KONSELING MENURUNKAN KECEMASAN DAN TERCAPAINYA MEKANISME KOPING IBU BERSALIN PRIMIPARA Kajian terhadap Kadar Kortisol, Kontraksi Uterus dan Lama Bersalin

S.F. Budi Hastuti, SKp.,M.Kes., Prof. dr. Sri Kadarsih, MSc., Ph.D

2011 | Disertasi | S3 Kedokteran Umum

Latar belakang: Persalinan yang sebenarnya merupakan peristiwa fisiologis tetapi dapat menjadi patologis, menyebabkan perlunya perhatian terhadap persalinan. Berbagai perubahan yang terjadi selama persalinan jika menimbulkan ketakutan, kecemasan, kelelahan, dapat mengganggu kemajuan persalinan. Konseling diperlukan oleh ibu yang akan bersalin agar mampu mengatur diri dalam menghadapi perubahan-perubahan yang terjadi dalam dirinya. . Tujuan: Mempelajari efek pemberian konseling terhadap kecemasan, mekanisme koping, konsentrasi kortisol, kontraksi uterus, dan lama bersalin. Metode: Rancangan pre eksperimental yang digunakan dengan membandingkan kelompok (static-group comparison). Penelitian dilakukan antara November 2007 sampai Agustus 2009, dilaksanakan dengan populasi sebanyak primipara yang bersalin di Puskesmas Tegalrejo dan Mergangsan Kota Yogyakarta, sejumlah 538 orang. Subjek penelitian 218, terdiri dari 109 kelompok perlakuan dan 109 pembanding. Konseling individual dilakukan 40-60 menit pada setiap subjek perlakuan yang sudah dalam persalinan kala I fase laten, frekuensi kontraksi 2x/10 menit, dilatasi serviks 1-2 cm. Analisis statistik menggunakan t-test (Mann-Whitney U-test) untuk kadar kortisol, kontraksi uterus dan lama bersalin, Xo-test untuk kecemasan dan mekanisme koping. Hasil: Distribusi karakteristik subjek distribusinya hampir merata antara kelompok perlakuan dan pembanding. Persentase yang paling besar untuk usia 20-25 tahun (> 69%), suku Jawa (> 95%), pendidikan SLTA (> 69%), menikah (> 85%), usia kehamilan 36-40 minggu (> 80%). Hasil penelitian menunjukkan tidak ada perbedaan bermakna antara kelompok yang diberi konseling dengan yang tanpa konseling pada kadar kortisol (29,30 ± 11,23 vs 29,88 ± 11,48; p = 0,061), kontraksi uterus: waktu relaksasi (90,30 ± 61,30 vs 75,10 ± 39,10; p = 0,066), lama kontraksi (80,60 ± 29,60 vs 82,70 ± 26,00; p = 0,341), amplitudo (45,93 20,58 vs 46,23 ± 20,72; p = 0,887); lama bersalin: kala I (476,60 ± 326,40 vs 513.90 ± 329.66; p = 0.485), kala II (56.40 ± 57.20 vs 53.40 ± 62.50; p = 0,361), kala III (7,40 ± 7,40 vs 7,70 ± 9,80; p = 0,734), lama persalinan keseluruhan (540,40 ± 335,80 vs 572,30 ± 346,30; p = 0,611). Untuk tingkat kecemasan dan mekanisme koping ada beda bermakna masing-masing p = 0,000 Kesimpulan: Konseling menyebabkan mekanisme koping tercapai dan kecemasan minimal, sehingga ibu merasa aman dan nyaman selama persalinan.

Background: Childbirth is a natural physiological event that might be a pathological one so that it is essential to be assesed. Anxiety, hesitation, and exhaustion which possibly appear during childbirth process are able to harass the process. Therefore, counseling is needed by pregnant women to organize themselves to face up any changes in their bodies during the process. Objective: The objective of this research is assessing the effects of counseling for mothers through the concentration of cortisol level, uterus contraction, coping mechanism, anxiety, and birth duration. Method: Static-group comparison method was used as pre-experimental design. The research was conducted from November 2007 to August 2009 at Tegalrejo and Mergangsan Health Community Centre in Yogyakarta. 218 of 538 primiparous were chosen as research objects. The research objects was divided into 2 groups, e.g.: 109 primiparous as treatment group and the rest as comparison group. Individual counseling had been applied to treatment group for 40-60 minutes. The counseling was applied while the objects entered the first childbirth latent phase with twice contractions in every 10 minutes and 1-2cm of cervix dilatation. Cortisol level, uterus contraction, and childbirth duration data were analyzed by using t statistics test (Mann-Whitney Utest). Meanwhile, chi square test was performed for anxiety and coping mechanism. Result: The research result showed that the objects’ characteristics was equally distributed between treatment group and comparison group. The research objects were characterized based on age, ethnic, education, marriage status, and gestational age. The respondents’ characteristics were about 20-25 years old of age (>69%), Javanese ethnic (>95%), high school level of education (>69%), married (>85%), and in the gestational age between 36 and 40 weeks (>80%). The research result indicated that there was no significant different between treatment group and comparison group, in cortisol level (29.30 ± 11.23 vs 29.88 ± 11.48; p = 0.061), uterus contraction: the relaxation time (90.30 ± 61.30 vs 75.10 ± 39.10; p = 0.066), duration (80.60 ± 29.60 vs 82.70 ± 26.00; p = 0.341), amplitude (45.93 ± 20.58 vs 46.23 ± 20.72; p = 0.887); the duration of labour: stage I (476.60 ± 326.40 vs 513.90 ± 329.66; p = 0.485), stage II (56.40 ± 52.70 vs 53.40 ± 62.50; p = 0.361), stage III (7.40 ± 7.40 vs 7.70 ± 9.80; p = 0.734), overall birth duration (540.40 ± 335.80 vs 572.30 ± 346.30; p = 0.611). Anxiety and coping mechanism were significantly different between treatment group and comparison group with p-value = 0.000. Conclusion: Counseling affected coping mechanism and minimized the mothers’ anxieties, so that they felt comfortable and secure during labour. Key words: cortisol, coping mechanism, uterus contraction

Kata Kunci : kortisol, mekanisme koping, kontraksi uterus