ABSTRAK Masih tingginya angka kematian neonatal di Indonesia dimana masih mencapai 34/1000 kelahiran hidup. Penyebab kematian neonatal tersebut antara lain adalah disebabkan oleh tetanus neonatorium, diare, pneumoni dan infeksi tali pusat yang mencapai 57,1 % (Djaja, 2003). Dari beberpa penelitian perawatan tali pusat menunjukkan pengaruh metoda terhadap lama puput dan terjadinya infeksi. Penelitian ini merupakan penelitian observasional dengan desain kohort karena melakukan observasi terhadap perawatan tali pusat sampai lepas puput tali pusat yang bertujuan untuk mengetahui hubungan metoda perawatan tali pusat terhadap lama puput tali pusat. Populasi penelitian adalah bayi sehat yang lahir secara spontan di Rumah Sakit Kesdam Jaya Jakarta dibagi tiga populasi untuk masing-masing metoda sebesar 24 bayi. Analisis data meliputi analisa univariat, analisis bivariat dengan uji chi square. Untuk melihat hubungan antara variabel bebas dengan variabel terikat dan analisis multivariat dengan uji regresi logistik untuk melihat faktor yang paling dominan. Hasil analisis multivariat menunjukkan bahwa terdapat 5 variabel yang berhubungan dengan lama puput tali pusat di Rumah Sakit Kesdam Jaya Jakarta yaitu variabel metoda perawatan tali pusat, timbulnya infeksi, cara perawatan, kelembaban tali pusat dan sanitasi lingkungan. Sedangkan berat lahir bayi dan lingkar tali pusat tidak berhubungan. Variabel yang paling dominan berhubungan dengan lama puput tali pusat adalah timbulnya infeksi dan sanitasi lingkungan . Hasil penelitian menunjukkan rerata waktu pelepasan tali pusat yang dirawat dengan metoda kering terbuka adalah 4,58 hari, kering tertutup 6,58 hari dan alkohol 8,46 hari. Bila dibandingkan perbedaan rata rata lama puput antara metoda alkohol dengan kering terbuka 3,38 hari, antara metoda alkohol dengan kering tertutup 1,88 hari dan antara metoda kering terbuka dengan kering tertutup 2,00 hari (p=0,000) terdapat perbedaan yang bermakna. Sehingga dapat ditarik kesimpulan perawatan tali pusat metoda kering terbuka puput lebih cepat dibandingkan metoda alkohol dan kering tertutup. Disarankan kepada rumah bersalin dan bidan dapat menerapkan dan dapat memberikan pendidikan kesehatan yang benar kepada ibu yang baru melahirkan agar dapat melaksanakan metoda dan cara perawatan tali pusat yang baik.

ABSTRACT Neonatal mortalities in Indonesia are still high reached 34/1000 live births. Some of them are caused by neonatarium tetanus, diarhea, pneumonia and umbilical cord infection that reach 57.1% (Djaja, 2003). Some researches show that there are influences of umbilical cord treatment method to the length of umbilical cord separation and infection occurance. This study is an observational research using kohort design because it observed the umbilical cord treatment till its separation that aims at knowing the correlation of the umbilcal cord treatment method to the length of its ravelation. The population of this study are normal born healthy babies in Kesdam Jaya Jakarta Hospital which are devided into three populations with 24 babies for each method. The data analysis includes univariat analysis; bivariat analysis with chi square test to see the correlation between independance variable and dependance variable; and multivariat analysis with logistic regression test to see the most dominant factor. Multivariat analysis results show that there are 5 variables related to the long of umbilical cord separation in kesdam jaya jakarta hospital, that are umbilical cord treatment method, infection occurrence, treatment ways, umbilical cord humidity, and environmental sanitation. While babies? birth weight and the umbilical cord bend are not related. The most dominant variables related to the the long of umbilical cord revelation are the infection occurence and environmental sanitation. The results show that the time average of umbilical cord ravelation with dry-open treatment method is 4.58 days, 6.58 days with dry-closed method, and 8.46 days with alcohol method. The time average comparation between alcohol and dry-open method is 3.38 days, alcohol and dry-closed method is 1.88 days, and between dry-open and dry-closed method is 2.00 days (p=0.000) which means there is a difference. Therefore, it can be concluded that the umbilical cord ravelation treatment with dry-open method is faster than alcohol and dry-closed method. It is recommended to the maternity home and the midwife to apply and provide the proper health education to new mothers who give birth in order to implement the proper umbilical cord treatment methods.;Neonatal mortalities in Indonesia are still high reached 34/1000 live births. Some of them are caused by neonatarium tetanus, diarhea, pneumonia and umbilical cord infection that reach 57.1% (Djaja, 2003). Some researches show that there are influences of umbilical cord treatment method to the length of umbilical cord separation and infection occurance. This study is an observational research using kohort design because it observed the umbilical cord treatment till its separation that aims at knowing the correlation of the umbilcal cord treatment method to the length of its ravelation. The population of this study are normal born healthy babies in Kesdam Jaya Jakarta Hospital which are devided into three populations with 24 babies for each method. The data analysis includes univariat analysis; bivariat analysis with chi square test to see the correlation between independance variable and dependance variable; and multivariat analysis with logistic regression test to see the most dominant factor. Multivariat analysis results show that there are 5 variables related to the long of umbilical cord separation in kesdam jaya jakarta hospital, that are umbilical cord treatment method, infection occurrence, treatment ways, umbilical cord humidity, and environmental sanitation. While babies? birth weight and the umbilical cord bend are not related. The most dominant variables related to the the long of umbilical cord revelation are the infection occurence and environmental sanitation. The results show that the time average of umbilical cord ravelation with dry-open treatment method is 4.58 days, 6.58 days with dry-closed method, and 8.46 days with alcohol method. The time average comparation between alcohol and dry-open method is 3.38 days, alcohol and dry-closed method is 1.88 days, and between dry-open and dry-closed method is 2.00 days (p=0.000) which means there is a difference. Therefore, it can be concluded that the umbilical cord ravelation treatment with dry-open method is faster than alcohol and dry-closed method. It is recommended to the maternity home and the midwife to apply and provide the proper health education to new mothers who give birth in order to implement the proper umbilical cord treatment methods.;Neonatal mortalities in Indonesia are still high reached 34/1000 live births. Some of them are caused by neonatarium tetanus, diarhea, pneumonia and umbilical cord infection that reach 57.1% (Djaja, 2003). Some researches show that there are influences of umbilical cord treatment method to the length of umbilical cord separation and infection occurance. This study is an observational research using kohort design because it observed the umbilical cord treatment till its separation that aims at knowing the correlation of the umbilcal cord treatment method to the length of its ravelation. The population of this study are normal born healthy babies in Kesdam Jaya Jakarta Hospital which are devided into three populations with 24 babies for each method. The data analysis includes univariat analysis; bivariat analysis with chi square test to see the correlation between independance variable and dependance variable; and multivariat analysis with logistic regression test to see the most dominant factor. Multivariat analysis results show that there are 5 variables related to the long of umbilical cord separation in kesdam jaya jakarta hospital, that are umbilical cord treatment method, infection occurrence, treatment ways, umbilical cord humidity, and environmental sanitation. While babies? birth weight and the umbilical cord bend are not related. The most dominant variables related to the the long of umbilical cord revelation are the infection occurence and environmental sanitation. The results show that the time average of umbilical cord ravelation with dry-open treatment method is 4.58 days, 6.58 days with dry-closed method, and 8.46 days with alcohol method. The time average comparation between alcohol and dry-open method is 3.38 days, alcohol and dry-closed method is 1.88 days, and between dry-open and dry-closed method is 2.00 days (p=0.000) which means there is a difference. Therefore, it can be concluded that the umbilical cord ravelation treatment with dry-open method is faster than alcohol and dry-closed method. It is recommended to the maternity home and the midwife to apply and provide the proper health education to new mothers who give birth in order to implement the proper umbilical cord treatment methods., Neonatal mortalities in Indonesia are still high reached 34/1000 live births. Some of them are caused by neonatarium tetanus, diarhea, pneumonia and umbilical cord infection that reach 57.1% (Djaja, 2003). Some researches show that there are influences of umbilical cord treatment method to the length of umbilical cord separation and infection occurance. This study is an observational research using kohort design because it observed the umbilical cord treatment till its separation that aims at knowing the correlation of the umbilcal cord treatment method to the length of its ravelation. The population of this study are normal born healthy babies in Kesdam Jaya Jakarta Hospital which are devided into three populations with 24 babies for each method. The data analysis includes univariat analysis; bivariat analysis with chi square test to see the correlation between independance variable and dependance variable; and multivariat analysis with logistic regression test to see the most dominant factor. Multivariat analysis results show that there are 5 variables related to the long of umbilical cord separation in kesdam jaya jakarta hospital, that are umbilical cord treatment method, infection occurrence, treatment ways, umbilical cord humidity, and environmental sanitation. While babies’ birth weight and the umbilical cord bend are not related. The most dominant variables related to the the long of umbilical cord revelation are the infection occurence and environmental sanitation. The results show that the time average of umbilical cord ravelation with dry-open treatment method is 4.58 days, 6.58 days with dry-closed method, and 8.46 days with alcohol method. The time average comparation between alcohol and dry-open method is 3.38 days, alcohol and dry-closed method is 1.88 days, and between dry-open and dry-closed method is 2.00 days (p=0.000) which means there is a difference. Therefore, it can be concluded that the umbilical cord ravelation treatment with dry-open method is faster than alcohol and dry-closed method. It is recommended to the maternity home and the midwife to apply and provide the proper health education to new mothers who give birth in order to implement the proper umbilical cord treatment methods.] File Digital: 1

Salah satu upaya menunmkan angka kesakitan dan kematian ibu adalah melalui pemberian pelayanan yang berkualilas. Pelayanan yang berkualitm dapai di wujudkan dengan adanya tenaga kesehatan yang kompeten, termasuk bidan di desa. Desain Penelitian dengan cross sectional untuk mengelahui kompetensi dan kinexja bidan di desa dalam melaksanakan pelayanan asuhan parsalinan nommal di Kabupaten Bengkayang lahun 2008. Populasi adalah bidan di desa yang bertugas di polindes. Sampel pmelitian ini adalah semua bidan di desa yang bexjumlah 53 orang yang sudah meudapatkan pelatihan asuhan persalinan normal (APN). Hasil penelitian menunjukkan sebagian besar (83,2%) bidan di desa kurang kompeten mc-laksanakan suhan persalinan normal (APN). Kompetensi merupakan faktor yang bermalcna terhadap kinexja bidan di desa dalam melaksanakan asuhan persalinan nomml berdmarkan indikator cakupan persalinan dengan Oddss Ratio 31 (95% CI: 3,4 - 28l,9) dan berdasarkan persentase kasus yang di mjuk pada alpha 5% terdapat perbedaan yang signiiikan antara rata-rata persentase kasus komplikasi persalinan yang di rujuk oleh bidan di desa dengan kompetensi. Bidan yang kurang kompelen merujuk rata-rata 13 % kasus komplikwi persalinan, sedangkan bidan yang kompeten merujuk rata-rata 4 % kmus komplikasi persalinam Vayiabel lain yang bennakna dengan lcineaja adalah pengalaman kelja bidan di desa dengan Oddss Ratio 6,7 (95% CI: 1,3 - 3317). Variabel pendidikan, umur, peralatan dan bahan menunjukkan hubungan yang tidak bemiakna. Oleh karena itu kompelensi bidan di dwa perlu ditingkatlcan bukan hanya dengan pelatihan saja tetapi perlu ditindak lanjuti dengan supervisi yang teerprogram dan uji sertifikasi kompefersi oleh suatu badan yang terakreditasi.

One of effort for decrease of morbidity and maternal mortality be giving a quality health care.That is necessary human resources of health which having competency, included midwife in the village This research to be done with cross- sectional design for knowing competency of midwife in the village on going nomially birth attendant care at Bengkayang District 2008. Population research are midwives in tlievillage which on duty at the village centre attendant Samples research are all of the midwives intthe village, there are 53 persons which got training normally birth attendant care. The result showed most of midwifes (83,2%) have not enough competent on going normally birth attendant care. Competency is afsigniticant factor to midwife performent on going normally birth attendant indicated birth attendant target with Odds Ratio '31 (95% CI:3,4 - 28I,9) and presentation of cases refered on alpha 5 %, there is a differentiation signilicantly between mean procentace cased refered with competency. The village's midwives which not enough competent refered mean 13% cases birth attendant complication, the midwives in the village which competent refered 4 % cases birth attendant complication. Significant variable with perrofmmtee is experienee job, odds nano 6,1 (95% cr; 1,3 _ sag). Another variables are educatiorg age and equipment showed not significant. That is why competency of the midwivx in the village necessary to be increased not only with training but also a programmly supervising and competency sertilication test from accreditation organization.

Setiap tahunnya, 585.000 ibu meninggal akibat komplikasi kehamilan dan persalinan, dan hampir 99% dari kematian tersebut terjadi di negara berkembang. Pada tahun 1995, Angka Kematian Ibu (AKI) di Indonesia di perkirakan sekitar 373 per 100.000 kelahiran hidup. Angka tersebut merupakan yang tertinggi dibandingkan negara ASEAN. Persalinan lama atau macet merupakan salah satu dari lima penyebab kematian ibu di negara berkembang. Berdasarkan hasil SKRT 1995, persalinan lama juga merupakan komplikasi persalinan yang paling sering dikeluhkan oleh ibu. Persalinan lama atau macet merupakan satu-satunya komplikasi persalinan yang mengakibatkan begitu banyak morbiditas kronis. Tujuan penelitian ini adalah untuk mengetahui hubungan antara penolong persalinan dengan kejadian persalinan lama, faktor-faktor yang berhubungan dengan persalinan lama dan untuk mengetahui informasi mengenai kebijakan dan program penatalaksanaan persalinan lama di tingkat pelayanan kesehatan dasar dan rujukan. Penelitian ini memadukan metode kuantitatif dan kualitatif. Metode kuantitatif menggunakan data Studi Morbiditas dan Mortalitas SKRT 1995 di Jawa Barat, sedangkan metode kualitatif menggunakan wawancara mendalam dan studi kasus di Kabupaten Tangerang. Hasil penelitian memperlihatkan bahwa angka kejadian persalinan lama di Jawa Barat sebesar 6,4%. Analisis data multivariat menemukan bahwa penolong persalinan dan tempat tinggal berhubungan dengan persalinan lama. Ibu yang tinggal di desa berpeluang mengalami persalinan lama 2,7 kali dibandingkan ibu yang tinggal di kota setelah dikontrol variabel penolong persalinan. Penelitian ini menunjukkan bahwa asuhan persalinan oleh tenaga kesehatan terlatih dapat menurunkan risiko komplikasi persalinan. Persalinan lama sering terlambat dirujuk karena dukun tidak mampu menilai kemajuan persalinan dan tidak mengetahui tanda-tanda atau penyebab ketika persalinan lama terjadi. Program pencegahan persalinan lama harus ditujukan untuk meningkatkan cakupan persalinan oleh tenaga kesehatan terlatih, menyediakan kartu sehat bagi kelurga tidak mampu, memperbaiki sistem transportasi, menunda pernikahan melalui program wajib belajar sembilan tahun serta meningkatkan status gizi dan kondisi lingkungan anak perempuan sehingga mereka dapat mencapai tinggi badan yang optimal.

Relationship between Birth Attendant and the Occurance of Prolonged Labor in West JavaAt least 585,000 women die each year from the complications of pregnancy and childbirth, and almost 99% of these deaths occur in developing countries. In 1995, Maternal Mortality Ratio (MMR) in Indonesia is estimated 373 per 100,000 live births. This figure is relatively high when compares to ASEAN countries. Prolonged or obstructed labor is one of the five major causes of maternal mortality in developing countries. Based on the 1995 Household Health Survey, prolonged labor is also the most common reported obstetric complication. No other complication of delivery is associated with as much chronic morbidity as prolonged or obstructed labor. The purposes of this research are to examine the relations between birth attendant and prolonged labor, to examine factors that might affects the occurance of prolonged labor and to review the policies and programs on the management of prolonged labor at primary and referral health services. This research combined quantitative and qualitative method. The quantitative method used the Maternal Morbidity and Mortality data from the 1995 Household Health Survey in West Java, and qualitative method used in-depth interview and case study in the District of Tangerang_The result showed that the prevalence of prolonged labor in West Java was 6.4%. The multivariate logistic regression analysis found that the birth attendant and the residence were associated with the occurance of prolonged labor. Women who lived in the rural area are 2.7 times as likely to experience prolonged labor than those who lived in the urban area, controlled by birth attendant. This study revealed that delivery care by trained health care provider could reduce the risks of prolonged labor. Prolonged labour were often referred too late because the traditional birth attendant (TBA) could not be able to assess the progress of labor, they did not know the symptoms and the causes when prolonged labour occur. Intervention programs should be directed to increase the coverage of delivery attended by trained health care provider, provide health card for poor family, improve transportation system, delay marriage until women have reached full physical maturity through compulsory universal education and improve nutrition status and living conditions for girls to prevent stunded growth.