Asuhan Kebidanan Komprehensif pada Ny. L Usia 27 Tahun G2P1A0 di Wilayah Kerja Puskesmas Kaliwungu Kecamatan Kaliwungu

Abstract

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) remain essential indicators of a nation’s health status. In Indonesia, the MMR in 2022 reached 207 per 100,000 live births, still above the Strategic Plan target of 190 per 100,000 live births. The leading causes of maternal death include hemorrhage, preeclampsia/eclampsia, infection, prolonged labor, and postpartum complications. Infant mortality is mainly caused by prematurity, asphyxia, infection, and congenital abnormalities. Efforts to reduce maternal and infant mortality continue through the Safe Motherhood Initiative and the implementation of Continuity of Care (CoC), which provides integrated and ongoing midwifery services during pregnancy, childbirth, postpartum, newborn care, and family planning. Comprehensive care facilitates early risk detection, prevents complications, and improves overall maternal and neonatal health outcomes. This study employed a descriptive case study approach involving Mrs. L, 27 years old, G2P1A0, who received comprehensive midwifery care at the Kaliwungu Health Center. The care included antenatal assessments following the 10T standard, pregnancy monitoring during the second and third trimesters, labor management using the 60 essential steps of APN, postpartum care, newborn assessment, and family planning counseling. Complementary care, such as oxytocin massage and prenatal yoga education, was provided based on the client's needs. The pregnancy, labor, postpartum period, newborn care, and family planning services proceeded physiologically without complications. The mother demonstrated good understanding of pregnancy danger signs, childbirth preparation, postpartum self-care, exclusive breastfeeding, and newborn care. Oxytocin massage contributed to improved breast milk production, and the newborn exhibited normal adaptation. The mother also successfully selected an appropriate postpartum contraceptive method. Comprehensive Continuity of Care midwifery services were effective in enabling early identification of risk factors, enhancing maternal knowledge, and supporting optimal maternal and neonatal health. Complementary care, such as oxytocin massage, provided additional benefits by improving breastfeeding outcomes and maternal comfort. The implementation of CoC should continue as a key strategy in supporting the reduction of maternal and infant mortality.

Abstrak

Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) masih menjadi indikator penting dalam menilai kualitas kesehatan suatu negara. AKI di Indonesia pada tahun 2022 tercatat sebesar 207 per 100.000 kelahiran hidup, masih di atas target Renstra 190 per 100.000 kelahiran hidup. Penyebab kematian ibu umumnya meliputi perdarahan, preeklamsia/eklamsia, infeksi, partus lama, dan komplikasi nifas. Demikian juga angka kematian bayi yang masih dipengaruhi oleh prematuritas, asfiksia, infeksi, dan kelainan bawaan. Upaya penurunan AKI dan AKB dilakukan melalui program Safe Motherhood dan penerapan Continuity of Care (CoC), yaitu pelayanan kebidanan berkesinambungan mulai kehamilan, persalinan, nifas, bayi baru lahir hingga keluarga berencana. Pelayanan yang komprehensif dan terintegrasi berkontribusi dalam deteksi dini risiko, pencegahan komplikasi, serta peningkatan kualitas kesehatan ibu dan bayi. Penelitian ini menggunakan metode studi kasus deskriptif pada Ny. L, usia 27 tahun, G2P1A0, yang mendapatkan asuhan kebidanan komprehensif di wilayah kerja Puskesmas Kaliwungu. Asuhan diberikan mulai dari kehamilan trimester II dan III, persalinan, masa nifas, perawatan bayi baru lahir, hingga pelayanan keluarga berencana. Tindakan meliputi pengkajian lengkap, pemeriksaan ANC sesuai standar 10T, pemantauan persalinan berdasarkan 60 langkah APN, perawatan nifas fisiologis, pemantauan tumbuh kembang bayi, serta konseling KB. Asuhan komplementer seperti pijat oksitosin dan edukasi prenatal yoga juga disertakan sesuai kebutuhan ibu. Seluruh proses—kehamilan, persalinan, masa nifas, perawatan bayi baru lahir, dan pelayanan KB—berlangsung fisiologis tanpa komplikasi. Ibu menunjukkan pemahaman yang baik mengenai tanda bahaya kehamilan, persiapan persalinan, perawatan diri masa nifas, pemberian ASI eksklusif, serta perawatan bayi. Produksi ASI meningkat setelah pemberian pijat oksitosin, bayi memiliki adaptasi yang baik, dan ibu memilih metode kontrasepsi sesuai kondisi pascasalin. Asuhan kebidanan Continuity of Care secara komprehensif terbukti efektif dalam mendeteksi dini risiko, meningkatkan pengetahuan ibu, serta mendukung kesehatan maternal dan neonatal. Penerapan asuhan komplementer seperti pijat oksitosin turut membantu optimalisasi pemberian ASI dan meningkatkan kenyamanan ibu. Layanan CoC perlu terus diterapkan sebagai upaya strategis dalam mendukung pencapaian target penurunan AKI dan AKB.