Effect of a progressive muscle relaxation therapy on reducing anxiety, stress, and improving pregnancy outcome in primigravida women

Background Anxiety and stress during pregnancy are associated with adverse maternal and neonatal outcomes, including prolonged labour, preterm birth, and low birth weight. Early identification and appropriate management of these psychological factors benefit both the mother and the fetus. This study aimed to evaluate the effectiveness of a progressive muscle relaxation therapy (PMR) in reducing anxiety, stress, and improving pregnancy outcomes among primigravida women in a district of Sri Lanka. Methods A community-based quasi-experimental study was conducted across six Medical Officer of Health areas in the Badulla district, Sri Lanka. Primigravida women between 20 and 28 weeks of gestation, with uncomplicated singleton pregnancies without any pregnancy complications were screened using the Depression Anxiety Stress Scale-21 (DASS-21). Women with elevated anxiety and/or stress were selected through a multi-stage sampling from antenatal clinics and assigned to intervention and control groups based on public health midwife (PHM) clusters. The control group received routine antenatal care, while the intervention group received routine antenatal care plus structured Progressive Muscle Relaxation (PMR) therapy, performed twice daily at home over six weeks. Anxiety and stress levels were assessed at baseline and post-intervention using the DASS-21. Data were analyzed using independent and paired t-tests, and Pearson’s correlation coefficient. Results A total of 288 primigravida women were enrolled (144 per group). At baseline, there were no statistically significant differences in anxiety or stress levels between groups (p > 0.05). Post-intervention, the intervention group showed a significant reduction in both anxiety and stress (anxiety, stress p < 0.001), while the control group demonstrated a significant increase (p < 0.001). Adverse pregnancy outcomes were higher in the control group, including caesarean section/assisted vaginal delivery (Odds Ratio:2.44, 95% Confidence Interval: 1.34–4.46), preterm birth (2.35, 1.31–4.21), prolonged labour (4.93, 1.05–23.27), and neonatal complications (such as birth asphyxia, hypoglycemia, respiratory distress, jaundice, and admissions to the Premature Baby Unit (PBU)) (2.12, 1.03–4.35 ). Conclusions PMR therapy significantly reduced anxiety and stress and improved pregnancy outcomes in primigravida women. Its integration into routine antenatal care, particularly in low-resource settings, offers a cost-effective, non-pharmacological approach to enhancing maternal mental well-being and reducing obstetric and neonatal complications.