PERILAKU PENCARIAN PELAYANAN PERSALINAN IBU HAMIL RISIKO TINGGI DI PUSKESMAS WARUROYOM KABUPATEN CIREBON PROVINSI JAWA BARAT

AMDAD, dr. Detty Siti Nurdiati, Sp.OG(K), MPH, PhD; Dr. Atik Triratnawati, MA

2015 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Setiap hari di seluruh dunia terjadi sekitar 800 kematian ibu akibat komplikasi kehamilan dan persalinan. Sebagian besar kematian terjadi di negaranegara berkembang. Angka kematian ibu (AKI) di Indonesia masih tinggi yaitu 359/100.000 kelahiran hidup. Kematian ibu di Jawa Barat tertinggi di Indonesia yaitu 781. Kematian ibu di Kabupaten Cirebon tertinggi ke-3 di Jawa Barat yaitu 56 kasus. Berbagai usaha telah dilakukan untuk menurunkan AKI, diantaranya pembentukan puskesmas dengan pelayanan obstetri neonatal emergensi dasar (PONED) di seluruh Indonesia, salah satunya Puskesmas Waruroyom, Cirebon. Namun, dalam 2 tahun terakhir khususnya di Puskesmas Waruroyom, masih terjadi kematian ibu. Penelitian kualitatif perlu dilakukan untuk memahami pencarian pelayanan persalinan ibu hamil risiko tinggi di Puskesmas Waruroyom. Tujuan : Memahami perilaku pencarian pelayanan persalinan ibu hamil risiko tinggi di Puskesmas Waruroyom Kabupaten Cirebon. Metode: Metode yang digunakan dalam penelitian ini adalah kualitatif dengan pendekatan studi kasus. Subjek penelitian adalah ibu hamil dan ibu bersalin dengan kehamilan risiko tinggi, orangtua, suami dan bidan puskesmas. Informan dipilih dengan purposive sampling, pengumpulan data menggunakan triangulasi, yaitu observasi, wawancara mendalam dan diskusi kelompok terfokus (DKT). Hasil Penelitian: Ibu hamil di Puskesmas Waruroyom tidak mengetahui bahwa kehamilannya adalah kehamilan risiko tinggi. Pencarian pelayanan persalinan ibu hamil dimulai dari pelayanan bidan, puskesmas dan rumah sakit. Ibu hamil memiliki sikap negatif terhadap persalinan di fasilitas kesehatan. Norma subjektif yang ada lebih mendorong ibu hamil untuk tidak menggunakan fasilitas kesehatan. Kontrol perilaku yang dimiliki belum mampu menumbuhkan intensi untuk memanfaatkan fasilitas kesehatan. Kebutuhan terhadap pelayanan persalinan dari fasilitas kesehatan belum dirasakan oleh ibu hamil. Kesimpulan: Pelayanan bidan adalah pelayanan utama yang dicari ibu hamil saat merasakan tanda-tanda persalinan. Sikap, norma subjektif dan kotrol perilaku tidak memunculkan intensi ibu hamil untuk menggunakan fasilitas kesehatan. Pelayanan persalinan di fasilitas kesehatan belum dirasakan sebagai suatu kebutuhan oleh ibu hamil.

Background: Every day about 800 maternal deaths occurred all over the world due to complications of pregnancy and childbirth. Most of the deaths occur in developing countries. Maternal mortality rate (MMR) in Indonesia is still high at 359/100.000 live births. Maternal mortality in West Java is the highest in Indonesia is around 781. Maternal mortality in Cirebon is the 3rd highest in West Java, namely 56. Various attempts have been made to reduce MMR. One of them is the establishment of public health center (PHC) with neonatal basic emergency obstetric care (PONED) throughout Indonesia, including PHC in Cirebon. However, in the last two years, especially in PHC Waruroyom, maternal deaths still occur. Qualitative research is needed to understand the delivery service seeking behavior of high risk pregnant high risk pregnant women at health centers Waruroyom. Objective: Understand the deliveries service seeking behavior of high risk pregnant women in PHC Waruroyom, Cirebon. Methods: The method used in this study was a qualitative case study approach. The subjects were pregnant women and maternal with high-risk pregnancies, parents, husbands and midwives. Informants selected with purposive sampling, data collection using a triangulation method that were observation, in-depth interviews and focus group discussions (FGD). Results: Pregnant women in PHC Waruroyom did not know that their pregnancy were high-risk. Pregnant women started looking for delivery service begins from midwives, health centers and hospitals. Pregnant women have a negative attitude to give birth in a health facility. Subjective norm is more encouraging pregnant women not to use health facilities. Perceived behavioral control that are owned not been able to grow the intention to utilize health facilities. The need for delivery service from health facilities has not been felt by pregnant women. Conclusion: Midwife services are the main services sought when the pregnant mother began to feel the signs of labor. Attitude, subjective norm and perceived behavioral control are not able to bring up intention pregnant women to use health facilities. Service delivery in health facilities has not been perceived as a need by pregnant women.

Kata Kunci : pencarian, pelayanan persalinan, ibu hamil risiko tinggi, budaya/ search, service delivery, high risk pregnant women, culture