experiment Post test
Mother Ruptur Perineum
X O2
in Tidak
I II
III Jumlah
lab or
n n
n n
n
Results 1. Rupture of perineum on Primipara
Primipa ra
1 6,67
2 13,33 9 60,
3 20,0 1
50,0
Maternal with Semi Fowler Position
1
in Puskesmas Ngadiluwih Kediri.
Rupture of the perineum on primiparous maternal using semi
Multipa ra
7 46,67
4 26,67 3 20,
1 6
,
1 5
50,00 5
fowler position can be seen in the table below:
Table 1.2 Rupture of the perineum Multipara Maternal with
6 6
Ruptur Perineum
1. Unrupture 2. Grade I
3. Grade II
n
7 4
3
Persentase
46,67 26,67
20,00
Semi Fowler Position
Table 1.2 shows that the majority of multiparous
maternal not
experienced spontaneous perineum rupture as many as seven people.
3. The Effectiveness Semi Fowler Position to Spontaneous
4. Grade III 1
6,66
Rupture Perineum On Primiparity and Multipara
Total 15
Maternal
100,00
Table 1.1 Perineum Rupture on primiparity Maternal with Semi
Fowler Position
Table 1.3 The Effectiveness Semi Fowler Position To Spontaneous
perineum rupture On Primiparity and Multipara
Maternal
Table 4.1 Explained about the results of the degree of rupture of the
perineum primipara maternal who birth to semi fowler position that is largely
primipara maternal with semi fowler position perineum ruptured grade II as
many as 9 people.
2. Rupture of the perineum Multipara Maternal with Semi
Ruptur Perineum
1. Unrupture 2. Grade I
3. Grade II 4. Grade III
Total
n
1 2
9 3
15
Persentase
6,67 13,33
60,00 20,00
100,00
fowler Position in Puskesmas Ngadiluwih Kediri.
Rupture of the perineum on multipara maternal using semi fowler
position can be seen in the table below:
797 Based on table 1.3, perineum rupture
on primiparous and multiparous maternal using semi fowler position
that was on primipara maternity who
experienced spontaneous
perineum experienced by the mother feels heavier
rupture grade II were 9 people. While and increasingly lose concentration
on maternity multiparous largely
when meneran so there rupture perineum ruptured as many as seven
perineum. If the uncomfortable feelings people.
Then to determine the
such as stress can be removed then the effectiveness semi fowler position on
the degree of spontaneous perineal rupture in primiparous and multiparous
maternal used Mann Whitney U-Test
with α: 0.05 Obtained results U test smallest value = 47.5. This value is
then compared with U tabel for n1 = 15 and n2 = 15 obtained U tabel value
= 56. Because Utabel Utest then H0 is rejected and H1 accepted, meaning
that there are different degrees of spontaneous rupture of the perineum
delivery process can be perceived as a process that is happy and proud that the
concentration of mother to meneran increased. This can lead to increased
concentration of the birthing process becomes more secure, comfortable and
smooth so as to minimize the perineal tears Desinta, 2008.
Based on research conducted by Roslena 2013 that there is a
relationship between the position of parturition with spontaneous perineal
between semi fowler position on
rupture in normal childbirth at Mother primiparous and multiparous maternal.
Discussion 1. Rupture of the perineum primiparous
Maternal with Semi Fowler Position
Table 1.2 explained that the results of the degree of perineum rupture on
maternal with semi fowler position on primipara maternal is mostly primipara
maternal with semi fowler position ruptured perineum grade II as many as 9
respondents. According to Liu 2008 85 of first births always accompanied
perineal tears. Perineal tears relationship with parity is due to soft tissue damage.
Damage to the birth canal is usually more pronounced in women because the
network on primipara denser and more resistant than multiparous women. On
delivery will take place emphasis on soft birth canal by the head of the fetus. With
intact perineum in primi will easily occur perineal tears, because the
perineum in some women less able to withstand the strain during childbirth
Bobak, 2005. To avoid severe rupture in particular by leading the delivery
and Child Hospital in Banda Aceh. Research data in table 4.2 in accordance
with the results of Fika and Farida 2008 about the level of parity
relationship with the occurrence of spontaneous perineal rupture in
Puskesmas Mergangsan is very low. So that the results obtained are of 186
primiparous birth mothers who experienced a rupture which is the
highest degree perineal ruptures II as much as 66.67, ruptured perineum
level I as much as 18.82, third degree perineal rupture is 1.61 and there is a
fourth-degree perineal rupture ie as much as 0.53, so as much as 87.63
of maternal primiparous experienced spontaneous rupture perineum.
The research results are compared with theory and previous research found
that the equation of 85 maternal primiparous experienced spontaneous
rupture perineum, and most of the largest spontaneous rupture perineum II
grade. The high incidence of rupture of the perineum in primiparous due to
unpreparedness mother in the face of
properly, preferably
semi fowler labor due to lack of information from the
position or lying on his
side midwife and the preparation in the face
Winkjosastro,2005. In terms of psychological,
primiparous birth mothers tend to feel anxious, afraid, worried in the face of
the delivery process. Uncomfortable feelings such as stress can make the pain
798 of labor. Various things can be done to
prevent rupture of the perineum that is done from the moment the pregnancy
process by teaching and motivating mothers to pregnancy exercise and
massage the perineum so that mothers
feel more relaxed and perineal muscles to be flexible during the delivery process
takes place, so that communication on maternal more easy because it has been
trained. Moreover, the competence of midwives in attending births less in
accordance with the standards of a normal delivery care APN that is set so
that the midwife must improve their competence in attending births with a lot
of practice and learn from what is obtained from friends midwife who has
done childbirth assistance in accordance with the standard APN. Midwife should
respond when an episiotomy is done on maternal multiparous so as not to rupture
perineum III grade, so that the capital cost of labor becomes more efficient. In
observations conducted by researchers that when there is rupture of the
perineum to grade III midwife who perform perineal suturing whereas in
theory mentioned midwife does not have the authority to suturing grade III.
Supposedly the event of rupture of the perineum to grade III should be referred
to the hospital and treated by a physician.
than primiparous multiparous so that the incidence of perineal tears is more
common in primipara. It is supported by the results of
research Fika and Farida 2008 about the level of parity relationship with the
occurrence of spontaneous perineal rupture in Mergangsan health centers
showed that of the 395 respondents mostly multiparous maternal not
ruptured perineum as many as 82.07 119 people, and there is a third degree
perineal rupture as much as 25 1. Another study of Lisa 2008 the support
that number of maternal multiparous many as 161 people are 91 people who
suffered a ruptured perineum 56.5 were most also experienced a rupture
grade I-II as many as 70 people 43.5 and who do not have rupture of 70
people43.5.
There are similarities between the studies that have been done with the
theory and previous studies showed that the majority of maternal multiparous not
ruptured perineum due to maternal multiparous own experience of giving
birth so that the state of the pelvic floor
2. Rupture of the
Perineum muscles in multiparas more elastic than
Multipara Maternal with semi Fowler primiparous. Maternal
Multiparous
Position
Based on the results of research conducted on 15 respondents who use
the multiparous maternal with semi fowler position showed that the majority
of maternal multiparous not ruptured perineum 46.67 7, and only 6.66
1 who have rupture of perineum grade III. It can be concluded that the amount
of maternity multiparous ruptured perineum using semi fowler position is
quite high, as much as 53.33.
According Bobak 2005 perineal rupture occurs in less than multiparous
primiparous. Parity can affect spontaneous perineal rupture due to the
network structure of the perineal area on majority being a housewife to do daily
activities such as mopping the floor with a squat position, and taking care of their
children so that the state of the perineum is more elastic. But on maternal
multiparous there is still a ruptured perineum grade III due to the possibility
of other factors, namely: the state of the perineum, fetal weight, distance delivery
with the last pregnancy, and sometimes uncooperative patient during childbirth
because the leadership feel the pain of contractions. So not only on maternal
primiparous but also on maternal multiparous by way of a midwife and
information given on the preparation in the face of labor semi fowler Position.
different multiparas elasticity. Rupture
3. Effectiveness Against
of the perineum always happen and often repeated in the next delivery
Sarwono, 2005. According Yuliatun 2009 Another cause is the state of the
pelvic floor muscles are more elastic
799
Spontaneous Perineum Rupture On Primiparity and Multipara Maternal
Based on the table above 4.3 on a ruptured perineum on primiparous and
multiparous maternal using semi fowler position is on maternity primipara who
experienced spontaneous rupture perineum as much as 93.33. Most
ruptured perineum grade II by 60 9, and maternity primiparous who ruptured
perineum grade III that is as much as birth canal and the surrounding muscles
Simkin, 2008. Kegel exercises are performed during pregnancy has the
advantage that it can make the elasticity of the perineum Nursalam, 2010.
According to research by Tuty Octaviany 2010 that the weakness of
20 3. While on maternal multiparous semi fowler
position in strain is this who experienced spontaneous perineum
rupture as much as 53.33. Most did not rupture perineum as many as 46.67
7, and there are mothers who have perineum rupture grade III by 20 3.
From the results of research and data analysis by Wilcoxon Mann Whitney U-
test with α: 0.05 Utest obtained value 47.5 is smaller Utabel 56, thus H0 is
rejected, which means that there are differences in the degree of spontaneous
perineal rupture in maternal primiparous and multiparous.
According Bobak 2005 incidence greater degree apparent rupture occurred
in primiparous because it has not been passed by the baby, still intact perineum,
vulva closed, pervoratus hymen, vagina narrow with ruggae so that the muscles
of the perineum has not stretch. Factors that affect risk rupture of perineum
spontaneous namely parity effect on the position lead to fatigue and stiffness in
the back, especially when prolonged labor process. The results of the analysis
of statistical tests performed by Heny, et al 2008 showed no difference in the
degree of rupture of perineum at delivery who use semi fowler position
or another position. Based on research conducted Suwarni Lis 2004 showed in
primiparous likely to rupture perineum almost doubling of incidence in this
study multipara. The result according to research conducted Purwati, et al 2011
about the relationship of maternal age, parity, and head circumference the
incidence of rupture of the perineum in hospitals Banjarnegara which suggests
that there is a significant relationship between parity with rupture of the
perineum.The results of this study are also consistent with studies conducted
by Dian Lestari in May 2004 on the
elasticity of the perineum so that the scientific work entitled Factors
- more the number of parity increasingly
elastic as well perineum her, the size of the fetus infant, relief management of
delivery includes an error in holding the perineum, the way strain maternal and
labor positions are wrong, and the last Factors That Cause Rupture of perineum
at Normal Delivery. At found as many as 78 of ruptured perineum while in
multiparous who have never given birth more than once found a 52 rupture of
the perineum.
factor is malpresentation and
There are similarities between malposition of the fetus that is the
location of latitude or breech Handerson, 2006. Another cause is the
state of the pelvic floor muscles are more elastic than primiparous
multiparous so that the incidence of perineal tears are more prevalent in
primigravida. At the time of delivery speed led the birth of the babys head
should be controlled because of the birth of the head that can cause sudden severe
laceration to the anal sphincter Yuliatun 2009. The birth canal to be flexible in
women who exercise. Outdoor sports is recommended because it can flex the
800 research, theory, and past research on
the degree of spontaneous perineal rupture in maternal primiparous and
multiparous is on maternity primiparous perineum rupture incidence greater than
in maternal multiparous. From these results parity has an important role in the
incidence of ruptured perineum, but not only parity of other factors also affect
the rupture of the perineum as a large baby, how to wrong strain , delivery is
fast, cooperation between mother and helper were not good, and competence
owned midwife in making aid delivery in accordance with the standard APN.
In Pregnancy Pregnancy Trimester III Against the perineum tear Mrs.
Kala
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802
REPRODUCTIVE HEALTH COUNSELING THERAPHY TOWARDS SEXUAL ATTITUDES OF ADOLESCENT AT PGRI TALUN HIGHSCHOOL BLITAR
Levi Tina Sari Program Studi D3 Kebidanan STIKes Patria Husada Blitar
viemuaniezyahoo.com Abstract
The nature of teenagers who always want to find out new things, especially about sex will lead to a negative attitude if not accompanied by a good knowledge and from the right
source, maturity for adolescents is psycho social even more severe, if the attitude toward casual sex less it will open opportunities for premarital sex or sex also called free free
sex, abortion, sexually transmitted diseases purpose of this study was to determine the influence of reproductive health counseling on adolescent sexual attitudes. The study
design used was quasi experiment, the pretest and posttest design with non-equivalent group. The total sample of 58 respondents were given treatment KRR counseling.
Univariate analysis with frequency distribution and bivariate to know the differences with the Mann-Whitney test. The results showed that before treatment is given as much as
55.2 do not have an attitude of support, but after being given treatment proved that 53.4 had a supportive attitude. Mann-Whitney test result adolescent reproductive health
counseling effect on the attitude of a teenager with a p-value of 0.0005. Adolescent reproductive health counseling influence the change in attitude conducive to not have sex
outside of marriage. Therefore, it is expected that the school always gives guidance and counseling KRR routinely in high school.
Keywords: reproductive health counseling, sexual attitudes, adolescent
INTRODUCTION 2010,
the number of Indonesian
Reproductive health received special attention globally since he raised the
issue at the International Conference on Population and Reproductive health
received special attention globally since he raised the issue at the International
teenagers aged 10-24 years about 67 million or 29 of the total population
BPS, 2013. The number of teenagers that nearly a third of the population of
Indonesia is capital to create the next generation of quality that is needed to
Conference on Population and
build a nation Development at Cairo UEA since 1994.
Currently, reproductive health Indonesia
agreed definition of
remains a public health problem in reproductive health since 1996 which is
a state of complete physical, mental and Indonesia is quite large scale. It can be
seen from the data and facts on some social as a whole, not merely free of
components of reproductive health,
disease or infirmity in all matters relating to the reproductive system and
its functions and processes BKKBN,2005.
According to the World Health Organization WHO is a teenage male
or female population aged 10-19 years BKKBN, 2005; UNHCR, 2012. The
current composition of the juvenile population in the world reached around
which is a matter of reproductive health in adolescents. Adolescent reproductive
health problems in addition to the physical impact, can also affect the
mental and emotional state of the economy and social welfare in the long
term. The long-term impact not only affect the teens themselves, but also on
families, communities and nations in the future.
1.3 billion UNFPA, 2009. Based on Adolecents,
there are
the results of the population census of accelerated
adult positively
and 802
