Tugas Ebm
Tugas Ebm
Tugas Ebm
ABSTRACT
Objective: To compare the early recovery after surgery (ERAS) pprotocol with the conventional one in women undergoing
elective CS.
Patients and Methods: The study included 96 women undergoing elective cesarean section for different reasons. They
were randomly divided into two groups 48 patients each, Group (A) received the ERAS regimen and Group (B) was
managed with the conventional care. Women with major medical or obstetric disorders were excluded.
Results: Cases' age ranged between 18- 35 years without significant difference between groups. Also, gestational age,
haemoglobin concentration and platelet count were comparable between groups. Intra and post-operative nausea and
vomiting were significantly higher (p value <0.0366) in the control group (8 vs 17). Group A had significantly shorter
interval to oral intake, ambulation, first intestinal sound and first motion. Moreover, the need to use opiate for pain control
with overall pain scores were significantly lower in study group with significantly better satisfaction rates and shorter
hospital stay.
Conclusion: ERAS protocol for women planned for elective CS is effective in controlling perioperative gastrointestinal
symptoms, pain control and encourages early ambulation with offering earlier resumption of intestinal motility, higher
satisfaction and fewer days of admission.
Key Words: Caesarean section (CS), early recovery after surgery (ERAS)
Received: 26th April 2019, Accepted: 14th June 2019
Corresponding Author: Sara Taha Mostafa, Department of Obstetrics & Gynecology, Benha University Hospitals, Elsaha
Street of Fareed Nada Street, Benha, Qalubeya, Egypt, Tel.: 00201226401231, E-mail: drsarataha75@yahoo.com
ISSN: 2090-7625, November 2019, Vol.9, No. 4
Personal non-commercial use only. EBX copyright © 2019. All rights reserved DOI: 10.21608/ebwhj.2019.64363
591
ENHANCED RECOVERY AFTER CS
Multiple obstetric institutions in UK either offered or the dating of the patient and ascertain the gestational age of
preparing to start their designed ER programs as a target the fetus and to exclude any abnormalities.
for reduction of hospital stay length for omen supposed to
go for planned CS. After fulfillment of the above criteria and prerequisites
each eligible patient was included in the study either as
AIM OF THE WORK subject in the study group or control group randomly
and after admission to the hospital full pre-operative
The aim of this work is to assess the enhanced recovery investigations and blood pressure measurement is done.
protocols versus the standard care in elective cesarean
section and to introduce enhanced recovery protocols to Day Before Surgery:
Benha University Hospitals to decrease the hospital stay
and opioid use. The used protocol was applied on the study group and
included; short fasting period (no solid food after midnight
PATIENTS AND METHODS or six hours preoperatively), good hydration during the
fasting period (drinking two glasses of water before going
This case control study was conducted after being to bed and two glasses of water before moving to the
approved from the local ethical committee. All patients hospital) and optional carbohydrate loading (for example
enrolled were from those attending Benha University apple juice). On the other hand, the control group went
Hospitals for elective caesarean sections in the period through complete fasting for 6 hours for solids and fluids of
between September 2018 and August 2019. The number operation time and no carbohydrate loading preoperatively.
of patients included in the study was 96 patients presented
for elective cesarean section who were classified into 2 Day of Surgery: Preoperative:
groups; the study group included 48 patients who were
exposed to the means of enhanced recovery protocols and The study group received acetaminophen 1gram orally
the control group included 48 patients who were treated two hours before surgery, thromboprophylaxis in patients
with the standard care known in the literature. with high risk of DVT and a warming blanket 30 minutes
before operation or even wrap the patient in blanket for
Inclusion criteria of pregnant women who attend keeping her warm if active warming blanket is not present,
the assigned hospital for elective caesarean sections while the control group did not receive pain prophylaxis
and had the following criteria ; primigravida or or warming.
multiparous women, age between 18 and 35 years old,
Intra-operative:
body mass index (BMI) less than 30, medically free,
single intra uterine viable pregnancy and gestational age Steps of cesarean section are the same for both groups
between 34w+0d and 42w+0d. and will be performed as following:
Exclusion criteria were age less than 18 or • After anesthesia, the vagina is washed with iodine
above 35, any maternal medical disease as (diabetes and urinary catheterization of the patient was done under
mellitus, hypertension, cardiac diseases, thyroid complete aseptic conditions as well as TED stocking
diseases……etc) either chronic or pregnancy complicated, application.
multiple gestations, any evidence of active maternal • Antibiotics administration (Cefazolin 2 gm) prior to
or fetal infections, non-sound postoperative history of skin incision by 1560- min.
previous section as post-partum hemorrhage (PPH), • Skin preparation using chlorhexidine-alcohol
history of pulmonary embolism or DVT, history of wound preparation.
sepsis, history of rupture uterus, ectopic pregnancy or • Joel Cohen or Pfannenstiel skin incision.
myomectomy and complicated pregnancy as placenta • Sharp extension of the incision through the
previa or placenta accreta. subcutaneous tissues and the rectus sheath is done as in
classical techniques or blunt as in Joel Cohen technique.
All patients will be subjected to thorough clinical • The loose uterovesical peritoneum was identified to
evaluation with emphasis on full medical and surgical create a bladder flap.
history will be taken from the patient with special emphasis • Uterine entry is done by sharp dissection of the
on the obstetric, gynecological and the menstrual history, lower uterine segment by an incision 23-cm then it is
general clinical examination, laboratory investigations ; either extended by blunt dissection laterally or sharply by
complete blood count (CBC), liver function tests (LFT), extending the incision by scissors.
kidney function test (KFT), coagulation profile, random • Delivery of the fetus and the placenta.
blood sugar (RBS) and viral markers (B and C), radiological • Ecbolic is routinely administered after delivery of the
studies ; trans-abdominal ultrasound examination to assure baby to minimize the risk of PPH.
592
Mostafa
•Identifying the uterine incision and uterine for at least six hours per day and following the standard
angles then closure of the uterine layers preferably VTE prophylaxis regimens.
in 2 layers using Vicryl material sutures in continuous
• Dietary management: The case was allowed to drink
non locking manner. Closure of anterior abdominal
just after exiting OR and food was allowed four hours
wall in layers after achieving adequate haemostasis.
post-operatively, while the control group started oral fluids
For the study group, we avoided administration after OR discharge by six hours. Ondansetron 4mg IV
of NG tube or it was removed at end of the and/or Promethazine 0.625mg IV was used for nausea and
operation if used. The pre warmed fluids during vomiting prevention.
operation to maintain normothermia throughout
operation (at 3638- degrees), short acting anesthetic • Pain management: Acetaminophen 1 gm orally or IV
agents whenever applicable able were used. every 8 hours. NSAIDS (Voltaren) was given either orally;
Dexamethasone 8 mg IV plus Ondansetron 4 mg half IM or rectally twice daily if oral intake was not tolerated.
hour before incision to guard against post-operative In breakthrough pain (defined as pain not responding
nausea and vomiting were used. Maintenance of to treatment for two hours), Morphine 2mg up to 10mg
euvolemia and minimizing long acting opiates were was given IM or IV. Pain score was assessed using the
followed strictly. Injection of subcutaneous tissue and Universal Pain Assessment Tool.
skin and fascia with local bupivacaine was performed for all
participants in the study group. All Foley's catheters were • Early removal of catheter and early ambulation.
removed at end of operation or maximally 3 hours post • Antibiotics: is given after 12 hours from exiting the or
operatively. according to the known regimens.
The patient is discharged from the hospital within 24
Postoperative in-patient follow-up:
hours postoperatively after changing the wound dressing
• VTE risk assessment and thromboprophylaxis by and after assessment of her satisfaction score using the
first ambulation within three hours post-operatively satisfaction score assessment tool.
593
ENHANCED RECOVERY AFTER CS
IBM© SPSS© Statistics version 21 (IBM© Corp., The patients are classified into two groups ; group A
Armonk, NY) was used for statistical analysis. The (the study group) included 48 cases who were subjected
normality of numerically distributed data was tested to means of enhanced recovery after cesarean section
by Shapiro-Wilk test. Normally distributed ones were and group B (the control group) included 48 cases were
shown as mean ± SD and differences between groups offered the standard conventional care used in cesarean
were compared using the independent-samples (t-test). section follow-up.
Median and inter-quartile range were used to show
skewed numerical data and comparisons between In this study, the comparison between the two groups
groups were performed by the Mann-Whitney U test to find any statistical significance using the following
non-parametrically. Qualitative data were presented in data ; demographic data, mean age, mean Hb and
number and frequency. Comparison of the two groups platelet count, mean GA, time till 1st oral intake, time
was performed by chi square test or Fisher’s exact test till 1st audible intestinal sound, time till 1st ambulation
whenever applicable. or movement, pain score, satisfaction scores, opiates
594
Mostafa
used and mean time of hospital stay was carried out. The The intra-operative and post-operative nausea
comparison between both groups showed no statistically and vomiting (IONV and PONV) was significantly
significant difference regarding age, gestational age at less in enhanced recovery after surgery (ERAS)
delivery and preoperative hemoglobin level (Table 1). group. Also, the interval time until first oral
intake and 1st intestinal sounds was shorter in women
The demographic data of the patients in both groups who started early oral intake in ERAS protocol.
showed that patients’ age ranged from 18-35 years in Moreover, women of ERAS program were able to start
both groups with statistically non-significant difference ambulation in significantly shorter time interval
regarding the age of both groups. GA at the time of was than those conventionally managed.
assessed and showed non-significant statistical difference
between the two groups. The preoperative laboratory Regarding the opiates used during the process
investigations were done with special concerns were of recovery for pain control in both groups the
taken towards the patient hemoglobin levels and overall mean of both groups was 0.25 ± 0.342 amp
platelet count and both parameters did not show any and 1.156 ± 0.463 amp in group (a) and group (b),
significant statistical difference between the two groups. respectively, where there was significant statistical
Regarding the type of anesthesia used, the percentage difference between the two groups. Furthermore, group
of patient taken spinal anesthesia to those taken general A had significantly lower postoperative pain scores,
anesthesia was 68.75 %: 31.25 % and 72.9 %: 27.1 % for higher satisfaction rates and shorter period of hospital
group (a) and group (b), respectively,(Table 2). stay.
Time to1st oral intake in min 142.083 ± 41.69 375.938 ± 23.94 <0.0001
Time to1st intestinal sound in min 249.271 ± 31.72 460.0 ± 54.24 <0.0001
595
ENHANCED RECOVERY AFTER CS
596
Mostafa
For post-operative pain analgesia in the study results where the percentage of patients sent home on
group multi-modal analgesia consisting of NSAIDS, the 1st postoperative day (Day 1) raised from 1.6% in
paracetamol with opiates, whenever needed, used the 1st quarter of 2012 to reach 25.2% in the 1st quarter
in breakthrough pain episodes not responding to of 2014.
analgesia for two hours, in addition of local infiltration
of the incision line with bupivacaine, while in the CONFLICT OF INTEREST
control group opiates analgesia with either NSAIDS
or paracetamol only was used. There are no conflict of interests.
The mean amount of opiates used was significantly REFERENCES
higher in the control group with significantly lower
pain score among women included in the case 1. Mazzoni, A., et al. (2011). "Women’s preference
group who received local infiltration anaesthesia for caesarean section: a systematic review and
as a step of our ERAS protocol. Lee et al. 2018[16] meta-analysis of observational studies." BJOG: an
published similar information that showed that international journal of obstetrics & gynecology
opioid dosage decreased significantly (p 0.001) 118(4): 391-399.
from 13.1 mg morphine to 7.7 mg. On the other hand,
the use of multimodal analgesia increased (p 0.001) 2. Knight, H. E., et al. (2013). "Evaluating maternity
from 5% to 87%. Furthermore, according to care using national administrative health datasets:
Adesope et al. 2016[21] revealed that local anesthetic How are statistics affected by the quality of data
wound infiltration significantly reduced opioid on method of delivery?" BMC health services
consumption at 24 hours. research 13(1): 200.
Elgohary et al. 2017[22] compared the pain score 3. Aluri, S. and I. Wrench (2014). "Enhanced
between ERAS and conventional care in elective recovery from obstetric surgery: a UK survey
colorectal surgery where they also found significant of practice." International journal of obstetric
difference between both groups of their study anesthesia 23(2): 157-160.
(p <0.001), while Meyer et al. 2018[23] found no
significant difference in the pain score with and without 4. Wilmore, D.W. and Kehlet, H., 2001.
ERAS protocols implementation (P value = 0.80). Management of patients in fast track surgery. Bmj,
322(7284), pp.473-476.
Satisfaction scores of the patients were done
using a scale from 0-10 where 0 was not satisfied 5. Varadhan, K.K., Neal, K.R., Dejong, C.H.,
at all and 10 was very satisfied, from which the Fearon, K.C., Ljungqvist, O. and Lobo, D.N.,
overall mean satisfaction score was significantly 2010. The enhanced recovery after surgery
higher in ERAS cases than those of conventional one. (ERAS) pathway for patients undergoing major
Nelson et al. 2014[24] where in their study they elective open colorectal surgery: a meta-analysis
concluded also significant difference in satisfaction of randomized controlled trials. Clinical nutrition,
score between the two groups of study in contrast to 29(4), pp.434-440.
what Polle et al. 2007[25] concluded that the patients’
satisfaction scores were comparable (p = 0.84) 6. Niranjan, N., Bolton, T. and Berry, C., 2010.
between studied groups. Enhanced recovery after surgery–current trends
in perioperative care. Up-date in Anaesthesia,
Hospital stay reduction is also one of the goals 26(1), pp.18-23.
of ERAS protocols where in this study the mean
hospital stay time was found to be 841.146 ± 112.54
min with range from 660 min (11 hours) to 1110 7. National Collaborating Centre for Women's and
min (18.5 hours) in group (A) and 1356.25 ± 80.43 Children's Health (UK), Caesarean Section: NICE
min with range from 1125 min (18.75 hours) to 1495 Clinical Guidelines, No. 132. National Institute of
min (24.97 hours) in group (B) indicating a significant Health and Clinical Excellence.
difference between the two groups of patients. These
results were supported by those results published by 8. Adamina, M., Kehlet, H., Tomlinson, G.A.,
Pilkington et al. 2016[26] which showed a decline in Senagore, A.J. and Delaney, C.P., 2011. Enhanced
the length of hospital stay from three to six days pre recovery pathways optimize health outcomes
ERAS protocols to be one to five days post use with and resource utilization: a meta-analysis of
an average of 2.5 days after implementation of those randomized controlled trials in colorectal surgery.
protocols. Also, Wrench et al. 2015[27] study has similar surgery, 149(6), pp.830-840.
597
ENHANCED RECOVERY AFTER CS
9. Grocott, M.P., Martin, D.S. and Mythen, M.G., Gynecology & Obstetrics, 128(2), pp.100-105.
2012. Enhanced recovery pathways as a way to
reduce surgical morbidity. Current opinion in 19. Mangesi, L. and Hofmeyr, G.J., 2002. Early
critical care, 18(4), pp.385-392. compared with delayed oral fluids and food
after caesarean section. Cochrane database of
10. Kumar, J.V., Shiva and, P.T. and Ravi, R., 2014. systematic reviews, (3).
Pre-operative ondansetron vs. Metoclopramide for
prevention of postoperative nausea and vomiting 20. Fearon, K.C.H., Ljungqvist, O., Von Meyenfeldt,
in elective lower segment caesarean section M., Revhaug, A., Dejong, C.H.C., Lassen, K.,
under spinal anaesthesia. International Journal of Nygren, J., Hausel, J., Soop, M., Andersen, J.
Research in Medical Sciences, 2(1), pp.175-179. and Kehlet, H., 2005. Enhanced recovery after
surgery: a consensus review of clinical care for
11. R. Afsargharehbagh1, S. Mosaed2, A. Nasiri3, patients undergoing colonic resection. Clinical
M. Afshari4*, M. Moosazadeh. Comparison of nutrition, 24(3), pp.466-477.
the effects of intravenous metoclopramide and
ondansetron on prevention of nausea and vomiting 21. Adesope, O., Ituk, U. and Habib, A.S., 2016. Local
after cesarean section. Biomedical Research anaesthetic wound infiltration for post caesarean
(2018) Volume 29, Issue 15. section analgesia: a systematic review and meta-
analysis. European Journal of Anaesthesiology
12. Smaill, F.M. and Grivell, R.M., 2014. Antibiotic (EJA), 33(10), pp.731-742.
prophylaxis versus no prophylaxis for preventing
infection after cesarean section. Cochrane 22. Elgohary, H., Baiuomy, M., Abdelkader, A.,
Database of Systematic Reviews, (10). Hamed, M. and Mosaad, A., 2017. Comparative
study between enhanced recovery after surgery
13. Saeed, K.B., Greene, R.A., Corcoran, P. and and conventional perioperative care in elective
O'Neill, S.M., 2017. Incidence of surgical site colorectal surgery. The Egyptian Journal of
infection following caesarean section: a systematic Surgery, 36(2), p.137.
review and meta-analysis protocol. BMJ
open, 7(1), p.e013037. 23. Meyer, L.A., Lasala, J., Iniesta, M.D., Nick,
A.M., Munsell, M.F., Shi, Q., Wang, X.S., Cain,
14. Ducloy-Bouthors, A.S., Baldini, A., Abdul-Kadir, K.E., Lu, K.H. and Ramirez, P.T., 2018. Effect
R. and Nizard, J., 2018. European guidelines of an enhanced recovery after surgery program
on perioperative venous thromboembolism on opioid use and patient-reported outcomes.
prophylaxis: Surgery during pregnancy and the Obstetrics & Gynecology, 132(2), pp.281-290.
immediate postpartum period. European Journal
of Anaesthesiology (EJA), 35(2), pp.130-133. 24. Nelson, G., Kalogera, E. and Dowdy, S.C.,
2014. Enhanced recovery pathways in
15. Huang, H., Wang, H. and He, M., 2016. Early gynecologic oncology. Gynecologic oncology,
oral feeding compared with delayed oral feeding 135(3), pp.586-594.
after cesarean section: a meta-analysis. The
Journal of Maternal-Fetal & Neonatal Medicine, 25. Polle, S.W., Wind, J., Fuhring, J.W., Hofland,
29(3), pp.423-429. J., Gouma, D.J. and Bemelman, W.A., 2007.
Implementation of a fast-track perioperative care
16. Lee, K.L., Lee, D.C., Huang, M., Hunt, E.J. and program: what are the difficulties? Digestive
Hedderson, M.M., 2018. Enhanced Recovery after surgery, 24(6), pp.441-449.
Surgery Implementation in a Cesarean Section
Population in an Integrated Healthcare System 26. Pilkington, L., Curpad, S. and Parveen, S., 2016.
[35B]. Obstetrics & Gynecology, 131, p.29S. Enhanced recovery after surgery (ERAS) in
obstetrics in Royal Gwent Hospital. European
17. Teoh, W.H.L., Shah, M.K. and Mah, C.L., 2007. Journal of Obstetrics and Gynecology and
A randomized controlled trial on beneficial effects Reproductive Biology, 206, p.e92.
of early feeding post-Caesarean delivery under
regional anesthesia. Singapore medical journal, 27. Wrench, I.J., Allison, A., Galimberti, A., Radley, S.
48(2), p.152. and Wil-son, M.J., 2015. Introduction of enhanced
recovery for elective caesarean section enabling
18. Guo, J., Long, S., Li, H., Luo, J., Han, D. and He, next day discharge: a tertiary center experience.
T., 2015. Early versus delayed oral feeding for International journal of obstetric anesthesia,
patients after cesarean. International Journal of 24(2), pp.124-130.
598
Ujian Tengah Semester EBM
Kelas : Tanjungpinang
Nim : 211015201223
(METODE ERAS)
KESIMPULAN :
Metode Enhanced Recovery After Surgery atau ERAS sudah digunakan sejak
tahun 1990-an pada tindakan bedah khusus atau colorectal. Metode ERAS adalah
langkah-langkah yang disusun untuk mencapai pemulihan lebih cepat pada pasien
yang menjalani tindakan bedah major atau besar. Saat ini metode pemulihan cepat
pada ibu melahirkan dikenal dengan nama Enhanced Recovery After Cesarean
Section (ERACS). Cara tersebut pertama kali dilakukan di Inggris pada 2013.
Dalam penelitian ini , peneliti melakukan penelitian tentang kepuasan pasien yang
menggunakan metode operasi eras dan pasien yang menggunakan metode operasi
konvensional. Dimana terjadi tingkat kepuasan yang signifikan lebih tinggi dengan
pasien menggunakan metode eras di bandingkan pasien yang menggunakan
metode operasi konvensional. Tetapi peneliti membandingkan antara penelitian
nya dengan penelitian Polle et al.2007 bahwa skor kepuasan pasien itu sebanding .
Jadi metode ERAS sangat baik digunakan untuk mempercepat pemulihan pasien
pasca operasi dan menyingkat durasi berapa lama seorang pasien di rawat di
rumahsakit. Tak kalah penting metode eras juga bisa mengurasi rasa nyeri pada
pasien pasca operasi, sehingga pasien tidak lagi merasakan sakit yang yang
berlebihan dan tidak mengalami trauma pasca operasi.
HUBUNGAN ANTARA PARITAS DENGAN KETERAMPILAN MENYUSUI YANG
BENAR PADA IBU NIFAS
Ansik Khoiriyah*
Ravita Prihatini**
ABSTRAK
Menyusui merupakan cara yang ideal bagi ibu untuk memberikan kasih sayang pada
anaknya dan cara terbaik memenuhi gizi bayi dengan keterampilan menyusui yang benar
pada ibu nifas. Metode observasi dengan analisa data analitik dan jenis rancangan cross
sectional. Populasi semua ibu nifas yang menyusui, jumlah sampel sebanyak 32 responden
di ambil secara simple random sampling. uji chi square dan koefisien phi. Hasil penelitian
menunjukan keterampilan menyusui pada ibu nifas masih kurang terutama pada ibu
Primipara. Dari hasil uji chi square di dapatkan hasil ρ (0,002) < α (0,05) artinya ada
hubungan antara paritas dengan keterampilan menyusui yang benar, maka konseling cara
menyusui yang benar harus ditingkatkan.
1
Jurnal Midpro, edisi 2 /2011
Penyuluhan di berikan pada masa membedakan, menggabungkan,
hamil misalnya tentang keuntungan mengelompokkan dan sebagainya.
pemberian ASI dan manajemen laktasi, 3. Strategi kognitif
bimbingan khusus kepada ibu hamil yang Stategi kognitif merupakan
belum pernah menyusui dan ibu yang kemampuan atau strategi pribadi untuk
mempunyai masalah laktasi.(Ridwan berpikir, mengingat dan belajar.
Amiruddin, 2009).
Konsep Dasar Menyusui
TUJUAN PENELITIAN Menyusui adalah cara yang alami
Menganalisis hubungan antara dan fisiologis untuk memberikan nutrisi ke
paritas dengan keterampilan menyusui bayi dan balita (Maimunah, 2005).
yang benar pada ibu nifas. Tiga reflek yang penting dalam
reflek hisapan bayi adalah :
TINJAUAN PUSTAKA 1. Reflek menangkap (rooting reflex)
Konsep Dasar Paritas Timbul bila bayi lahir tersentuh
Para adalah seorang wanita yang pipinya, bayi akan menoleh kearah
pernah melahirkan bayi yang dapat hidup sentuhan. Bila bibirnya di rangsang
atau viable (Rustam, 2008). dengan papilla mamme, maka bayi akan
Menurut Rustam (2008) membagi membuka mulut dan berusaha
istilah paritas menjadi 4 macam yaitu : menangkap putting susu. (Perinasia,
1) Nullipara adalah seorang wanita yang 2004).
belum pernah melahirkan bayi 2. Reflek menghisap (sucking reflex)
pertama kali Reflek ini timbul apabila langit –
2) Primipara adalah seorang wanita yang langit mulut bayi tersentuh, biasanya
melahirkan bayi hidup untuk pertama oleh putting. Supaya putting mencapai
kali bagian belakang palatum maka
3) Multipara atau pleuripara adalah sebagian besar areola harus tertangkap
seorang wanita yang pernah mulut bayi. Dengan demikian maka
melahirkan bayi beberapa kali (sampai sinus laktiferus yang berada dibawah
lima kali) areola akan tertekan antara gusi, lidah
4) Grandemultipara adalah seorang dan palatum, sehingga ASI terperas
wanita yang pernah melahirkan bayi keluar (Perinasia, 2004).
enam kali atau lebih hidup atau mati 3. Reflek menelan (swallowing reflkex)
Segera setelah mulut bayi penuh
Konsep Dasar Keterampilan dengan ASI, ia akan menelannya.
Menurut Maimunah (2005) Biasanya bayi belajar menghisap dan
kategori keterampilan adalah : menelan pada akhir bulan ke delapan
1. Informasi verbal kehamilan.
Keterampilan dalam kelompok ini Manfaat Menyusui
merupakan kemampuan menyimpan Keuntungan menyusui meningkat
informasi dalam ingatan berupa fakta seiring lamanya menyusui bayi secara
atau informasi dan mengeluarkannya eksklusif hingga enam bulan. Setelah itu,
kembali, perilaku yang di harapkan dengan tambahan makanan pendamping
adalah menyebutkan kembali informasi ASI pada usia lebih dari enam bulan,
yang telah dipelajari. keuntungan menyusui meningkat seiring
2. Kemampuan intelektual dengan meningkatnya lama pemberian ASI
Berupa kemampuan menggunakan dalam 2 tahun atau lebih.
symbol untuk berinteraksi, Manfaat menyusui bagi bayi
mengorganisir, dan membentuk arti, 1. ASI mengandung nutrisi yang optimal
misalnya : membaca, menulis, 2. ASI meningkatkan kesehatan bayi
2
Jurnal Midpro, edisi 2 /2011
2. ASI meningkatkan kecerdasan bayi Ada hubungan antara paritas
3. ASI meningkatkan jalinan kasih dengan keterampilan menyusui yang benar
sayang ibu dan bayi pada ibu nifas.
Manfaat menyusui bagi ibu
1. Meningkatkan jalinan kasih sayang ibu
dan anak METODE PENELITIAN
2. Mengurangi resiko kanker payudara Metode penelitian observasional
3. Mengurangi resiko kanker indung telur analitik dengan menggunakan pendekatan
4. Mengurangi stress dan gelisah secara cross sectional. Populasi ibu nifas
5. Berat badan lebih cepat kembali normal sebanyak 35 Ibu nifas. Besar sampel
6. Sebagai salah satu alternative Sampel 32 ibu nifas bulan Juli – Agustus
kontrasepsi (Perinasia, 2004). 2014 diambil dengan teknik simple
random sampling. Instrumen penelitian
Faktor yang Mempengaruhi menggunakan Check list. Uji analisis
Keterampilan Menyusui dengan Chi Square.
1. Pendidikan
2. Pekerjaan HASIL PENELITIAN
3. Umur Dari data yang sudah di tabulasi
4. Paritas kemudian di analisis dengan uji chi square
5. Lingkungan kebudayaan menggunakan SPSS dan di dapatkan nilai
6. Faktor psikologis (Perinasia, 2004). x² =10,041 dengan nilai ρ(0,002) < α(0,05)
maka H1 di terima yang artinya ada
Konsep Hubungan antara Paritas hubungan antara paritas dengan
dengan Keterampilan Menyusui keterampilan menyusui yang benar.
Konsep dasar paritas adalah Selanjutnya dilakukan uji koefisien phi
keadaan wanita berkaitan dengan jumlah untuk mengetahui apakah hubungan
anak yang di lahirkan (Ramali, 2008). tersebut mempunyai arti (berpengaruh)
Paritas sangat mempengaruhi pengalaman atau tidak dan di dapatkan nilai phi -0,560
ibu nifas dalam keterampilan pemberian dan hasil ρ(0,002) < α(0,05) sehingga
ASI. Dengan mempunyai pengalaman dapat diketahui bahwa paritas berpengaruh
menyusui sebelumnya maka akan terhadap keterampilan menyusui.
menunjang keterampilan menyusui yang
sekarang dan dengan kegagalan menyusui PEMBAHASAN
di masa lalu akan mempengaruhi ibu untuk Paritas
menjadi yang lebih baik. Sehingga Bahwa sebagian besar paritas
pengetahuan ibu pada multigravida lebih responden di BPS Li’ilah,Amd.Keb.
banyak daripada pengetahuan ibu Kecamatan Paciran Kabupaten Lamongan
primigravida karena factor pengalaman adalah Primipara sebanyak 18 orang
dan pengetahuan. (Huliana, 2003) (56,3%).
Dari uraian tersebut dapat di Bahwa pembentukan diri
simpulkan bahwa paritas akan berhubungan dengan pengalaman. Dan
menghasilkan perubahan atau peningkatan diharapkan, bahwa dengan pengalaman
pengetahuan, dan pengetahuan akhirnya maka seseorang dapat mempunyai
akan berpengaruh pada sikap dan pengetahuan yang lebih baik dari pada
keterampilan ibu nifas dalam pemberian yang belum mempunyai pengalaman. Dari
ASI kepada bayinya. (Soetjiningsih, 1997) uraian di atas dapat di ketahui bahwa ada
kesamaan antara teori dan kenyataan
HIPOTESIS bahwa paritas akan berpengaruh pada
pengetahuan dan keterampilan.
3
Jurnal Midpro, edisi 2 /2011
Sebagian besar responden berusia dengan nilai ρ (0,002) < α (0,05) sehingga
relatif muda sehingga mempunyai paritas dapat diketahui bahwa paritas berpengaruh
yang rendah (primipara). Pada umumnya terhadap keterampilan menyusui.
semakin tinggi paritas seseorang maka Pengetahuan ibu Multipara lebih
semakin banyak pengalaman dan banyak dari pada pengetahuan ibu
pengetahuan yang dimilikinya termasuk Primipara karena faktor pengalaman dalam
informasi yang di dapatkan baik dari orang hal menyusui. Dengan pengalaman maka
lain ataupun dari tenaga kesehatan. seseorang dapat mempunyai pengetahuan
yang lebih baik dari pada yang belum
Keterampilan Menyusui Bayi rnemperoleh pengalaman. Pendidikan yang
Bahwa sebagian besar responden di rendah mengakibatkan seseorang kurang
BPS Li’ilah,Amd.Keb. Kecamatan Paciran mengerti tentang manfaat pemberian ASI
menyusui dengan cara yang salah ataupun dampak dari pemberian ASI
sebanyak 17 orang (53,1%) dari 32 dengan cara yang salah sehingga
responden. menyebabkan timbulnya masalah pada
Dalam hal ini dapat di ketahui pemberian ASI dan bayi tidak
bahwa ada kesamaan antara teori dan mendapatkan ASI sesuai kebutuhan.
kenyataan bahwa keterampilan menyusui
juga di pengaruhi oleh paritas. SIMPULAN DAN SARAN
keterampilan menyusui yang salah dapat di Simpulan
pengaruhi oleh paritas ibu yang sebagian Ada hubungan antara paritas
besar adalah primipara. Pada umumnya ibu dengan keterampilan menyusui yang benar
nifas dengan paritas lebih dari dua
(multipara dan grandemultipara) Saran
menunjukkan bahwa pengetahuan ibu nifas Tidak hanya konseling bagi ibu,
tentang perawatan masa nifas (cara tetapi praktek menyusui bayi dengan benar
meneteki yang benar, mobilisasi dini, dll) agar dapat meningkatkan pemberian ASI
lebih baik dibandingkan ibu nifas yang eksklusif pada bayi.
baru pertama kali melahirkan, pendidikan
ibu yang rendah juga berpengaruh DAFTAR PUSTAKA
terhadap cara pemberian ASI karena
semakin tinggi pendidikan memungkinkan Utami Roesli, 2004. Kesehatan Anak, (Di
seseorang untuk lebih mudah menerima akses 01 Januari 2010)
informasi atau pengetahuan baru termasuk
cara menyusui yang benar. Ridwan amiruddin. 2009. Faktor yang
mempengaruhi pemberian ASI, (Di
Hubungan Antara Paritas Dengan akses 01 Januari 2010)
Keterampilan Menyusui Bayi
Setelah dilakukan uji statistik chi Huliana, Melyana. 2003. Perawtan Ibu
square antara paritas ibu nifas dengan Pasca Melahirkan. Jakarta : Puspa
keterampilan menyusui bayi yang benar Swara.
dengan menggunakan SPSS dan di
dapatkan nilai x² =10,041 dengan nilai Maimunah, Siti. 2005. Kamus Istilah
ρ(0,002) < α(0,05) maka Ho di tolak yang Kebidanun. Jakarta : EGC.
artinya ada hubungan antara paritas
dengan keterampilan menyusui yang Mochtar, Rustam. 1998. Sinopsis Obstetri ,
benar. Selanjutnya dilakukan uji koefisien Obstetri Fisiologi, Obstetri
phi untuk mengetahui apakah hubungan Patologi. Jakarta : EGC.
tersebut mempunyai arti (berpengaruh)
atau tidak dan di dapatkan hasil Ø = -0,560
4
Jurnal Midpro, edisi 2 /2011
Nursalam dan Siti Pariani. 2003. Prawirohardjo, Sarwono. 2005. Ilmu
Pendekatan Praktis Metodologi Kebidanan. Jakarta : EGC
Riset Keperawata. Jakarta : Sagung
Seto. Ramali, Ahmad. 2008. Kamus Kedokteran.
Jakarta : Djambatan
Perinasia. 2004. Manajemen Laktasi Edisi
2. Jakarta : Bina Rupa Aksara Soetjiningsih. 1997. ASI Petunjuk Untuk
Tenaga Kesehatan. Jakarta : EGC
5
Jurnal Midpro, edisi 2 /2011
Ujian Tengah Semester EBM
Kelas : Tanjungpinang
Nim : 211015201223
HASIL PENELITIAN
Dari data yang sudah di tabulasi kemudian di analisis dengan uji chi square
menggunakan SPSS dan di dapatkan nilai x² =10,041 dengan nilai ρ(0,002) <
α(0,05) maka H1 di terima yang artinya ada hubungan antara paritas dengan
keterampilan menyusui yang benar. Selanjutnya dilakukan uji koefisien phi untuk
mengetahui apakah hubungan tersebut mempunyai arti (berpengaruh) atau tidak
dan di dapatkan nilai phi -0,560 dan hasil ρ(0,002) < α(0,05) sehingga dapat
diketahui bahwa paritas berpengaruh terhadap keterampilan menyusui.
kesimpulan dari hasi penelitian jurnal diatas adalah , adanya hubungan antara
paritas dengan keterampilan menyusui yang benar pada ibu nifas. Karena paritas
dengan primipara dan paritas dengan multipara lebih baik keterampilan
menyusuinya ibu dengan paritas multipara atau ibu yang pernah melahirkan bayi
hidup atau mati lebih dari satu. Sedangkan pengetahuan ibu paritas primipara
mereka lebih cenderung belum mengetaui cara menyusui yang baik dan benar.
Mengapa ibu dengan paritas multipara sangat baik keterampilan menyusuinya?
Karena pada dasarnya pengalaman dari kelahiran sebelumnya yang bisa membuat
mereka belajar semakin baik tentang cara menyusui yang benar. Sedangkan ibu
dengan primipara mereka tidak mempunyai pengalaman menyusui sebelumnya,
sehingga pengetahuan tentang menyusui yang baik dan benar belum mereka
dapatkan . Dengan pengalaman seorang ibu akan mendapatkan pengetahuan yang
baik tentang menyusui.