A COMPREHENSIVE STUDY OF MIDWIFERY CARE (CONTINUITY OF CARE)

A COMPREHENSIVE STUDY OF MIDWIFERY CARE  (CONTINUITY OF CARE)

IN MANDIRI  MIDWIFE PRACTICES WITH  APN'S STANDARD-BASED

(NORMAL DELIVERY CARE) SAMARINDA

YEAR 2017

Siti Noorbaya¹⁾, Purwaningtyas Budi Utami²⁾, RR Nyndia Mayangsari³⁾

¹⁾ Mutiara Mahakam Midwifery Academy, Samarinda, Indonesia
E-mail:sitinoorbayanaz.y@gmail.com
²⁾ Mutiara Mahakam Midwifery Academy, Samarinda, Indonesia
E-mail:tiyas@akbidmm.ac.id

³⁾Mutiara Mahakam Midwifwery Academy, Samarinda, Indonesia
E-mail:nyndia@akbidmm.ac.id

Abstract: The number of MMR  is very high in the world. In 2016, more than 216 per 100,000 live births of women die every day due to complications of pregnancy and child birth, recorded 800 women die every day. Based on data from the Ministry of Health, the number of MMR in Indonesia in 2016 is 305 maternal deaths per 100,000 live births, while the IMR is 22.23 per 1,000 live births. MMR in East Kalimantan is still high as many as 137 people from the number of live birth as many as 69.372 people and as many as 7 babies IMR. This becomes an irony because to achieve the target of SDG, s up to 2030 is reducing MMR below 70 per 100,000 live births and by 2030 ending preventable infant and toddler deaths. For that role, midwife as health worker does continuity of care which has been standardized APN able to decrease MMR and IMR. This study aims to describe the implementation of comprehensive midwifery care in Standardized Midwife Practice APN Samarinda. The method used is descriptive qualitative with case study approach. The subjects of the study were trimester pregnant women III. The results of the study of comprehensive care (Continuity of Care) given starting from pregnancy, delivery, newborn, childbirth, neonate until the family planning of normal walking there is no data leading to emergency or pathological and there is no gap between theory and practice. From the results of the study it can be concluded that comprehensive care given to patients starting from pregnancy, delivery, newborn, childbirth, neonates until care KB get physiological results and can prevent emergency maternal and neonatal emergency

Keywords: Midwifery Care, Comprehensive, APN'S Standard-Based

BACKGROUND

Health and mortality problems are closely related to Maternal Mortality Rate (MMR) or more known maternal mortality. Maternal death is the death of a woman during pregnancy or for 42 days from termination of pregnancy regardless of duration and place of delivery, due to pregnancy or management.

The number of maternal mortality rates (MMR) is very high in the world, in 2016 more than 216 per 100,000 live births of women die every day due to complications of pregnancy and childbirth, recorded 800 women die every day.

Based on data from the Ministry of Health, the number of maternal mortality (MMR) in Indonesia in 2016 is 305 maternal deaths per 100,000 live births, while the IMR is 22.23 per 1,000 live births. MMR in East Kalimantan is still high as many as 137 people from the number of live birth as many as 69,372 people and Infant Mortality Rate (IMR) as many as 7 babies. Continuity of care (CoC) is a service achieved when a continuous relationship exists between the client and the midwife. Continuous care is related to the quality of service from time to time that requires a continuous relationship between clients with professional health workers, of course, with midwife who has been certified APN (Normal Birth Attendance). to achieve the target of SDG, s up to 2030 is reducing MMR below 70 per 100,000 live births and by 2030 ending preventable infant and toddler deaths. Therefore, the role of midwife as a health worker to do continuity of care and has standardized Normal Birth Attendance (APN) can decrease maternal mortality rate (MMR) and infant mortality (IMR). This study aims to describe the implementation of comprehensive midwifery care in Standardized Midwifery Practice of Normal Birth Attendance (APN) of Samarinda. Specifically to know the description of implementation of midwifery care of pregnancy, childbirth, newborn, childbirth, neonate until KB counseling using scientific mindset through step approach varney, The method used is descriptive qualitative with case study approach.

RESEARCH METHODS

The method used is descriptive qualitative with case study approach. The subjects of the study were trimester pregnant women III with or without risk factors, maternal mothers, newborns, postpartum, neonates and prospective KB acceptor. The data collection techniques to be used are primary data and secondary data. Primary data included interview, observation and physical examination and care while secondary data included digging data on mother cohort in practice, data from maternal and child health book (KIA), then the data used in this study transformed the results of research data into an information used to draw conclusions that are documented into the form of SOAP (Subjective, Objective, Assessment, Planning).

In conducting this comprehensive obstetric care, researchers use the format of assessment and checklist, observation and partographic sheets, leaflets and instruments used instruments (Antenatal Care), Partus kit, and tools for examination of newborns.

RESULTS

Based on the primary data collecting and secondary data of Comprehensive Compliance Practice in Standardized Midwife Practices (APN) of Samarinda Year 2017.

Table 1.1 Distribution of Implementation of Midwifery Pregnancy Care at Samarinda Independent Midwife Practice Year 2017

Antenatal Care	Frekuensi	Time
ANC visit to 1	1	09/03/17
ANC visit to 2	1	13/03/17

Based on table 1 above, the description of the implementation of pregnancy midwifery care as much as 2 x (times) ANC visit to 1 (09/03/17) and ANC visit to 1 (13/03/17). By documenting SOAP (Subjective, Objective, Assessment, and Planning).

Table 1.2 Distribution of Maternity Midwifery Implementation in Samarinda Independent Midwife Practice Year 2017

Intranatal Care	Frekuensi	Time
Kala 1 (13.10)	1	13/03/17
Kala 2 (15.20)	1	13/03/17
Kala 3 (15.37)	1	13/03/17
Kala 4 (15.50)	1	13/03/17

Based on table 2 above, the description of the implementation of midwifery care is 4x. The stage of labor is Kala 1 at (13.10 wita) at 2:15 pm and at 4:50 pm. By doing SOAP documentation (Subjective, Objective, Assessment, and Planning).

Table 1.3 Distribution of Implementation of Newborn Midwife Care Born in Samarinda Independent Midwife Practice Year 2017

Newborn Baby Care	Frekuensi	Time
BBL (0-12 Jam)	1	13/03/17

Based on table 3 above, got the description of the implementation of newborn midwifery care that there is 1x the upbringing at the time of newborn. By doing SOAP documentation (Subjective, Objective, Assessment, and Planning).

Table 1.4 Distribution of Childbirth Midwifery Implementation in Samarinda Independent Midwife Practice Year 2017

Postnatal Care	Frekuensi	Time
KF 1 (6 hr-3 hr)	1	14/03/17
KF 2 (4-28 hr)	1	18/03/17
KF 3 (29-42 hr)	1	20/03/17

Based on table 4 above, the description of the implementation of midwifery care is 3x (times) visit that is KF 1 at at 05.00 wita, KF 2 at at 15:35 wita, KF 3 at (15.00 wita). By doing SOAP documentation (Subjective, Objective, Assessment, and Planning)

.

Table 1.5 Distribution of Neonates Midwifery Implementation in Samarinda Independent Midwife Practice 2017.

Neonatus Care	Frekuensi	Time
KN 1 (6-42 hr)	1	14/03/17
KN 2 (3-7 hr)	1	18/03/17
KN 3 (8-28 hr)	1	27/03/17

Based on table 5 above, the description of Neonatus midwifery implementation is 3x (times) visit that is KN 1 at at 08.00 wita, KF 2 at at 15.10 wita, KF 3 at at 15.00 wita. By doing SOAP documentation (Subjective, Objective, Assessment, and Planning)

Table 1.6 Distribution of Implementation of Midwifery Care of Family Planning Counseling at Samarinda Independent Midwife Practice Year 2017

KB Care	Frekuensi	Time
Acceptor KB	1	27/03/17

Based on table 3 above, the description of the implementation of contraceptive midwifery care is that there is 1x of care on KB acceptor at (15.30 wita). By documenting SOAP (Subjective, Objective, Assessment and Planning)

Figure 1.1 Distribution of Comprehensive Midwifery Compliance in Independent Midwife Practice 2017

Based on Figure 1 above, a comprehensive implementation of comprehensive obstetric care includes pregnancy, delivery, newborn, childbirth, neonates and contraceptive care in Samarinda Mandiri Midwife Practice 2017 is done by CoC (Continuity Of Care) all the care get physiological results (100 %).

DISCUSSION

A.   Antenatal Care (ANC)

Clients have complaints in the third trimester, such as complaining frequent urine, the growing uterus presses the bladder because the head of the fetus begins to descend under the pelvis. The author explains that frequent urination is an inconvenience

in the third trimester. This is a physiological thing, the authors explain to the mother that to avoid getting up at night, limit drinking before bed.Saat cough, laugh, and sneeze, sometimes out a little urine. To avoid this, do pelvic exercises regularly , avoid constipation and often empty the bladder. The client's perceived complaints during the third trimester correspond to the inconvenience that will be felt during the third trimester so that the complaint can still be overcome.

B.   Intranatal Care (INC)

In the intranatal care occurs mucus and blood discharge due to upgrading and opening, the opening causes mucous membranes contained in the cervical canal disengaged, blood discharge occurs due to blood vessel capillaries rupture.Terjadi discharge of fluid due to rupture of membranes.This theory in accordance with clients where clients experience mules and felt tight, out mucus mixed with blood examined 4 cm opening.

The period of time I in primigravida lasts 12 hours and in multi gravida lasts about ± 8 hours. This is in accordance with the client where the client is multigravida, the first stage lasts ± 4 hours, ie at 13.30 WITA check the opening 4 cm and at 15.25 WITA opening 10 cm in this case the patient under normal circumstances. Kala II is a period of infant expenditure lasting ± 2 hours in primigravida and ± 1 hour in multigravida. This is in accordance with the client's situation at 15:25 WITA opening of 10 cm, amniotic (-), portio not palpable, decreased hodge IV head, there is a feeling of want BAB and his stronger and regular is 4 times 10 minutes with a duration of 40-50 seconds. At 15:35 WITA the baby was born spontaneously with female gender A / S: 7/9. Kala III is the time for placental release and removal after the second stage which lasts no more than 30 minutes. The authors performed active management of stage III which consisted of the primary step of injection of oxytocin in the first minute of the newborn, stretching the controlled cord and fundus uteri massase. Kala III client takes place well and normal without any complications. The period of the third time lasts about 15 minutes. This is consistent with the theory that the third stage lasts no more than 30 minutes Kala IV begins from the birth of the placenta until the first 2 hours post partum. The client's 4th stage of monitoring is still within normal limits and there is no gap between theory and practice

C.   Newborn Baby Care

Normal newborns are birth weight between 2500-4000 gram, enough month, born directly cry and no congenital abnormalities (congenital defects) are heavy. This corresponds to a baby born with a weight of 3800 grams. At 15.35 WITA the baby was born spontaneously with female gender with APGAR score ie A / S: 7/9. And the baby's handling is given Vit K injection, and given eye ointment.

D.   Postnatal Care (PNC)

The postpartum period begins after the birth of the placenta and ends when the uterus returns to its pre-pregnancy state. The puerperium lasts for about 6 weeks. First postpartum visit at 6 hours to 3 days after delivery, second visit within 4th day up to 28th day after delivery, and 3rd visit within 29th day up to day 42 after delivery. Examination given are blood pressure, pulse, respiration, temperature, TFU examination (uterine infusion), lochea examination and other vaginal discharge, breast examination and exclusive breastfeeding advice 6 months, 200 000 IU Vitamin A capsule twice giving birth, the second is given after 24 hours of first vitamin A capsule. And birth control services.

E.   Neonatus Care

At neonatal visit I that is 12 hours after birth of the authors do the monitoring, the general state of neonate is good, pulse, breathing and body temperature of the neonate in normal limits.Good baby center, no signs of cord infection.Neonatus consume breast milk and neonates have BAK ± 4 times clear yellow, CHAPTER 1 times blackish color. At the 2nd visit 5 days after delivery, the authors perform the examination on the neonate, the result of good general condition, pulse, respiration and neonate body temperature within normal limits, good elimination, and nutrition are met. The baby's cord is loose and the baby is in good health. And on the third visit 26 days after birth the situation is still within normal limits, From the 1st visit until neonatal visit II was in good condition and the results of the examination on minor fontanelle and neonatal major fontanel were still open. This is in accordance with the theory that the minor fontanel closed at the age of 8 weeks. And major fontanel closed at the age of 18 months (1.5 years).

F.      Acceptor KB Care

Contraception comes from the word counter which means to prevent or fight, whereas conception is the meeting between mature eggs and sperm cells that result in pregnancy. The purpose of contraception is to avoid / prevent pregnancy as a result of a meeting between mature eggs and sperm cells. The client's current age is 29 years. Researchers conduct counseling about preparation in using contraceptives that will be used after the end of the puerperium. After counseling about various contraceptives, the client decided to use a 3-month injection method. Clients use this 3-month injection method because before this pregnancy the client has been using 3-month injection kb and feel fit with this method. Decisions that have been taken by the client and husband in accordance with the wishes of the client. Researchers argue that long-term contraceptive methods are better used by clients because of the age of clients who are 29 years old and already have 2 children. But the client is not interested in contraception other than 3 months injection.

CONCLUSION

The implementation of Comprehensive Midwifery Care in Standardized Midwife Practice of APN (Normal Birth Sail) of Samarinda Year 2017, runs with physiology covering pregnancy care, maternity, newborn, childbirth, neonate, until contraception service, can be drawn conclusion that the importance of care provided by the midwife to the mother during pregnancy to contraceptive services after delivery as early detection of possible complications can be avoided or overcome

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