scale in both the study and control groups
after cesarean section at pre and post-intervention phases (n=170)
 Shaimaa Hassan Mohamady Pre-intervention Post-intervention 6834
t- p- t- p-
Study control Study control
Items Perceived Stress Scale tes val tes valu
Mean Mean Mean Mean
t ue t e
±SD ±SD ±SD ±SD
Being upset that happened unex- 1.58±0. 1.0 0.3 5.5 0.00
1.45±0.74 0.64±0.73 1.35±0.92
pectedly 90 1 1 1 0**
Feeling powerless over essential 2.92±1. 1.0 0.2 5.1 0.00
2.75±1.12 1.62±0.67 2.37±1.15
aspects of one’s life 06 5 9 9 0**
2.56±1. 1.7 0.0 1.32 ± 4.6 0.00
Feeling nervous and “Stressed” 2.28±1.06 2.09±0.97
02 5 8 1.15 6 0**
Inability to deal effectively with
2.45±1. 0.8 0.3 3.1 0.00
day-to-day concerns and annoy- 2.58±0.87 1.48±0.92 1.98±1.13
04 7 8 8 2*
ances
Not feeling capable of adequately
2.64±0. 0.4 0.6 4.9 0.00
dealing with significant life 2.70±1.01 1.36±0.76 2.04±0.99
81 1 7 9 0**
changes
Feeling not confident about ability 2.64±0. 0.3 0.7 1.74 2.15 3.0 0.00
2.69±0.83
to handle personal problems 92 4 2 ±0.81 ±0.39 6 3*
Dissatisfied with the pace at which 2.63 ± 2.57 ± 0.4 0.5 1.52 ± 2.04 ± 3.4 0.00
events were unfolding, 0.88 0.85 4 6 0.99 0.98 0 0**
As if I couldn’t handle everything
2.68 2.51 1.1 0.2 1.29 1.88 ± 4.3 0.00
that needed to be done, I felt over-
±0.94 ±0.92 5 5 ±0.97 0.79 1 0**
whelmed.
2.40 ± 2.30 0.7 0.4 1.83 ± 5.7 0.00
Unable to control irritation in life 1.02±1.04
0.96 ±0.75 0 8 0.78 2 0**
2.03 1.8 0.0 1.68± 5.1 0.00
Not feeling on top of things 1.82±0.69 1.08±0.72
±0.82 1 7 0.78 5 0**
Being enraged because things were 2.17 2.15 ± 0.1 0.9 1.17 ± 1.67 ± 3.0 0.00
spiraling out of control ±1.19 1.22 2 0 0.94 1.13 8 2*
Do not think about the things that 2.45 2.36 ± 0.5 0.6 1.23 ± 1.80 ± 3.3 0.00
are to be accomplished ±1.29 1.14 0 1 1.13 1.09 0 1**
Unable to control the way of spend- 2.52± 2.60±0. 0.6 0.5 5.6 0.00
1.74±0.62 2.37±0.83
ing time 0.66 84 0 4 5 0**
Feeling that difficulties were piling
2.80± 2.74 0.5 0.5 2.11 3.6 0.00
up so high that they could not be 1.64±0.85
0.68 ±0.69 5 7 ±0.82 5 0**
overcome

A Statistical significant p ≤ 0.05 **A greatly Statistical significant p ≤ 0.001

6835 Journal of Positive School Psychology

Table (7) shows that prior to adopting than 0.001, the statistically significant
Benson’s relaxation technique, there was variations between the two groups were
no statistically significant difference in identified in mean scores of perceived
mean ratings of perceived stress scale- stress scale linked items after Benson’s
related items between the study and control relaxation technique administration.
groups. Nonetheless, with p-values less

Figure (2): Proportions distribution of the stud-

ied sample as per overall score of perceived
Stress Scale in both study and control groups af-
ter cesarean section at pre and post-intervention
stages (n=170)

Figure (2) displays that (3.7%), and

(5.9%) of the study group and control group
had mild stress levels before the application
of Benson’s relaxation technique,
respectively. Meanwhile, after applying
Benson’s relaxation technique, 50.0% of
the study group had mild stress levels
contrasted with 7.5%% of the control
group. This means that there is a significant
reduction in stress levels in the post-
intervention phase contrasted with the pre-
intervention phase in the study group more
than in the control group.
Shaimaa Hassan Mohamady 6836

Table (8): Correlation between the overall score of perceived stress scale and socio-demographic features in both the study and control groups after
cesarean section at the pre and post-intervention phases (n=170)
Variable Pre-intervention Post-intervention
Study group n=85 Control group n=85 Study group n= 85 Control group n= 85
Mild Moderate Sever Mild Moderate Sever Mild Moderate Sever Mild Moderate Sever
No No (%) No (%) No No (%) No (%) No (%) No (%) No No No (%) No
(%) (%) (%) (%) (%)
Age (years)
<25 21(24.7) 19(22.4)
0(0.0) 25(29.4) 0(0.0) 34(40.0) 25(29.4) 21(24.7) 0(0.0) 3(3.5) 49(57.6) 1(1.2)
≥25-30 9(10.6) 6(7.0)
0(0.0) 25(29.4) 0(0.0) 19(22.4) 16(18.8) 18(21.2) 0(0.0) 0(0.0) 24(28.3) 1(1.2)
≥30 0(0.0) 4(4.7)
0(0.0) 5(5.9) 0(0.0) 3(3.5) 2(2.4) 3(3.5) 0(0.0) 0(0.0) 7(8.2) 0(0.0)

X2 (p-value) 3.67 p-value 0.15 1.07 p-value 0.89

Educational level
Read and write 0(0.0) 4(4.7) 5(5.9) 0(0.0) 8(9.4) 5(5.9) 4(4.7) 5(5.9) 0(0.0) 3(3.5) 10(11.8) 0(0.0)
Basic education 0(0.0) 5(5.9) 3(3.5) 0(0.0) 9(10.6) 7(8.2) 4(4.7) 4(4.7) 0(0.0) 0(0.0) 16(18.8) 0(0.0)
Secondary education 0(0.0) 18(21.2) 14(16.5) 0(0.0) 21(24.7) 10(11.8) 15(17.6) 17(20.0) 0(0.0) 0(0.0) 30(35.3) 1(1.2)
University education 0(0.0) 28(32.9) 8(9.4) 0(0.0) 18(21.2) 7(8.2) 20(23.6) 16(18.8) 0(0.0) 0(0.0) 24(28.2) 1(1.2)

X2 (p-value) 4.70 p-value 0.19 3.75 p-value 0.71

Occupation
Work 0(0.0) 17(20.0) 2(2.4) 0(0.0) 19(22.4) 4(4.7) 19(22.4) 0(0.0) 0(0.0) 3(3.5) 20(23.5) 0(0.0)
housewife 0(0.0) 38(44.7) 28(32.9) 0(0.0) 37(43.5) 25(29.4) 24(28.2) 42(49.4) 0(0.0) 0(0.0) 60(70.6) 2(2.4)
X2 (p-value) 10.26 p value 0.001 18.40 p value 0.000**
Residence
Rural 0(0.0) 32(37.6) 8(9.4) 0(0.0) 25(29.4) 6(7.0) 29(34.1) 11(12.9) 0(0.0) 0(0.0) 30(35.3) 1(1.2)
Urban 0(0.0) 23(27.1) 22(25.9) 0(0.0) 31(36.5) 23(27.1) 14(16.5) 31(36.5) 0(0.0) 3(3.5) 50(58.8) 1(1.2)
 6837 Journal of Positive School Psychology

X2 (p-value) 12.08 p-value 0.001 11.95 p-value 0.003

Present social -support
Mother 0(0.0) 30(35.3) 16(18.8) 0(0.0) 35(41.2) 18(21.2) 26(30.6) 20(23.5) 0(0.0) 3(3.5) 50(58.8) 0(0.0)
Mother-in-law 0(0.0) 11(12.9) 5(5.9) 0(0.0) 11(12.9) 3(3.5) 8(9.4) 8(9.4) 0(0.0) 0(0.0) 13(15.3) 1(1.2)
Sister 0(0.0) 14(16.5) 9(10.6) 0(0.0) 10(11.8) 8(9.4) 9(10.6.) 14(16.5) 0(0.0) 0(0.0) 17(20.0) 1(1.2)
X2 (p-value) 1.68 p-value 0.43 3.59 p-value 0.46
*A statistically significant p ≤ 0.05 **An extremely statistical significant p ≤ 0.001

For both the control and study groups, there was no statistically significant association between stress level and socio-demographic factors such as age or
educational level, or current social support prior to or during the intervention. The pre-and post-intervention stress levels in both the study and control groups had a
highly statistically significant relationship with other socio-demographic characteristics, such as place of residence and occupation (p-value less than or equivalent to
0.001
Shaimaa Hassan Mohamady 6838

Discussion 3.96 years in a row, with no significant

difference between the study and control
The number of cesarean sections performed groups. Regarding the residence, more than
worldwide is on the rise. CS doubled from half of the study group and about two-thirds
2003 to 2018, reaching 21%, and is of the control group lived in urban areas.
growing at a rate of 4% per year (Khalid et Furthermore, less than half of the study
al., 2017). The cesarean section usually group had a University education, and
results in experiencing an increased level about one-third of the control group had
of postnatal pain, and psychological secondary education, with insignificant
problems, which leads to stress disorder. relation between them.
Pain and tension after a cesarean section are In terms of occupation, more than
complicated issues that interfere with the two-thirds of both the control and study
mother’s healing and function. According groups were homemakers. Nonetheless, in
to data, cesarean delivery is a terms of religion, Muslims made up the
biopsychosocial event requiring a holistic bulk of both the study and control groups.
strategy that encourages control and pain More than half and roughly two-thirds of
and stress management (Donaldson- the study and control groups, respectively,
Evans, 2019). received social assistance from their
A relaxation reaction is a mothers. In terms of socio-demographic
beneficial approach for turning off the characteristics, there were no statistically
fight-or-flight response and restoring the significant differences between the two
body to a pre-pain and pre-stress state groups, implying that the two groups under
before it. Relaxation is a physically study are homogeneous. This may be
relaxing state that enhances the because the Egyptian people preferred
parasympathetic nervous system, which is educating women and were not delayed
the other half of our nervous system childbearing after marriage, and some
(MacDonald, 2020). Learning tremendous families preferred that women not work to
relaxation is one of the most crucial matters take care of the children.
we can do in our lives. To decrease This result agreed with El slayed et
discomfort and stress, it is best to exercise al. (2017), who investigated “Benson’s
the relaxation response first thing in the relaxation medication. It is impacting on
morning for 10 to 20 minutes (Ibrahim et stress and coping among high-risk
al., 2019). pregnancy women”, and mentioned that the
The researchers tried to majority of the sample group was between
investigate the impact of Benson’s the ages of 20-<30 years, that more than
relaxation approach on pain and stress two-thirds of them had a technical or
reduction in post-cesarean section mothers University degree, that they were not
in this study. The current study’s findings working, and that they were from rural
strongly supported the study’s hypotheses. areas.
Personal characteristics can play a Concerning their past and present
major role in determining the exact features obstetrical history, current research results
of the post-CS mothers that may affect their showed that the gestational age of about
pain and stress after delivery. In the study one-third of the study and slightly less than
sample’s characteristics, the current data half of the control groups was 38 weeks,
were revealed that more than half and respectively, with a mean gestational age of
roughly two-thirds of both the study and 38.51 ± 1.12 weeks and 38.35 ±0.94 weeks,
control groups were under the age of 25, respectively. According to abortion,
with mean ages of 23.31±3.96 and 22.91± slightly less than one-third of the study and
6839 Journal of Positive School Psychology

slightly less than one-quarter of the control group intake and one-eighth of the control
groups had an abortion. For both research group more than four cups.
and control groups, more than three- Regarding the resumption of
quarters and a majority of the participants mobility after a cesarean section, the
had CS in their futures. General anesthesia current research finding revealed that most
was used in most of both the research and of the study group and more than two-thirds
control groups. of the control group were mobile within 10
In addition, both the study and hours of the post-cesarean section, with a
control groups showed transverse LSCS. very significant difference between the
As per the results, there was no statistically study and control groups. This could be
significant difference in obstetric attributed to the influence of Benson’s
experience between the two groups. relaxation approach on lowering pain and
This result was congruent with assisting women in resuming movement
Ibrahim et al. (2014), who noted that more and daily routine activities. This result was
than two-thirds of the control and supported by Jyoti and Kshirsagar,
study groups did not have a history of (2014), who discovered that post-operative
abortion. Around half of the study and problems related to immobility are the
control groups were anesthetized, with an basic cause of mortality and morbidity in
average gestational age of 38.21 0.92 cesarean section patients. Women can be
weeks and 38.35 1.36 weeks, respectively. aided in preventing post-operative
All study and control groups employed the difficulties and consequences such as DVT
transverse incision. P>0.05 indicates that and respiratory infection by receiving
there was no statistically significant preventative and promotional post-
difference in obstetrical history between operative treatment. Early ambulation can
the two groups. Another study found that be one of the most critical parts of
29.1 percent of the population was comprehensive post-operative treatment. It
classified as having chronic sinusitis, which implies that patients can get out of bed as
is in line with this study’s findings (13.2 soon as feasible following a cesarean
percent as emergency CS and 15.9 percent section. This time frame could be as little as
as arranged CS). This may be the general 6-8 hours.
perception that cesarean delivery is much Most moms who have CS have
safer now than in the past. It can also help acute post-operative pain, yet research
alleviate some of the stress of waiting for suggests that only about half of them get
labor to begin. adequate pain medication. Benson’s
relaxation technique is one of many post-
Coffee and tea are famous operative therapies and management
international beverages that positively strategies for minimizing and controlling
impact the human body, including the post-operative pain Chou et al. (2016). As
cardiovascular and neural systems, and per the research, before applying Benson’s
improve one’s sense of well-being. relaxation approach, there was no
Regarding the factors affecting the reliving statistically significant difference in pain
pain method (coffee and tea), Rabiepoora et intensity between the study and control
al. (2018), the current study results groups. Nevertheless, after applying
indicated that the two-fifth of the study Benson’s relaxation method to two groups,
group and about one-third of the control a very statistically significant difference in
groups were not intaken tea and coffee. pain intensity was noticed between the two
Meanwhile, about one-fifth of the study groups (p-values less than 0.001). These
results emphasized the significant and
Shaimaa Hassan Mohamady 6840

positive role of Benson’s relaxation has not bonded when the wound is still wet,
technique in affecting pain levels among resulting in intense agony. Pain is lessened
post-cesarean section women. Therefore, once the incision is dried and tissue
women who plan to deliver by CS should attachment has occurred. The pain was
be trained about Benson’s relaxation reduced in the intervention group owing to
technique through antenatal educational Benson’s relaxation intervention.
programs to relieve post-CS pain. These results came in the same
Muscle atrophy, poor immune harmony with Ningrum et al. (2017), who
function and wound healing, organ failure, stated that “in the hospital of Dr. H. Moch,
and mortality may result from the stress according to Ansari Saleh Banjarmasin, the
reaction following surgery, which causes handheld relaxation techniques were
disruptions in the inflammatory, acute efficacious in decreasing pain intensity
stage, hormonal, and genomic responses following a cesarean section, with the
El-Gabalawy et al. (2019). Prior to using consequence that the p-value (0,000 less
Benson’s relaxing method, there was no than 0,05).
discernible difference in mean stress scale Also, the current study’s outcomes
ratings between the control and study are inseparably linked with a study by
groups. Sindhumol and Thadathil (2017), who
However, a statistically significant reported that the average pre-pain score of
difference was detected between the two post-cesarean mothers was 6.26 on the first
groups as per mean scores of perceived day and 5.74 on the second day. There is a
stress scale-related items after applying 95 percent (p-value less than 0.005)
Benson’s relaxation technique with p- statistically significant decrease in pain
values < 0.001. Before applying Benson’s perception after all four sessions. On a 5-
relaxation technique, few control and study point Likert scale, 74% of the respondents
groups had mild stress levels. Meanwhile, said they were completely happy with the
after applying Benson’s relaxation treatment. Furthermore, Ju et al. (2019)
technique, half of the study group had mild stated that patients who used relaxation
stress levels compared to a few control methods experienced a marked decrease in
groups. As a result, the post-intervention pain contrasted to those who received
stress level was significantly lower than the standard nursing care.
pre-intervention stress level. This finding Additionally, Radha et al. (2019),
might be owing to Benson’s relaxation demonstrated that Benson’s relaxation
technique used, which has been of value in treatment successfully lowered pain and
helping to relieve stress levels after CS. As tension in post-c-section mothers. Bommi,
a result, Benson’s relaxation technique ( 2016), cleared that Benson’s relaxation
must adopt self-care initiatives to enhance treatment effectively reduced pain and
overall health and well-being following CS. stress among post-cesarean mothers.
This is consistent with the findings of The previously mentioned results
Solehati and Rustino (2015), who found a came in the same harmony with Priya et al.
significant difference in pain severity (2017), who illustrated that most of the pain
between the two groups before and after the among post-cesarean mothers had severe,
intervention, with the intervention group and moderate in the pre-test, and moderate,
experiencing greater pain reduction than mild, and no pain in the post-test. This
the control group. shows the imperatives need to understand
This could be related to the mother’s the purpose of Benson’s relaxation therapy
adaption to pain during the post-cesarean regarding the decrease of the level of pain
section wound healing process. The tissue among post-cesarean mothers. It will
6841 Journal of Positive School Psychology

improve the quality of life, including relaxation towards the anxiety level in
stability in physiological, psychological, cervical cancer cases in the inpatient ward
sexual, vocational, and lifestyle aspects. of Camar III at General Hospital of Arifin
Moreover, Parmar and Tiwari, Achmad Pekanbaru”, Paramban et a.
(2020) demonstrated that Benson’s (2016) who conducted a study entitled by
relaxation treatment, which is a non- “Efficiency of Benson’s relaxation therapy
pharmacological strategy, has been shown on the decrease of stress among
to help the body achieve a sense of calm primigravid mothers”, Sajadi et al. (2017)
and contentment. It is a treatment that has who conducted Benson’s Relaxation
been shown to be useful in lowering pain impact in contrasting to Systematic
and tension and promoting healthy sleep. Desensitization on Anxiety of Female
Sapthica, (2014), illustrated that the Nurses: A Randomized Clinical Tria”, El-
findings showed that Benson’s relaxation Sayed et al. (2017) who studied Benson’s
treatment is a modest non-pharmacological Relaxation treatment: Its impact on Stress
strategy that is beneficial in lowering pain and Coping among Mothers with High-
perception and tension in moms who had Risk Pregnancy”. Yekta et al.
LSCS. ( 2016) who performed a study entitled
In support of what was mentioned “The Comparison of Two Types of
previously, it was found that Ajitha, Relaxation methods on Postoperative State
(2012), revealed that there was a Anxiety in Candidates for The Mastectomy
statistically significant reduction in the Surgery: A Randomized Controlled
stress and pain level after Benson’s Clinical Trial”. Ibrahim et al. (2019),
relaxation treatment among post-cesarean performed “The impact of Benson
mothers. Also, Salmanzadeh et al. (2018), relaxation method on anxiety in the
mentioned that the results of this study emergency care”.
showed that Benson’s relaxation approach Moreover, Olia et al, (2019) who
alleviated the anxiety before cesarean studied “The impact of Benson Relaxation
section in nulliparous women of cesarean on Oxidative Stress Marker of
section. Therefore, it is suggested that this Premenstrual Syndrome in Students of
method should be used to reduce pre- Khoy University of Medical Sciences”,
cesarean anxiety in nulliparous women. Mohammadi and Parandin, (2019) who
This convergence of the present study performed a study entitled by “Impact of
result and the other studies could be the mixture of Benson’s relaxation method
explained by the convergence in the sample and brief psychoeducational intervention
size and characteristics. on multidimensional pain and negative
Generally, many studies proved psychological symptoms of pregnant
that Benson’s relaxation therapy had a women: A randomized controlled trial”,
positive impact in relieving stress, anxiety, Mirhosseini et al, (2019) who studied
and pain level of many diseases, whether in “Benson Relaxation method on the Fatigue
obstetrics and gynecology, or other Severity of Patients with MS”, Poorolajal
specialties. It can be mentioned, for et al, (2017) who studied “I of Benson
example, as follows: Sreedevi, (2014), who relaxation approach on the pre-operative
studied “Effectiveness of relaxation anxiety and hemodynamic status: A single
program on institutionalized women with blind randomized clinical trial”, Elsayed e
pregnancy-induced hypertension. t al, (2019) who studied “The Impact of
Vinayaka Missions University. Salem, Benson’s Relaxation Technique on
Tamilnadu, India”, Safitri, (2017) who Anxiety, Depression and Sleep Quality of
conducted “The impact of Benson’s Elderly Patients Undergoing Hemodialysis,
Shaimaa Hassan Mohamady 6842

Egypt”, Abd-Elraziek et al,( 2017) who Solehati and Rustina ( 2015), stated that
conducted “The Effect of Benson’s pain severity was not related to age. There
Relaxation Technique Training Program on was a link discovered between education
Elderly Patients with Renal Failure, and pain intensity. There was a connection
Egypt”, Momen et al, (2017) who studied between pain severity and parity, even
“The Effect of Benson’s Relaxation though employment did not affect pain
Method on Pain Severity After severity. Parity-related pain coping
Laminectomy in Patients Admitted to AJA mechanisms probably certainly cause the
Hospitals”. parity impact. Compared to multiparous
mothers, primiparous mothers may have
Regarding the correlation between little experience with labor pain and how to
pain and socio-demographic features, the manage it. This discrepancy in results could
current research’s findings demonstrated a be related to the study’s diverse locations
statistically significant correlation between and the investigated sample’s personal
pain and socio-demographic features in attributes.
both study and control groups immediately The current study’s findings
after cesarean section except for education differed from those of Radha et al. (2019),
in the control group. Additionally, a who found no significant relationship
significant correlation was noticed after between pain levels and demographic
two hours in both study and control groups characteristics in the study and control
except for age in the study group. groups. Additionally, the findings of this
Meanwhile, after four hours, a significant study contradicted those of Bommi
correlation is found in the control group (2016), who found no significant link
contrasted to an insignificant correlation in between the stated demographic factors and
the study group. Moreover, insignificant the level of pain in either the experimental
association during the second day and or control groups before and after the
third-day pain assessment with socio- intervention. A previous study (Priya et
demographic characteristics in both study al., 2017) concluded that demographic
and control groups except for significant variables such as education, age, parity,
occupation found in both the study and occupation, weight, and cesarean type were
control groups. There is a chance that aging not associated with pain intensity.
has a big impact on discomfort. One of the In this regard, it was discovered
elements that might impact a person’s that Sapthica, (2014) indicated no
behavior is education level, which is linked significant link between subjects’ post-test
to knowledge and can help a person deal pain levels and their age, education,
with post-cesarean section pain in the occupation, or type of LSCS in the
elderly. The influence on employment is experimental group. There is no significant
most likely attributable to methods of pain correlation between the control group’s
management used at work. Compared to post-test pain levels and their age,
employed women, homemakers have little education, occupation, or type of LSCS.
experience with labor pain and dealing with The discrepancies in sample size and area
it. Also, those women living in urban areas of residency may explain the disparity
were more likely to cope with pain because between the current research results and
they were more probable to be those of other investigations.
knowledgeable about coping strategies. Additionally, the current research
These results were disagreed with outcomes revealed a significant correlation
(in age point) and were similar to (in between pain and obstetrical history (type
education and employment points). of anesthesia and type of CS) and factors
6843 Journal of Positive School Psychology

affecting the pain reliving method (Tea and and control groups regarding the stress’
coffee intake) in the control group in the pre post-test level.
and post-intervention phases. Meanwhile, a Furthermore, the findings of this
highly significant correlation was observed study contradicted those of Bommi,
after two hours in the study group. This (2016), who showed no significant
result was opposite to Solehati and relationship between selected demographic
Rustina (2015), who discovered no characteristics and stress in both the
statistically meaningful link between experimental and control groups during pre
elective cesarean delivery and pain level and post-intervention. Sapthica, (2014),
emergency. Additionally, Priya et al. discovered that there was a strong
(2017) stated that there was no significant association between the experimental
correlation between pain intensity and the group’s age and post-test stress scores.
type of cesarean. Sapthica (2014) found no However, there was no correlation between
correlation between the kind of LSCS and education or occupation and post-test stress
the post-test pain levels of patients in the ratings of experimental group individuals.
therapy group. There was no significant There is no significant relationship between
correlation between the kind of LSCS and the control group’s post-test stress scores
the control group participants’ post-test and their age, education, or occupation. The
pain ratings. The disparity in findings disharmony between the current research
between our study and the other study could results and the other findings may be due to
be attributed to differences in the eligibility the difference in the place of research, the
criteria, which are impacted by cultural and different characteristics of the studied
environmental factors. samples, and the criteria for selecting and
Concerning the relation between excluding the sample.
stress level and selected socio-demographic
features, our research results clarified that Conclusion
there was no statistically significant Benson’s relaxation technique decreased
relationship between stress level and stress and pain in post-cesarean section
selected socio-demographic features of the mothers. Our observations showed no
studied sample, which were age, statistically significant variations in pain
educational level, and present social intensity between the study and control
support at the pre-intervention and post- groups prior to using Benson’s relaxation
intervention stages. In contrast, there was a approach. Meanwhile, with p-values of less
highly statistically significant relation than 0.001, a statistically significant
between stress level and other socio- difference in pain intensity was seen
demographic features of the studied between the two groups following
sample: residence and occupation (P> Benson’s relaxation technique intervention.
0.001). From present research results, the Before Benson’s relaxation technique
researchers found that the greater the age, intervention, there were no statistically
the greater the educational level, and the significant variations in mean ratings of
more social assistance present, the less perceived stress scale-related categories
sense of stress because that gives more between the study and control groups.
ability to adapt to the pressures. The However, after utilizing Benson’s
previous finding contrasted with Radha et relaxation technique, there was a highly
al. (2019), who reported no substantial statistically significant difference in mean
correlation between the tension level and scores of perceived stress scale-related
demographic features in the experimental items between the two groups, with p-
values less than 0.001. As a result, the
 Shaimaa Hassan Mohamady 6844

impact of Benson’s relaxation technique a selected hospital, Bangalore” Master’s

was reversed. These data validated the Degree in Nursing (Obstetric and Gynaeco-
research hypotheses. logical Nursing). St. Philomena’s College
Of Nursing.
Recommendations 3. Bain G., Kuwahata T., Raymod B and
The following suggestions were derived Foster R. (2005): Tea Tree hydrogel dress-
from the findings of the current study: ing used in wound care, available at: //
▪ A similar study utilizing a large repre- www.ridc.gov.aul reports / tt 0105-114.pdf
sentative probability sample is highly sug- 2013; 15:845–53
gested in various maternity facilities to gen- 4. Basyouni N.R., Gohar IE and Zaied N.F.
eralize the results further. (2018): Effect of Foot Reflexology on Post-
▪ Training each mother suspected of cesarean Cesarean Pain IOSR Journal of Nursing and
section to apply BRT immediately after Health Science (IOSR-JNHS) e- ISSN:
delivery. 2320–1959.p- ISSN: 2320–1940, 7(4): PP
▪ A booklet explaining Benson’s relaxation 01-19.
technique might be created and used in the 5. Batieha A.M., Al-Daradkah S.A.,
prenatal, labor, and postnatal units. Khader Y.S., Basha A., Sabet F.,
Future recommendation Athamneh T.Z. and Sheyyab M. (2017):
▪ Training all staff nurses in the obstetrics Cesarean Section: Incidence, Causes, Asso-
department to apply BRT for each woman ciated Factors and Outcomes: A National
after a cesarean section. Prospective Study from Jordan. Gynecol
Obstet Case Rep, .3(3):55.
Acknowledgments doi:10.21767/2471-8165.1000055.
The authors are thankful to all mothers who 6. Bommi K. (2016): A study to evaluate the
were enrolled in the post-partum recovery effectiveness of Benson’s relaxation ther-
ward in the obstetrics and gynecology apy on reduction of pain and stress among
department clinic at Benha University post caesarean mothers admitted at selected
Hospital and involved in this research and hospital, Pudukkottai. Master’s thesis,
to the health care workers in the post- Karpaga Vinayaga College of Nursing,
partum recovery ward, for their kind and Pudukkottai; pp:30-56.
efficient co-operation. 7. Chen, Y., Yang, X., Guo, C., Liao, Y.,
Guo, L., Chen, W., Chen, I., Krewski, D.,
Conflict of interest Wen, S.W., and Xie, R.(2020): Preva-
No conflict of interest in this work was lence of Post-Traumatic Stress Disorder
found. Following Caesarean Section: A System-
atic Review and Meta-Analysis, Journal of
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