Faktor-faktor yang berpengaruh terhadap pelaksanaan manajemen aktif kala III oleh bidan dalam pertolongan persalinan di Kabupaten Klaten

SUMANTRI, Prof.dr. Djaswadi Dasuki, MPH.,SpOG.,PhD

2004 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Perdarahan postpartum sampai saat ini masih merupakan penyebab utama kematian ibu di negara berkembang yang belum terpecahkan. Sampai saat ini kematian ibu di Indonesia merupakan kematian tertinggi di Asia Tenggara. Salah satu upaya untuk mencegah perdarahan postpartum dengan menerapkan manajemen aktif kala III dalam pertolongan persalinan oleh bidan. Disamping itu faktor pengetahuan, sikap dan perilaku bidan di desa mempunyai kontribusi yang bermakna terhadap pencegahan perdarahan postpartum. Tujuan: Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berpengaruh terhadap pelaksanaan manajemen aktif kala III oleh bidan dalam pertolongan persalinan. Metode Penelitian: Penelitian ini merupakan jenis penelitian survey dengan rancangan penelitian cross sectional secara kuantitatif. Populasi dalam penelitian ini adalah semua bidan di 10 Kecamatan di wilayah Kabupaten Klaten, Propinsi Jawa Tengah. Teknik pengambilan sampel secara total sampling, dengan jumlah sampel 90 orang bidan di desa. Pengukuran pendidikan, pengetahuan dan sikap bidan didapatkan dengan daftar pertanyaan atau angket. Sedangkan pengukuran perilaku bidan dalam melaksanakan manajemen aktif kala III diungkap secara observasi dengan menggunakan pedoman observasi. Pengolahan datanya menggunakan komputer, dengan dianalisis secara univariat, bivariat, stratifikasi dan multivariate. Hasil : Hasil penelitian membuktikan bahwa pendidikan mempunyai hubungan yang signifikan (p=0,000) dengan pelaksanaan manajemen aktif kala III (RR=1,949; IK 95%: 1,015-3,742), pelatihan menunjukkan hubungan yang signifikan (p=0,008) terhadap pelaksanaan manajemen aktif kala III (RR=1,467; IK 95%: 0,962-2,236) dan tempat pertolongan persalinan menunjukkan hubungan bermakna (p=0,000) serta mempengaruhi pelaksanaan manajemen aktif kala III oleh bidan (RR=1,584; IK 95%: 1,122-2,237). Kesimpulan: Faktor pendidikan bidan mempengaruhi pelaksanaan manajemen aktif kala III. Semakin tinggi tingkat pendidikan, semakin baik pengetahuan dan sikap bidan, maka pelaksanaan manajemen aktif kala III dalam pertolongan persalinan akan semakin baik dan benar. Tempat pertolongan persalinan diduga mempengaruhi pelaksanaan manajemen aktif kala III oleh bidan dalam pertolongan persalinan. Dari hasil penelitian ini disarankan agar pendidikan bidan ditingkatkan baik secara formal maupun informal.

Background: Postpartum bleeding until this time still considered as the main cause of maternal mortality in developing country that is not yet being solved. Until this time, maternal mortality in Indonesia is the highest mortality in South East Asia region. One of the efforts in preventing the postpartum bleeding is by implementing 3rd Stage active management in delivery assistance by midwife. Besides that, factor of knowledge, attitude and behavior of midwife in the village has a significant contribution toward the prevention of postpartum bleeding. Objective: This research was aimed to find out factors that influence the implementation of 3rd Stage active management by midwife in delivery assistance. Method: This was a survey research with quantitative cross sectional research design. The population in the research was all midwives in 10 sub districts in the area of Klaten district, the province of Central Java. The sample was taken with total sampling, with the sample of 90 midwives in the village. The measurement of education, knowledge and attitude of midwifes was obtained from the question list or questioner. The measurement of midwife behavior in the implementation of 3rd Stage active management was explored by observation that used observation guidance. Data processing used computer and analyzed with univariat, bivariat, stratification and multivariate. Result: The result of this research showed that education had a significant relationship (p=0,000) toward the implementation of 3rd stage active management by midwife (RR=1,949; 95% CI: 1,015-3,742)., trainned normal delivery showed a significant relationship (p=0,008) as well as influenced the implementation of 3rd stage active management by midwife (RR=1,467; 95% CI: 0,962 – 2,236) and birth place assistance showed a significant relationship (p=0,000) as well as influenced the implementation of 3rd stage active management by midwife (RR=1,584; 95% CI: 1,122 – 2,237). Conclusion: Factor of midwife’s education influenced the implementation of 3rd stage active management. The better education of the midwife, the more appropriate the implementation of 3rd stage active management in delivery assistance. Based on the result of the result, it is suggested that to increase the education toward midwivery was appropriate formal or informal education.

Kata Kunci : Kesehatan Ibu,Persalinan,Pertolongan Bidan, 3rd Stage active management, factors, implementation, midwife