CORRELATION BETWEEN PARITY AND THE IMPLEMENTATION OF
EARLY INITIATION OF BREASTFEEDING (EIBF) IN CIPARAY HEALTH CENTER AT BANDUNG DISTRICT PERIOD MARCH - JUNE 2019
Ratih Ruhayati, Cici Liska, Sri Sylvia Dewi ratihruhayati@gmail.com
Indonesian High School of Health (STKINDO) Wirautama Bandung ABSTRACT
Early Initiation of Breastfeeding (EIBF) is an opportunity given to babies to be able to breastfeed naturally as soon as the baby is born by putting the baby on the mother's stomach. This process is carried out approximately 60 minutes or 1 hour after the baby is born. According to data from WHO with the implementation of EIBF can reduce 22% of deaths of infants in 28 days, and provide opportunities for mothers to successfully give exclusive breastfeeding to babies compared to mothers who do not do EIBF. Based on the results of the Basic Health Research (Riskesdas) the proportion of early initiation of breastfeeding (EIBF) at 2018 in Indonesia, is still at 58.2%, just as in West Java the proportion of early initiation of breastfeeding (EIBF) in 2018 was 61.0 %.
The study design used was cross-sectional, to determine the correlation of parity with the implementation of EIBF in Ciparay Community Health Center, Bandung District Period March - June 2019. In this study, the variable are parity and implementation of observation of early initiation of breastfeeding (EIBF). The population used in the study was 77 mothers who gave birth at the Ciparay Community Health Center. The sampling technique used is saturated sampling (total sample), with a total of 77 samples. Analysis of the data used is the chi-square test.
The results showed that for the parity variable as many as 23 respondents (30.0%) were primiparous and the remaining 54 respondents (70.0%) were multiparous. As for the EIBF variable as many as 25 respondents (32.5%) succeeded in doing EIBF and the remaining 52 respondents (67.5%) did not succeed in doing EIBF.
The results of the chi-square test analysis found no significant correllation between parity and the implementation of EIBF ( = 0.369).
So it can be concluded that the implementation of early initiation of breastfeeding (EIBF) in Ciparay Community Health Center was largely unsuccessful in conducting EIBF, and this did not have a significant correllation with maternal parity
Keywords:Early initiation of breastfeeding (EIBF), Parity, Ciparay Community Health Center.
INTRODUCTION
Early Initiation of Breastfeeding (EIBF) is an opportunity given to babies to be able to breastfeed naturally as soon as the baby is born by putting the baby on the mother's stomach. This process is carried out approximately 60 minutes or 1 hour after the baby is born. The benefits of carrying out EIBF for the mother are helping the uterus to contract so that it stimulates the removal of the placenta and reduces bleeding after childbirth, increases milk production, and increases the fabric of maternal and infant love. While the benefits for the baby are preventing heat loss (hypothermia), helping the
baby coordinate suction, swallowing and breathing (Menkes, 2010; Fikawati, 2015)
Early Initiation of Breastfeeding (EIBF) provides an opportunity for mothers to successfully give exclusive breastfeeding to babies compared to mothers who do not do EIBF. Also, EIBF can reduce 22% of infant mortality by 28 days (World Health Organization, 2014; Fikawati, 2015).
The results of the Basic Health Research (Riskesdas) in Indonesia, showed the proportion of Early Initiation of Breastfeeding (EIBF) increased from 34.5% in 2013 to 58.2% in 2018. Similar in the Province of West Java the proportion of Early Initiation of Breastfeeding (EIBF) increased from
48.0% in 2013 to 61.0% in 2018 (Ministry of Health Research and Development Agency, 2018).
One of the Puskesmas in the Bandung Regency, West Java Province, is the Ciparay Health Center. Based on data from the Ciparay Community Health Center the number of live births in 2018 was 1,064, with 966 (90.79%) babies born normally and 98 babies (9.21%) born with complications. In labor with a normal-born baby, EIBF must be carried out, because each Puskesmas has a standard operating procedure (SOP) for implementing Early Initiation of Breastfeeding (EIBF), and this must be applied to all labor processes. (Data of the Ciparay Health Center Report, 2019).
Republic of Indonesia Government Regulation Number 33 of 2012 in Chapter III, Part Two of Article 9 which states that health workers and providers of health care facilities are required to Early Initiation of Breastfeeding (EIBF) for newborns to their mothers for a minimum of 1 hour.
IMD Stages: Cry: signs of the lungs begin to function, Relaxation: the baby seems calmer, Awake: Eyes open 3 minutes after birth, Active:
reflex rooting 5 minutes after birth, Rest: may occur several times during EIBF, Crawling: approaching the breasts 35 minutes after birth, Habit: lick the nipples, touch and massage the breasts 45-60 minutes after birth, Breastfeeding: attach to the breast and suck colostrum, Sleep: fall asleep for 1.5- 2 hours ( Roesli, 2012).
Based on Fara Yumastura's research (2017) on the description of the implementation of early breastfeeding in the Independent Practice Midwife in the Work Area of the Padang City Health Center, the implementation of early initiation of breastfeeding (EIBF) carried out for 60 minutes was 30.6%, while the implementation of early breastfeeding in less than 60 minutes was 69 4%.
Yeti Yuwansyah's research (2017) regarding factors related to the implementation of early initiation of breastfeeding (EIBF) in women in the UPTD Work Area of Cigasong Health Center, Majalengka Regency, shows that the factors that are significantly related to the implementation of EIBF are the maternal condition, maternal attitudes, and parity. Vera Yusnita (2012) regarding the factors that influence the implementation of early initiation of breastfeeding (EIBF) at the East Agam Health
Center, according to the results of research that carried out EIBF as much as 42.8% and those who did not do EIBF 57.1%, with factors affecting the implementation of EIBF were knowledge, parity, labor, family support, and midwife behavior.
Parity is the condition of giving birth to a child whether alive or dead, but not abortion, regardless of the number of children. With high parity, it is assumed that mothers have better and more knowledge and experience than those who first give birth. Likewise, with the implementation of EIBF, mothers who have knowledge and experience can carry out EIBF at the time of delivery. (Varney, 2006)
Mothers and children are priority groups in the implementation of health efforts because the health of mothers and children is an indicator of the success of a nation's health development. Efforts to maintain children's health are aimed at preparing healthy, intelligent and quality future generations and to reduce child mortality. This effort was carried out since the fetus was still in the womb, born, after birth, and until the age of 18 years. WHO recommends early initiation of breastfeeding (EIBF), which is putting the baby on the mother's breast immediately after the baby is born with the skin to skin method, the baby's head placed between the breast of the mother and then letting the baby with his instincts look for his mother's mother's papillae, with a minimum of 60 minutes or 1 hour.
(Ministry of Health, 2010)
Based on this background, the authors are interested in examining the correllation of parity with the implementation of early initiation of breastfeeding (EIBF) at the Ciparay Community Health Center, Bandung District, Period March to June 2019.
METHODS
This research is a cross-sectional analytic study, in which the researcher conducts a parity assessment and the implementation of early initiation of breastfeeding (EIBF) using observation. In this study, the variables studied were parity and early initiation of breastfeeding (EIBF) in Ciparay Public Health Center, Bandung District Period March to June 2019. (Sugiyono, 2016: 58).
Table 1 Operasional Definition
No Variable Operasional Definition Instrument Category Scale
1 The implementation of early initiation of breastfeeding
An action or implementation of the baby's stomach in the mother's breast with the baby's skin attached to the skin of the mother, the mother and baby covered, the mother touches the baby to stimulate the baby, the baby is looking for the mother's nipples, and the baby's skin and mother's skin is attached for 1 hour. (Roesli, 2012: 21)
Job Sheet 1. Succeed doing IMD, if the 9 steps IMD are done.
2. Not succeed in doing IMD, if one of the 9 steps of IMD is not done.
(Roesli, 2012: 21)
Nominal
2 Parity The birth of a baby that can survive. (Varney, 2006)
Status Patient 1. Primiparous :
< 2
2. Multiparous :
≥ 2
Nominal
The population in this study is the average number of mothers giving birth per month in the Ciparay Community Health Center, Bandung District, period January to March 2019, which is 77 people. While the sampling technique used is saturated sampling or total sample, because the population is less than 100. So the number of samples to be used is 77 mothers giving birth at the Ciparay Community Health Center, Bandung District.
The data used consists of primary and secondary data. Primary data obtained by observation of mothers who were giving birth then observed the implementation of early initiation of breastfeeding (EIBF) for 1 hour. Observations made are a type of non-participatory observation, where the researcher is not united with what is studied, the researcher is merely an observer. Secondary data used are maternal identity and parity obtained from
patient status records at the Ciparay Community Health Center. Data analysis in this study uses across the table to find out the tendency of the correllation between 2 (two) variable. Because the scale of the independent variable and the dependent variable is categorical (nominal), the analysis used is the Chi-Square Test. (Notoatmodjo, 2010: 182;
Sugiyono, 2016: 145).
RESULTS AND DISCUSSION
Research on the correllation of parity with the implementation of early initiation of breastfeeding (EIBF) at the Ciparay Community Health Center, Bandung District, period March to June 2019, has been carried out on 77 mothers who were giving birth at the Ciparay Community Health Center, Bandung District. The results of the descriptive analysis of the observations made are as follows:
Table 2. Distribusi Frekuensi Parity & Implementation of Early Initiation of Breastfeeding (EIBF) in Ciparay Community Health Center
No Variable Category Amount
n=77 %
1 Parity Primiparous 23 30,0
Multiparous 54 70,0
2 EIBF Succeed 25 32,5
Not succeed 52 67,5
Source : Secondary & Primary Data, 2019
Based on table 2, it can be explained that of the 77 mothers giving birth, most of the 55 respondents (70,%) were multiparous and the remaining 23 respondents (30.0%) were primiparous.
Based on table 2, it can be explained that from the results of observations made to mothers giving
birth at the Ciparay Community Health Center, most of the 52 respondents (67.5%) did not succeed in implementing the early initiation of breastfeeding (EIBF), and the remaining 25 respondents (32.5%) succeeded implement early initiation of breastfeeding (EIBF)
Table 3. Correlation between Parity and Implementation of Early Initiation of Breastfeeding (EIBF) in Ciparay Community Health Center
Variable
Implementation of EIBF
ρ
Not succeed Succeed Amount
n= 52 % n= 25 % n= 77 %
Parity
1. Primiparous 2. Multiparous
14 38
60,9 70,4
9 16
39,1 29,6
23 54
100 100
0,369 Source: Chi Square test, with meaning value ρ ≤ 0,05
Based on the table above it can be seen that the correlation of parity variable with the implementation of EIBF shows the value of ρ = 0.369 < 0.05 so it can be said that parity with the implementation of EIBF shows no significant correlation.
This research was conducted on 77 respondents, this study aimed to examine the correllation of parity with the implementation of early initiation of breastfeeding (EIBF) in Ciparay Health Center. The results showed that for the parity variable as many as 23 respondents (30.0%) were primiparous and the remaining 54 respondents (70.0%) were multiparous. As for the EIBF variable as many as 25 respondents (32.5%) succeeded in doing EIBF and the remaining 52 respondents (67.5%) did not succeed in doing EIBF. The results of the chi-square test analysis found no significant corellation between parity and the implementation of EIBF (ρ = 0.369).
Early initiation of breastfeeding (EIBF) is a breastfeeding process that starts as soon as possible.
EIBF is done by letting the baby skin contact with the skin of his mother for at least the first hour after birth or until the initial breastfeeding process ends.
The way babies do EIBF is called the breast crawl or crawl looking for breasts. Early initiation of breastfeeding (EIBF) will be very helpful in the continuity of exclusive breastfeeding and the duration of breastfeeding. Thus, the baby will be met until the age of 2 years and prevent undernourished children. (Roesli, 2012; Maryunani, 2015).
The steps that must be taken when EIBF is when a newborn baby, the baby is immediately dried and placed on the mother's stomach, then the umbilical cord is cut so that after that the baby is bent on the mother's chest so that the baby's skin is attached to the mother's skin, after which the mother and baby are covered and the baby is given a hat.
Next, the mother is advised to hug her baby to stimulate the baby to look for nipples. This must be
The implementation of EIBF is said to be successful if the baby is placed on the mother's chest with the baby's skin attached to the mother's skin, the mother and baby are covered together, the baby is given a hat, the mother touches the baby to provide stimulation to the baby, the baby is looking for the mother's nipple to suckle early and the baby's skin and mother's skin clings for 1 hour.
Implementation is an action or behavior from a plan that has been prepared in a mature and detailed, implementation of the implementation of activity is usually done after planning is considered ready.
Including the implementation of EIBF, EIBF will be carried out if all the components are ready, be it standard operating procedures (SOP), infrastructure, midwives as caregivers in the delivery process and also mothers who are giving birth (Roesli, 2012).
The factors that support early breastfeeding initiation consist of standard operating procedures (SOP), in the Ciparay Community Health Center there are SOPs regarding the implementation of EIBF that must be carried out in the delivery process, as well as the facilities and infrastructure for implementing EIBF as well, the number of beds and rooms that are available. closed allows for maternal EIBF to do at least 1 hour. The mother's room and baby's room are not separated so that the mother can make contact with the baby at any time for 24 hours.
Another factor is the physical and psychological readiness of the mother that must be prepared since pregnancy, most respondents said that since pregnancy Midwives provide information about the delivery process including the implementation of EIBF so that during delivery the respondent is not surprised and refuses during EIBF.
But some respondents initially refused because they were still exhausted and wanted to rest. Some respondents also did not bring a baby head covering (hat) to carry out EIBF, so that the baby remained warm.
Another factor is Midwives as health workers who provide childbirth care, including EIBF. Some midwives take the baby from the mother before 1 hour with the reason will be examined on newborns and other care on newborns. Besides, this often happens when there are many patients giving birth and midwives who are guarding less, so no one is watching the baby during EIBF. (Roesli, 2012;
Maryunani, 2015).
Based on the results of the study showed that the implementation of EIBF at the Ciparay Community Health Center was largely unsuccessful at doing EIBF, which was 52 respondents (67.5%).
This result is in line with research conducted by Bambang Budiraharjo (2014) on the Practice of early initiation of breastfeeding (EIBF) at the Limbangan Health Center, which states that of the 200 respondents, the majority of which are 103 people (51.5%) do not do IMD, and the remaining 97 people (48.5%) did EIBF. Likewise with the results of Fara Yumastura's research (2017) on the description of the implementation of early breastfeeding initiation in the Independent Practice Midwife in the Work Area of Padang City Health Center, the implementation of early breastfeeding which was carried out for 60 minutes was 30.6%, while the implementation of early breastfeeding was less than 60 minutes as much as 69.4%.
(Budiraharjo, 2014; Yumastura, 2017).
Based on the results of the chi-square test showed that there was no significant relationship between parity with the implementation of EIBF, with a value of ρ = 0.369. The results of this study are not in line with Roesli's statement that parity influences the process of early initiation of breastfeeding (Roesli, 2012) This result is in line with Aik Khoniasari's (2015) research, regarding the influence of parity, maternal knowledge, family support and the role of health workers in the implementation of early breastfeeding initiation in Salatiga Regional Hospital, which states that there are two insignificant variables, namely parity, and family support. These results are also in line with Anni Seciawati's research (2017), about the Elements related to the Success of early initiation of breastfeeding (EIBF) in BPM Midwife "B" Sukasari Serang Baru, Bekasi District, which states that of the 5 elements studied, only 1 significant element is the attitude of the midwife, while the 4 other elements consisting of education, knowledge, parity and family support have no corellation with the
implementation of EIBF. (Khoniasari: 2015;
Seciawati: 2017)
The implementation of early breastfeeding is influenced by many factors, not only from the mother's factor, but also the factor of health workers is very influential. Therefore the role of health workers in the successful implementation of early initiation of breastfeeding (EIBF) is worth considering.
CONCLUSIONS
Based on the results of research that have been conducted with the title "Correlation Parity and the implementation of early initiation of breastfeeding (EIBF) at the Ciparay Community Health Center, Bandung District Period March - June 2019 ", the results showed that for the parity variable as many as 54 respondents (70.0%) were multipara. As for the EIBF variable of 52 respondents (67.5%) did not succeed in doing the EIBF. The results of the chi- square test analysis found no significant corellation between parity and the implementation of EIBF (ρ
= 0.369).
So it can be concluded that the implementation of early initiation of breastfeeding (EIBF) at the Ciparay Community Health Center was largely unsuccessful in conducting EIBF, and this did not have a significant correlation with maternal parity.
It is expected that health workers can carry out EIBF in accordance with the steps contained in the SOP so that the baby can successfully perform EIBF, besides midwives are required to provide information about EIBF to the mother, so that the maternity mother knows more about the benefits of implementing EIBF in newborns and is willing to do so, and also make preparations since pregnancy.
With this research, it is expected that the Community Health Center will conduct monitoring so that every delivery process can be carried out by EIBF, bearing in mind the benefits gained by mothers and babies are numerous.
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