Antenatal care practice and the chance of having nurse/midwife birth attendant: a study in Central Mountain of Papua

Abstrak Latar belakang: Papua merupakan salah satu propinsi di Indonesia dengan angka kematian ibu tertinggi di Indonesia. Penolong persalinan terlatih dan asuhan antenatal (ANC) merupakan salah satu faktor yang penting untuk menurunkan angka kematian ibu. Tujuan studi ini untuk mengidentifikasi pengaruh ANC dan beberapa faktor yang lain terhadap kemungkinan persalinan yang ditolong oleh perawat/bidan di Papua. Metode: Studi potong lintang dengan sampling purposif dilakukan terhadap perempuan yang mempunyai anak balita yang datang ke Posyandu pada 15-30 Januari 2014 di 24 desa wilayah pegunungan tengah Jayawijaya, Papua. Karakteristik demografi, praktek ANC dan persalinan didapatkan melalui wawancara. Subjek diklasifikasikan ke dalam 2 kelompok, yang bersalin didampingi perawat/bidan) dan yang menolong sendiri atau ditolong keluarga. Analisis dilakukan dengan regresi Cox dengan waktu konstan. Hasil: Dari 469 subjek, 391 subjek yang dianalisis terdiri dari 280 subjek yang melahirkan ditolong sendiri/keluarga dan 111 subjek yang ditolong perawat/bidan. Subjek yang yang melahirkan di hutan atau kandang hina hanya 3 orang. Dibandingkan dengan yang tidak pernah ANC, subjek yang melakukan ANC di Posyandu 5,6 kali kemungkinan melahirkan ditolong perawat/bidan [risiko relatif suaian (RRa) = 5,60; interval kepercayaan 95% (CI) = 2,99-10,47]. Selain itu, subjek yang mendapatkan pemeriksaan ANC oleh bidan dan kunjungan ANC 4 kali memiliki kemungkinan lebih tinggi untuk melahirkan ditolong perawat/bidan, masing-masing 4,9 kali (RRa = 4,89; 95% CI = 2,70-8,86) dan 6,9 kali (RRa = 6.90; 95% CI = 3,59-13,27). Kesimpulan: Asuhan antenatal adalah cara untuk meningkatkan angka persalinan yang ditolong oleh tenaga tenaga perawat/bidan di Papua. (Health Science Indones 2014;2:60-6) Kata kunci: asuhan antenatal, persalinan oleh perawat/bidan, Papua Abstract Background: Papua has one of the highest maternal mortality rates in Indonesia. Nurse/midwife birth attendants and regular antenatal care (ANC) are important factors in decreasing maternal mortality rate.  This study aimed to identify the association of ANC to nurse/midwife-assisted birth in Papua. Methods: The subjects of this cross-sectional study and purposive sampling consisted of females with toddlers in the family visiting the integrated community center on 15-30 January 2014 in 24 villages in Central Mountain of Jayawijaya, Papua. Several demographic characteristics, ANC practices, and labor practices were collected by interview. Analysis was carried out by Cox regression with constant time. Results: There were 469 subjects, but only 391 subjects were available for analysis which consisted of 280 subjects with self/family-assisted births and 111 with nurse/midwife-assistedbirths. There were only 3 subjects that gave birth in the forest or stable (“kandang hina”). Compared with those who never had ANC, those who had ANC in the integrated community center had 5.6-fold possibility to have a nurse/ midwife-assisted birth [adjusted relative risk (RRa) = 5.60; 95% confidence interval (CI) = 2.99-10.47]. In addition, compared with those who never had ANC, those who had ANC by midwife and 4 ANC visits had higher possibility to have nurse/midwife-assisted birth, 4.9-fold (RRa = 4.89; 95% CI = 2.70-8.86) and 6.9-fold (RRa = 6.90; 95% CI = 3.59-13.27) respectively. Conclusion: Antenatal care service is a possible way to increase the proportion of deliveries by nurse/midwife in Central Mountain of Jayawijaya, Papua. (Health Science Indones 2014;2:60-6) Key words: antenatal care, nurse/midwife attended birth/labor, Papua