Uterus Involution And Psychological Adaptation In Postpartum Mothers

Latar Belakang : Masa nifas merupakan masa setelah persalinan. Involusi uterus pada ibu postpartum merupakan proses yang sangat penting karena ibu memerlukan perawatan yang khusus, bantuan dan pengawasan demi pulihnya kesehatan seperti sebelum hamil. Sebagian besar kematian ibu (88%) terjadi dalam waktu 4 jam setelah persalinan. Penyebab kematian terbesar ibu di Indonesia yaitu perdarahan (30,3%). Jika involusi uterus berjalan dengan normal maka akan dapat mengurangi kejadian perdarahan terutama perdarahan postpartum yang merupakan salah satu penyebab langsung dari kematian ibu. Involusi uterus pada ibu postpartum merupakan proses yang sangat penting karena ibu memerlukan perawatan yang khusus, bantuan dan pengawasan demi pulihnya kesehatan seperti sebelum hamil. Salah satu indikator dalam proses involusi adalah tinggi fundus uteri. Penurunan tinggi fundus uteri ini bisa terjadi dengan baik bila kontraksi dalam uterus baik. Selain penurunan tinggi fundus uteri, kemampuan penyesuaian diri pada masa nifas juga sangat penting dijaga. Pelaksanaan yang kurang maksimal dapat menyebabkan ibu mengalami berbagai masalah, bahkan dapat berlanjut pada komplikasi masa nifas.

Tujuan penelitian untuk mengetahui perubahan involusi uterus dan untuk mengetahui gambaran adaptasi psikologis pada ibu postpartum di BPM Eka Santi dan Sulistiyo Rahayu, Lampung Tengah.

Metode penelitian deskriptif kuantitatif. Populasi seluruh ibu 8 jam postpartum memenuhi kriteria inklusi dan ekslusi di Praktik Mandiri Bidan (PMB) Eka Santi dan Sulistiyo Rahayu, Lampung Tengah. Sampelpenelitian 93 responden ibu postpartum dengan cara purposive sampling yang didasarkan pada suatu pertimbangan tertentu yang dibuat oleh peneliti sendiri. Variabel penelitian dalam penelitian yaitu perubahan involusi uterus dan adaptasi psikologi ibu nifas.

Hasil penelitian dengan karakteristik umur ibu 20-35 tahun sebanyak 77 (82,8%) dan tidak bekerja sebanyak 91 (97,8%) dengan hasil pada kunjungan pertama, tinggi fundus uteri yang sesuai 87 (93,6%), kontraksi baik 87 (93,5%), perdarahan normal 86 (92,4%) dan lochea normal 93 (100%). Pada kunjungan dua, tinggi fundus uteri yang sesuai 92 (98,9%), kontraksi baik 91 (97,8%), perdarahan normal 91 (97,8%) dan lochea normal 90 (96,8%). Pada kunjungan ketiga tinggi fundus uteri yang sesuai 90 (96,8%), kontraksi baik 91 (97,8%), perdarahan normal 92 (98,9%) dan lochea normal 92 (98,9%). Pada kunjungan keempat tinggi fundus uteri yang sesuai 91 (97,8%), kontraksi baik 90 (96,7%), perdarahan normal 91 (97,8%) dan lochea normal 90 (96,8%).

Kesimpulan involusi uteri ibu postpartum berjalan dengan baik. Begitu juga adaptasi psikologi ibu normal.

Saran dapat meningkatkan kinerja bidan dalam mengidentifikasi ketidaksesuaian perubahan fisiologis maupun psikologis pada ibu nifas, sesuai dengan tahapannya, dalam upaya peningkatan kesejahteraan ibu pada masa nifas, juga dapat mengaplikasikan keilmuan bersinergis dengan program yang dilaksanakan oleh pemerintah, dalam upaya memberikan asuhan kebidanan.

Kata kunci :  Adaptasi Psikologi, Involusi Uterus, Masa Nifas

ABSTRACT 

Background: The postpartum period is the period after childbirth. Meanwhile, uterine involution in postpartum mothers is crucial because the mother requires special care, assistance, and supervision to restore health as before pregnancy. In this case, most maternal deaths (88%) occurred within four hours of delivery. In Indonesia, the biggest cause of maternal death was bleeding (30.3%). If uterine involution proceeds normally, it will reduce the incidence of bleeding, especially postpartum bleeding, which is one of the direct causes of maternal death. One of the indicators in the process of involution is the height of the uterine fundus. The decrease in uterine fundal height can occur properly if the contractions in the uterus are good. In addition to decreasing the height of the uterine fundus, it is also vital to maintain the ability to adjust during the puerperium. Improper implementation can cause the mother to experience various problems, and it can even lead to complications during the puerperium.

The purpose of the study was to determine changes in uterine involution and describe the psychological adaptation of postpartum mothers at BPM Eka Santi and Sulistiyo Rahayu, Central Lampung.

Method used in this research was descriptive quantitative. The population of this study was all mothers with eight hours postpartum who met the inclusion and exclusion criteria at the independent midwife practice (PMB) Eka Santi and Sulistiyo Rahayu, Central Lampung. The samples taken in this study were 93 postpartum mothers. The sample selection in this study was carried out by purposive sampling based on certain considerations made by the researchers themselves. The research variables in this study were changes in uterine involution and the psychological adaptation of postpartum mothers. The study results with the characteristics of mothers aged 20-35 years were 77 mothers (82.8%) and not working as many as 91 mothers (97.8%). The results at the first visit revealed that the appropriate uterine fundal height was 87 mothers (93.6%), good contractions were at 87 mothers (93.5%), the normal bleeding was at 86 mothers (92.4%), and normal lochia was at 93 mothers (100%). At the second visit, the appropriate uterine fundal height was 92 mothers (98.9%), the good contraction was 91 mothers (97.8%), normal bleeding was at 91 mothers (97.8%), and normal lochia was 90 mothers (96.8%). At the third visit, the appropriate uterine fundal height was at 90 mothers (96.8%), good contractions were at 91 mothers (97.8%), normal bleeding was at 92 mothers (98.9%), and normal lochia was at 92 mothers (98.9%). At the fourth visit, the appropriate uterine fundal height was at 91 mothers (97.8%), good contractions were at 90 mothers (96.7%), normal bleeding was at 91 mothers (97.8%), and normal lochia was at 90 mothers (96.8%).

Conclusion: Based on the data analysis results and discussion, it can be concluded that uterine involution for postpartum mothers was going well, as was the psychological adaptation of normal mothers.

Suggestions: The results of this study are expected to improve the performance of midwives in identifying discrepancies in physiological and psychological changes in postpartum mothers, according to the stages, to improve maternal welfare during the postpartum period, and to apply science in synergy with programs implemented by the government to provide midwifery care.

Keywords: psychological adaptation,puerperium,uterus involution