BAB 1.

PRELIMINARY

1.1 Background Nursing has important roles in health care. It is proven that 40% -75% of health service in hospitals and in community is nursing service (Gillies, 1994 & Swansburg, 1999). This requires to nurse not only skilled intellectual and engineering, but also skilled at interpersonal relationships with patients. Maternity nursing is one form of nursing services. Maternity nursing is a professional nursing service aimed at women include reproductive system, pregnancy, childbirth period, and postpartum period, newborn babies up to age 40 days, and family. According to the demographic health survey of Indonesia 2002-2003, the maternal mortality rate in Indonesia is 307 per 100,000 live births. Infant mortality was recorded 35 per 1000 live births. According to the Demographic and Health Survey 2007, the maternal mortality rate in Indonesia is 228 per 100,000 live births, while infant mortality 34 per 1000 live births. From the results of the survey (SKRT, 2001), it is known that the complications of the largest causes of maternal deaths are haemorrhage, hypertension in pregnancy (eclampsia), infection, parturition time, and complications of miscarriage. Neonatal mortality rate mainly due to, among others, infections and low birth weight infants. According to the National Development Planning Agency, challenges or problems encountered on maternal mortality, among others: 1. limited public access to quality health care facilities, especially for the poor in underdeveloped areas, remote, border and island; 2. limited availability of health personnel both in terms of quantity, quality and spreading, especially midwives; 3. the low knowledge and awareness of the importance of maintaining health and safe motherhood; 4. the low nutritional status and health of pregnant women;

5. the low rate of contraceptive use and high unmet need; and 6. AKI is still not precise measurements, because the system for recording causes of maternal death is still not adequate. The challenge for infant mortality according to the National Development Planning Agency, there are: 1. the low immunization coverage; 2. not optimal early detection and prompt treatment for sick infants or Integrated Management of Childhood Illness; 3. limited efforts to improve nutrition in children; 4. the low family involvement in children's health; 5. still low effort to control environmental risk factors; and 6. there is limited access to health services. Welfare and health of women in Indonesia is currently still needs to be improved, because it looks maternal and infant mortality rates are still relatively high. Under the MDGs (Millennium Development Goals) set by heads of state and representatives of 189 countries in the UN General Assembly in New York in September 2000, the maternal mortality target of 102 per 100,000 live births in 2015. The infant mortality rate target of 23 per 1000 live births. Target will not materialize if the health problems particularly problems in maternity nursing unresolved. Health problems of women and newborns are increasingly complex demands of a comprehensive settlement and management of a competent nursing. To that end, the author are interested to discuss about the maternity nursing professional and able to respond appropriately to the maternity health problems.

1.2 Formulation of The Problem Base on background, formulation of the problem are: 1. Who are the target of maternity nursing? 2. What are characteristic of maternity nursing? 3. What are the philosophy of maternity nursing? 4. What are the concept of maternity nursing services? 5. What are the service policy of maternity nursing?

6. What are the paradigm of maternity nursing 7. What are the professionalism quality of maternity nurse? 8. What are the role of maternity nurse? 9. What are activities in maternity nursing? 10. How does the nursing process in maternity nursing?

1.3 Purposes and Benefits The purposes and benefits are: 1. increase knowledge about maternity nursing; 2. know the basis, purpose and role of maternity nursing; 3. can apply the maternity nursing appropriate principles or philosophy maternity nursing; and 4. can help resolve health problems, especially problems of maternity.

BAB 2. LITERATURE REVIEW

2.1 The Target of Maternity Nursing Treatment for pregnant women focuses on the care of pregnant women and their families at all stages of pregnancy and birth, including the first four weeks after birth. During the prenatal period, the nurse providing care and teaching materials to help families prepare for the birth. Nurses who have undergone special training can provide intensive care to high-risk infants in special care units and the high-risk mothers in the antepartum or at home. Efforts made in improving health during childbearing age could potentially make a significant difference, not only in improving maternal and infant health, but also public health. Maternity nursing is a term used to describe the awarding of nursing care safely and quality, focused, and adapt to the physical and psychosocial needs of pregnant women, families, and newborns. Nursing care based on family to maintaining family unity, improve, and protect the physiological prosperity of mothers and newborns. Maternity nursing is a holistic service include biological, psychological, social, and spiritual. Maternity nursing is a professional nursing service aimed to women include reproduction system, pregnancy period, childbirth period, and postpartum period, newborn babies up to age 40 days, and family.

2.2 Characteristic of Maternity Nursing Maternity nursing is a professional nursing who has the characteristics as follows.
1. Focus on the women of childbearing ages needs concerned with

reproduction system.
2. Approach to the family (father, mother and child) as unity.

3. Activities such as:

a. educate women of childbearing age in face of reproduction issues and prepare for a pregnancy; b. give consultation about pregnancy and ANC (Antenatal Care); c. assist childbirth; d. care for pstnatal women up to 6 weeks; and e. care the baby.
4. In carrying out the role, nurse interact with client to:

a. assessing health issues and resources available; b. make plan and implement; c. give support to the potential available; and d. refer to other health team members.
5. Teamwork.

2.3 The Philosophy of Maternity Nursing The philosophy of maternity nursing are: 1. 2. 3. 4. 5. 6. maternity nursing is focused on client, family, and community; every individual has the right to born healthy and get health services; health disorders is a family developmental tasks; believes that pregnancy and childbirth is a normal and natural event; early pregnancy is the early formation interaction with family; attitudes, values, and individual health behaviors are influenced of cultural background, religion and belief; 7. the function of maternity nursing is an advocate or defender to protect the rights of client; 8. 9. promoting health is an important task for maternity nurse; the maternity nursing provide a challenge for nurse role and is a major factor in promoting health of individual, family and community; and 10. convinced that nursing research can add knowledge in improving the quality of maternity services.

2.4 The Concept of Maternity Nursing Services According to the Association of Women in Gynecology and Neonatal Health (2002) concept of maternity nursing care as follows. 1. The caring attitude of nurse Nurses who carry out maternity nursing care have to apply the caring attitude to the client. Caring attitude starting from the assessment, nursing diagnosis, arrange action plan, implementation, and evaluation. Maternity nursing care quality can be achieved when nurses can carry out the caring attitude to the client, for example with honesty, trust, and goodwill. Caring attitude can be done by touch, provide hope, and always stands beside the client. 2. Family centered care Maternity nurses able to carry out nursing actions for family care, women of childbearing age, pregnancy women, childbirth women, and newborn babies up to age 40 days, and family. 3. The adaptation consept of intra extra uterine The role of maternity nurse is to monitor the condition of the fetus in the uterus and respond to any acts utter . 4. Bonding attachment Bonding attachment is an advanced process when the newborn is in the arms of mothers to breastfeed directly. This action is done to give trust between mother and child. 5. Eksklusive breast feeding Eksklusive breast feeding is exclusive breastfeeding from birth to 6 months because breast milk contains many kinds of antibodies that protect the baby from germs attack the causes of infection. That antibodies are immunoglobulin A (IgA), IgG, IgM, IgD, dan IgE. 6. Self care Self care is given in order to achieve health for women, pregnant women, postpartum mothers, newborns, and family optimally.

7. Hospitalization Hospitalization is a process through which individuals in condition of ill and should receive treatment in hospital. Hospitalization is also a condition of separation of individuals with a family, neighborhood and social groups. Generally, the reactions of hospitalization which is experienced by the mother is anxiety cause separation with baby and family. This is causes the mother to lose her control. So that, maternity nurse are needed in order the mother not to lose her control. 8. The process of losing The reaction of grieving cause loss can be observed from physiological and psychological change that experienced by family, including mother. Family's ability to cope with the process of grieving cause loss is influenced by personality, social cultural and support system. The role of maternity nurse is to support family by providing nursing care that is focused on assistance to family in dealing the process of grieving cause loss optimally. 9. Safety and injury prevention One task of maternity nurse is to provide comfort and precautions against injury to women of childbearing age, pregnant women, postpartum mother and newborns.

2.5 The Service Policy of Maternity Nursing The service policy of maternity nursing are: 1. 2. 3. 4. 5. providing services of trained personnel; increase knowledge of public health; increase the acceptance of family planning movement; provide education to tocologist; and improve the referral system.

2.6 The Paradigm of Maternity Nursing Maternity nursing paradigm includes humans, nursing, environmental, and health. 1. Human Consisting of women include the reproductive system, pregnancy, during delivery, and postpartum period, newborn babies up to age 40 days, and the family, is a creature of bio-psycho-socio-spiritual that have different properties individually. 2. Nursing Maternity nursing is a professional nursing service aimed at women include reproductive system, pregnancy, during delivery, and postpartum period, newborn babies up to age 40 days, and family. This nursing focuses on meeting basic needs in physical and psychosocial adaptation by using the nursing process approach. 3. Environmental The birth process is the initial formation of relationships within the family which is very important that maternity services will encourage positive interaction of the elderly, infants and other family members. 4. Health Health is a state of fulfillment of basic needs, dynamic in which the physical and psychosocial changes affect one's health. Every individual have the right to be born healthy, so women and mothers have to get quality health services.

2.7 The Professionalism Quality of Maternity Nurse Some actions that the professionalism quality of maternity nurse is as follows. 1. Improving family health that focuses on the current condition of mother and family planning. 2. Provide effective antenatal care for pregnant women through antenatal visits.

3. Providing physical and psychological support during birth. 4. Provide comprehensive nursing care to baby, mother and family during the post partum. 5. Provide nursing services to baby until the age of 40 days . 6. Provide comprehensive services to women outside the perinatal period. 7. Using a systematic problem solving process in implementing the nursing care.

2.8 The Role of Maternity Nurse According to a consortium of health science in 1989, the nurse's role as provider of nursing care, advocate, educator, coordinator, collaborator, consultant, and researcher. The role of maternity nurse is not much different from the role of nurses in general. The role of maternity nurse is to provide nursing care, as an advocate, educator, coordinator, collaborator, consultant, and researcher on women of childbearing age, pregnant women, women giving birth, postpartum mother, newborns through age 40 days, and family.

2.9 Activities in Maternity Nursing The activities undertaken in maternity nursing including : 1. 2. advocacy and educate women of childbearing age; perform nursing actions in addressing the problem of pregnancy childbirth and postpartum; 3. assist and detect early deviations from normal condition during pregnancy until birth; 4. 5. 6. 7. provide consultation on prenatal care; control of birth; assist in the birth process and help normal birth; caring for women during childbirth and newborns up to age 40 days to independence; and 8. referring to other health team for conditions that require further treatment.

2.10 Nursing Process in Maternity Nursing 2.10.1 Assessment Assessment in pregnant women includes: 1. History of pregnancy Provide important information about previous pregnancies for nurses to determine possible problems in pregnancy now, includes: a. gravida and abortion; b. infant birth weight and gestational age; c. experience, type, place and helper of birth; d. type of anesthesia and birth difficulties; e. maternal complications such as diabetes and hypertension; f. complications in infants; and g. infant feeding plan; 2. Menstrual history Menstrual history includes: a. b. c. last menstrual; the interval between menstrual periods; and approximate date of birth.

3. History of contraception Some forms of contraception may be detrimental to the fetus, mother, or both. A complete history of contraception must be obtained during the first visit. Use of oral contraception before birth and continues during pregnancy which not known can have a negative impact on the formation of the sexual organs of the fetus. 4. History of disease and surgery 5. Medical history Medical history includes: a. age; b. chronic disease; c. previous disease; d. previous infection;

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e. smoke; f. contact with pets; g. allergies and sensitive to the drug; h. the work associated with disease risk; and i. family history. 6. Physical examination Physical examination includes: a. vital signs include, blood pressure, pulse, respiration, and temperature; b. cardiovascular system; c. musculoskeletal system; d. neurological system; e. integumentary system; f. the endocrine system; g. gastrointestinal system; h. urinary system; and i. reproductive system.

2.10.2 Nursing Diagnosis 1. Trimester 1 a. Anxiety b. Painful c. Nutrition disorders

d. Changes in patterns of sexual 2. Trimester 2 a. Painful b. Impaired self-image c. Changes in the family d. Anxiety e. Changes in patterns of sexual 3. Trimester 3 a. Painful

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b. Ineffective breathing pattern c. Changes in sleep patterns d. activity intolerance e. Changes in patterns of sexual

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BAB 3. CONCLUSION

Maternity nursing is one of nursing service which aimed to women include reproduction system, pregnancy period, childbirth period, and postpartum period, newborn babies up to age 40 days, and family. Maternity nursing is a term used to describe the awarding of nursing care safely and quality, focused, and adapt to the physical and psychosocial needs of pregnant women, families, and newborns. The role of maternity nurses different with nurses in other health services. A large number of maternity nurses take the time to teach pregnancy, birth process, childbirth and recovery, and skill to be a parent. Maternity nurses are required to be able to solve the problems that occur in maternity nursing. Thus, are needed professional nurse and able to respond appropriately to the maternity health problems.

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BIBLIOGRAPHY

Bobak, Irene M., Lowdermilk, Deitra Leonard, and Jensen, Margaret Duncan. 2004. Buku Ajar Keperawatan Maternitas. Jakarta: EGC. Tucker, Canobbio, Paquette, and Wells. 1998. Standar Perawatan Pasien: Proses Keperawatan, Diagnosis, dan Evaluasi. Jakarta: EGC. Wulaningsih, Indah. 2008. Profesionalisme Pelayanan Keperawatan Maternitas. Jurnal.pdii.lipi.go.id/admin/Jurnal/21081521. [16 Oktober 2011].

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