Determinan penolong persalinan di rumah di Kabupaten Banggai Kepulauan

SUMIATY, Prof. dr. Djaswadi D, SpOG(K)., MPH, Ph.D

2010 | Tesis | S2 IKM-Kesehatan Ibu dan Anak-Kesehatan Reproduksi

Latar Belakang: Upaya making pregnancy safer (MPS) belum dapat menekan tingginya persentase persalinan rumah di Indonesia (70%). Harapan mencapai target 80% tahun 2005, ternyata baru 50% persalinan ditolong oleh tenaga kesehatan. Profil kesehatan Kabupaten Banggai Kepulauan tahun 2007 menunjukkan bahwa proporsi persalinan di rumah masih tinggi (87,1%) dengan penolong non-nakes (49,8%). Tujuan Penelitian: Mengetahui faktor-faktor penentu yang kemungkinan menyebabkan ibu bersalin di Kabupaten Banggai Kepulauan memilih penolong persalinan di rumah. Metode: Jenis penelitian observasional, rancangan cross sectional study melalui pendekatan kuantitatif dan kualitatif. Pemilihan sampel secara non-probability sampling menggunakan metode consecutive sampling. Subjek penelitian adalah ibu bersalin yang melahirkan di rumah periode Maret 2009 sampai Mei 2009 di Kabupaten Banggai Kepulauan sebanyak 211. Dianalisis menggunakan chi-square, logistik regresi dan analisis kualitatif. Hasil: Analisis bivariabel menunjukkan bahwa pada faktor predisposing, ibu bersalin paritas > 1 (RP=1,54 CI= 1,29-1,85) dan ibu bersalin berpengetahuan rendah (RP=3,20 CI=2,35-4,37) lebih cenderung ditolong non-nakes. Pada faktor enabling, Ibu bersalin dengan status ekonomi keluarga yang kurang (RP=2,26 CI=1,84-2,72) lebih cenderung ditolong non-nakes. Pada faktor need, Ibu bersalin dengan pengambil keputusan utama suami atau keluarga (RP=2,27 CI=1,82-2,83) dan ibu bersalin dengan jumlah kunjungan ANC < 4 kali (RP=1,37 CI=1,14-1,64) lebih cenderung ditolong non-nakes. Pada analisis multivariabel, variabel yang bermakna terhadap penolong persalinan di rumah adalah pengetahuan ibu (RP=2,64 CI=1,46-4,78), status ekonomi keluarga (RP=1,72 CI=1,15- 2,57) dan pengambil keputusan (RP=1,73 CI=1,14-2,65). Alasan utama ditolong non-nakes karena kebiasaan. Kesimpulan: Paritas, pengetahuan, status ekonomi keluarga, pengambil keputusan dan jumlah kunjungan ANC merupakan faktor-faktor yang berhubungan dengan penolong persalinan di rumah. Faktor penentu menggunakan non-nakes sebagai penolong persalinan di rumah adalah rendahnya pengetahuan ibu tentang tanda bahaya kehamilan/persalinan.

Background: Efforts of making pregnancy safer (MPS) are still unable to minimize high percentage of home childbirth in Indonesia (70%). Projection to reach the target of 80% in 2005 only reached 50% of childbirth assisted by health staff. Health profile of Banggai Kepulauan District 2007 indicated that the proportion of home childbirth was still relatively high (87.1%) assisted by non health staff (49.8%). Objective: Identify determining factors that most probably caused mothers giving birth at home at District of Banggai Kepulauan. Method: The study was observational that used cross sectional design and qualitative and quantitative approach. Samples were taken with consecutive sampling method. Subject of the study were 211 mothers who gave birth at home from March to May 2009 at District of Banggai Kepulauan. Data analysis used chi square, logistic regression and qualitative analysis. Result: The result of bivariable analysis showed that predisposing factors of parity > 1 (RP=1.54 CI= 1.29 – 1.85) and poor knowledge pf mothers (RP=3.20 CI=2.35 – 4.37) tended to use non – health staff assistants; enabling factor of low economic status of mothers (RP=2.26 CI=1.84 – 2.72) tended to use non – health staff assistants; need factor of husband or family as major decision maker (RP=2.27 CI=1.82 – 2.83) and number of ANC visits < 4 times (RP=1.37 CI=1.14 – 1.64) tended to use non – health staff assistants. The result of multivariable analysis showed that variables significantly associated with home childbirth assistants were knowledge of mothers (RP=2.64 CI=1.46 – 4.78), economic status of the family (RP=1.72 CI=1.15 – 2.57) and decision makers (RP=1.73 CI=1.14 – 2.65). The major reason for having non health staff assistants was habit. Conclusion: Parity, knowledge, economic status of the family, decision maker, number of ANC visits were factors associated with home childbirth assistants. The determining factor for the use of non health staff as home childbirth assistants was poor knowledge of mothers about signs of high risk pregnancy/childbirth.

Kata Kunci : Persalinan,Penolong persalinan,Pregnancy safer,childbirth, childbirth assistants, making pregnancy safer