 Adaptasi (Kamus Besar Bahasa

Indonesia, 2005)
 penyesuaian terhadap lingkungan,
pekerjaan dan pelajaran

 Psikososial (Papilia, 2008)

 segala sesuatu menyangkut aktivitas
atau masalah sosial yang timbul
sehubungan dengan faktor psikologis
atau proses mental
 Adaptasi psikososial
 cara individu untuk
menyesuaikan status mental
dan emosionalnya terhadap
perubahan-perubahan yang
terjadi di dalam lingkungan
sosialnya
 Adaptasi
psikososial
sbg self Role
Self
concept system model
model

Interdepen-
dence
model
Tujuan Adaptasi
Menghadapi tuntutan keadaan secara
sadar

Menghadapi tuntutan keadaan secara

realistik

Menghadapi tuntutan keadaan secara

obyektif

Menghadapi tuntutan keadaan secara

rasional
 • Mempunyai peran sosial pertama dan utama
• Pendidikan
Keluarga • Perlakuan orang tua
• sikap

• lingkungan tempat dirinya bergaul dengan

Lingk individu lain terutama yang sebaya dengan
pergaulan dirinya dengan alasan, memiliki tujuan dan
latar belakang yang serupa

• Pengaruh yang signifikan

Pasangan • Menyebabkan stress
hidup • Disfungsi sesksual
Inisiasi persalinan
 Tergantung pada unit
fetoplasenta
 Peningkatan sintesis estrogen
plasenta
 Peningkatan sintesis prostaglandin
 Oksitosin
Hormon dalam persalinan

1. Oksitosin (hormon cinta)

 memediasi refleks ejeks (ejakulasi
sperma, ejeksi janin saat lahir, refleks
pelepasan plasenta, refleks let-down

 mengontrol aktivitas miometrium,

mencapai puncaknya saat persalinan
2. Beta-endorphin
 hormon stres, dirilis di bawah tekanan
dan rasa sakit
 sebagai analgesik
 meningkat saat kehamilan dan
persalinan
 membantu ibu bersalin mengubah
persepsi rasa nyerinya dan memasuki
kesadaran persalinan yang tidak
terganggu
 Bila kadarnya meningkat dalam
persalinan  menghambat rilis oksitosin
3. Adrenalin dan noradrenalin (hormon
katekolamin)
 Respon terhadap stres
 Kadar katekolamin tinggi 
menghambat rilis oksitosin  persalinan
lama dan distres janin

 Saat persalinan sudah dekat 

noradrenalin meningkat  mengaktifkan
refleks ejeksi janin  ibu mengalami
peningkatan energi
 Setelah bersalin kadar katekolamin
menurun, bila suhu menurun  katekolamin
meningkat  rilis oksitosin terhambat 
perdarahan pascasalin
 Pada bayi baru lahir  kadar katekolamin
tinggi membantu bayi terhadap efek
hipoksia dan asidosis selama proses
persalinan
 Memastikan bayi membuka matanya lebar
dan waspada saat kontak pertama
dengan ibunya
 Kadar katekolamin bayi menurun setelah
kontak dengan ibunya
4. Prolaktin (hormon ibu)
 Sintesis ASI dan menyusui
 Kadarnya meningkat tajam di akhir
masa persalinan dan mencapai
puncaknya setelah bersalin
 Menyusui akan mengaktifkan
kewaspadaan ibu dan memprioritaskan
kebutuhan bayinya
 Berperan dalam mengembangkan dan
mematangkan sistem neuroendokrin
bayi
Pengalaman sebelumnya

Kesiapan emosi

Persiapan menghadapi persalinan

Support system
Kala I (Fase Laten dan Fase Aktif)

Kala II

Kala III

Kala IV
 Perilaku adaptasi psikologi membantu
kemampuan seseorang untuk
menghadapi stressor, diarahkan pada
penatalaksanaan stress dan didapatkan
melalui pembelajaran dan pengalaman
sejalan dengan pengidentifikasian perilaku
yang dapat diterima dan berhasil.
 • membantu individu menerima
Perilaku tantangan untuk
menyelesaikan konflik
konstruktif

• mempengaruhi orientasi
realitas, kemampuan
Perilaku pemecahan masalah,
kepribadian dan situasi yang
destruktif sangat berat, kemampuan
untuk berfungsi
 proses yang dilalui oleh individu dalam
melakukan situasi stressfull.
 respon induvidu terhadap situasi yang
mengancam dirinya baik fisik baikpun
psikologik
 • gejala yang ditimbulkan tergantung
pada 2 faktor yaitu bagaimana
koping persepsi atau penerimaan induvidu
terhadap stressor
psikologis

• reaksi psikososial terhadap

adanya stimulus stress yang di
Koping terima atau dihadapi oleh klien
psikososial
 1. Berbicara dgn orang
metode lain
koping
jangka 2. Melakukan latihan fisik
untuk mengurangi
panjang ketegangan masalah

metode 1. Menggunakan alkohol

koping /obat2an
jangka 2. Menangis
pendek 3. Banyak tidur
 (Burroughs & Leifer, 2001)
 Kemampuan ibu untuk rileks dan
berkonsentrasi kepada sekelompok otot,
mempertahankan kecemasan tetap
rendah, juga berperan dalam kemajuan
persalinan normal
Masalah :

 Stress maternal ketika partus

 Kesiapan orang tua  rasa takut, dll
 Kemajuan persalinan  jalan lahir,
fetus, kekuatan persalinan dan faktor
psikososial.
 Kecemasan
 Pengalaman kehamilan sekarang
 Pengalaman melahirkan yang
lalu
 Harapan terhadap persalinan
 Dukungan dan budaya
 Informasi
 merupakan usaha pemecahan masalah
yang lebih dilaksanakan secara sadar,
 Pengetahuan ibu perlu dikaji dengan
menanyakan segala sesuatu yang
mereka ketahui tentang persalinan
sehingga dapat diketahui hal-hal yang
sudah dipelajari dan difahami 
meningkatkan kontrol ibu terhadap
persalinan
 Keyakinan beragama
Memberikan konseling
persalinan

Dukungan persalinan

Manajemen Nyeri
 Konseling Persalinan
Tujuan memberikan konseling persalinan
adalah :
 memberi informasi tentang segala hal yang
berkaitan dengan keadaan kesehatan
klien
 memberi dorongan psikologis dan sosial
kepada klien dalam menghadapi masalah
fisik dan psikologis sehingga pasien dapat
menghadapinya secara mandiri;
 memberi dorongan kepada klien agar
menyesuaikan diri dengan keadaannya
yang baru,
Adapun langkah-langkah konseling
kebidanan pada ibu bersalin :
 Menjalin hubungan yang baik
 Kehadiran
 Mendegarkan
 Sentuhan dalam pendampingan klien
 Memberikan informasi
 Memandu persalinan
 Mengadakan kontak fisik kepada klien
 Memberikan pujian
 Memberikan selamat
 Dukungan Persalinan
Metode-metode dukungan persalinan
mencakup asuhan sayang ibu berupa :
 Menghadirkan seseorang yang dapat
memberikan dukungan selama persalinan
 Pengaturan posisi
 Relaksasi dan pernafasan
 Istirahat dan privasi
 Penjelasan mengenai
proses/kemajuan/prosedur yang akan
dilakukan
 Asuhan diri
 Sentuhan
Strategi untuk keberhasilan pendekatan
dukungan persalinan adalah :
 Percaya tentang nilai persalinan dan
kelahiran normal
 Percaya bahwa ibu dapat
melakukannya (‘can do it')
 Keterpaparan ibu terhadap persalinan
dan kelahiran normal sebagai
observer/assistant atau sebagai ibu
 Membina hubungan baik dengan ibu
 Sadar terhadap rencana persalinan ibu
 Rencana strategis terhadap dukungan
 Pain relief approach
Language suggestive of pain as
a problem
Paternalistic, ‘we can protect you Egalitarian empaowerment ‘we
from unnecessary stress’
Techno/rationalm age, pain is
preventable/treatable
Neutral impact of environment
Clinical expertise of professional
companion
Special session/focus in
antenatal education
Working with pain approach
Language suggestive of pain as
a normative
are alongside you’
Labour pain timeless
component of ‘rite-of-passage’
transition
Seminal impact of environment
Supportive role of birth carers
Woven throughout labour
preparation sessions
‘menu approach’ to option for Supportive strategies for journey
coping with pain of labour

Pain as a ‘management issue’ Pain as one dimension of labour

for assembly-line birth care in one-to-one, small scale
birth settings
Contributes to trend of rising Contributes to trend of less
epidural rate pharmacological analgesia

Risks of pharmalogical agents ‘cascade of intervention’

outweighed by benefits dynamic

First birth special case for ‘menu First birth optimal opportunity for
approach’ ‘working with pain’

Informed choice means all Informed choice within context

option must be presented of birthing plan and philosophy
Metode yang digunakan untuk manajemen
nyeri menurut L, Jones et al, 2012 adalah :
1. Intervensi non farmakologis
 Hypnosis
 Biofeedback
 Injeksi Intrakutan atau subkutan air steril
 Berendam dalam air
 Aromaterapi
 Teknik relaksasi
 Akupunktur/akupresur
 Masase, refleksiologi dan metode manual
 TENS (transcutaneous electrical nerve
stimulation)
2. Intervensi farmakologis
 Analgesi inhalasi
 Opioid
 Obat-obatan non-opioid
 Local anaesthetic nerve blocks
 Epidural (termasuk kombinasi epidural
spinal)
Sedangkan menurut Walsh (2007) metode
yang dapat digunakan untuk manajemen
nyeri adalah :
 Metode psikologis (hypnosis, teknik relaksasi)
 Terapi fisik (sentuhan, masase, sacral
pressure, abdominal effleurage,
shoulder/back kneading)
 Metode sensoris (aromaterapi, hidroterapi)
 Terapi komplementer (akupunktur,
akupresur/shiatsu, homeopathy, herbal)
 Pendekatan spiritual
 Teknologi dan obat-obatan (TENS, opioid,
epidural, narkotik (pethidin), injeksi air steril).
1. Childbirth Experience Questionaire (CEQ)
 Tujuan: untuk membantu mengidentifikasi
kebutuhan dukungan dan konseling

 Dimensi yang diteliti:

- Kapasitas diri / own capacity (8 item)
- Dukungan professional / professional support
(5 item)
- Keselamatan / perceived safety (6 item)
- Partisipasi / participation (3 item)
 Cara: menggunakan kuesioner dengan
skala Likert sebanyak 22 item
pertanyaan dengan nilai 1, 2, 3, 4

1 : sangat setuju sekali (totally agree)

2 : sangat setuju (mostly agree)
3 : sangat tidak setuju (mostly
disagree)
4: sangat tidak setuju sekali (totally
disagree)
Daftar pertanyaan:
 Own capacity
1. Experienced level of labour pain in
dilatation stage, VAS
2. I felt strong
3. I felt capable
4. Experienced level of control, VAS
5. I felt happy
6. I felt that I handled the situation well
7. I felt tired
8. The labour progress went as I had
expected
Professional support
1. My midwife also devoted enough time
to my partner
2. I felt very well taken care of by the
midwife
3. My midwife devoted enough time to
me
4. My midwife kept me informed about
what was happening during labour and
birth
5. My midwife understood my needs
Perceived safety
1. Experienced level of sense of security, VAS
2. Some of my memories from the labour process make
me feel depressed
3. My impression of the medical competence made
me feel secure
4. I have many negative memories from the labour
process
5. I have many positive memories from the labour
process
6. I felt scared

Participation
1. I felt I could choose whether I should be up and
moving or lie down
2. I felt I could choose the delivery position
3. I felt I could choose which pain relief method to use
2. Maternal Perceptions of Support and Control in Birth
(SCIB)
 Dasar: Kontrol dan dukungan yang tinggi selama persalinan
berhubungan dengan peningkatan outcome kelahiran dan
kepuasan maternal dengan pengalaman melahirkan

 Dimensi yang diteliti:

- Kontrol internal / internal control (10 item)
- Kontrol eksternal / eksternal control (11 item)
- Dukungan / support (12 item)

 Cara: menggunakan kuesioner dengan skala Likert sebanyak

33 item pertanyaan dengan nilai 1, 2, 3, 4, 5.
1 : sangat setuju (completely agree)
2 : setuju (agree)
3 : tidak ada pendapat (neither agree or disagree)
4 : tidak setuju (disagree)
5 : sangat tidak setuju (completely disagree)
 Daftar pertanyaan:
Internal control
1. The pain was too great for me to gain control
over it
2. I was overcome by the pain
3. I was able to control my reactions to the pain
4. I was mentally calm
5. I was in control of my emotions
6. I felt my body was on a mission that I could not
control
7. Negative feelings overwhelmed me
8. I gained control by working with my body
9. I could control the sounds I was making
10. I behaved in a way not like myself
External control
11. I had control over when procedures happened
12. I could influence which procedures were carried
out
13. I decided whether procedures were carried out or
not
14. The people in the room took control
15. I had control over the decisions that were made
16. I could get up and move around as much as I
wanted
17. People coming in and out of the room was beyond
my control
18. I chose whether I was given information or not
19. I could decide when I received information
20. I had control over what information I was given
21. I felt I had control over the way my baby was finally
born
Support
22. The staff helped me find energy to continue when I
wanted to give up
23. The staff seemed to know instinctively what I wanted or
needed
24. The staff went out of their way to try to keep me
comfortable
25. The staff encouraged me to try new ways of coping (such
as breathing)
26. The staff realized the pain I was in
27. The staff encouraged me not to fight against what my
body was doing
28. I felt the staff had their own agenda
29. I felt like the staff tried to move things along for their own
convenience
30. I was given time to ask questions
31. The staff helped me to try different positions
32. The staff stopped doing something if I asked them to stop
33. The staff dismissed things I said to them
3. Labor Agentry Scale (LAS)
 Dikembangkan oleh Hodnett and Simmons-
Tropea (1987). Digunakan untuk mengukur
perasaan ketika mengontrol persalinan,
terdiri dari 29 item pertanyaan,
menggunakan skala Likert dari 1 sampai 7.
1 : selalu
2 : sangat sering
3 : agak sering
4 : kadang-kadang
5 : agak jarang
6 : jarang
7 : sangat jarang
Daftar pertanyaan:
 1. I felt competent.
 2. I was dealing with labor.
 3. Everything made sense.
 4. I felt very responsible.
 5. I felt incomplete and like I was going to pieces.
 6. I felt secure.
 7. I felt incapable.
 8. I experienced a sense of great anxiety.
 9. I felt adequate.
 10. I felt open and receptive.
 11. I felt good about my behavior during labor.
 12. I felt powerless.
 13. I experienced a sense of being with others who care.
 14. I did not know what to expect from one moment to
the next.
 15. I experienced complete awareness of everything that
was happening.
 16. Everything seemed unclear.
 17. I felt relaxed.
 18. I experienced a sense of conflict.
 19. I felt fearful.
 20. I had a sense of not being in control.
 21. I felt important.
 22. Everything seemed wrong.
 23. I felt victorious.
 24. I experienced a sense of active striving.
 25. I had a feeling constriction and of being
confined.
 26. I felt awkward.
 27. Someone or something else was in charge
of my labor.
 28. I experienced a sense of success.
 29. I had a sense of perspective on what was
happening.
4. Satisfaction with Childbirth Scale (SatCh)
 Untuk mengukur kepuasan ibu dalam
persalinan, terdiri dari 10 item pertanyaan,
dengan menggunakan skala Likert dari 1
sampai 7.

7 – sangat setuju/ Strongly Agree

6 – setuju/ Agree
5 – sedikit setuju/Slightly Agree
4 – tidak ada pendapat/Neither agree
nor disagree
3– sedikit tidak setuju/Slightly disagree
2 – tidak setuju/Disagree
1 – sangat tidak setuju/Strongly disagree
Daftar pertanyaan:
 1. In most ways, my childbirth experience was close to my
ideal.
 2. The conditions of my childbirth experience were
excellent.
 3. I am satisfied with the experience of my baby’s birth.
 4. I got what I wanted out ofmy childbirth experience.
 5. If I could do it over, I would change almost nothing
about my childbirth experience.
 6. In most ways my childbirth experience was far from my
ideal.
 7. I am not satisfied with the experience of my baby’s
birth.
 8. The conditions of my childbirth experience were
horrible.
 9. I did not get what I wanted outof my childbirth
experience.
 10. If I could do it over, I would change mostthings about
my childbirth experience.
5. Perceived Control in Childbirth Scale
(PCCh)
 Dikembangkan oleh Drew, Salmon, &
Webb, 1989 , untuk mengkaji beberapa
aspek tentang pengalaman melahirkan,
menggunakan skala Likert 1 sampai 6.
• 6 – sangat setuju/Strongly agree
• 5 – cukup setuju/Moderately agree
• 4 – agak setuju/Slightly agree
• 3 – agak tidak setuju/Slightly disagree
• 2 – cukup setuju/Moderately disagree
• 1 – sangat setuju/Strongly disagree
Daftar pertanyaan:
 1. I was able to participate in decision-making frequently during my labor
and birth.
 2. The doctors and nurses provided explanations of procedures before they
were performed.
 3. The doctors explained things to me in a way I could understand.
 4. My questions were answered by the staff.
 5. I was in control of my pain medication (deciding when I wanted it and
how much).
 6. I was asked what type of pain medication I preferred.
 7. I was told the major risks of each procedure before they were performed.
 8. I was asked my opinion about each unplanned procedure before it was
performed.
 9.I was able to move around freely during labor if I wanted to.
 10. I was able to move around as best I could even though I had certain
interventions (IV, external fetal monitoring, internal monitoring)
 11. I was able to have a bath ora shower if I wanted one.
 12. I was able to have exactly whom I wanted to attend my labor and birth.
 13. The nurses came promptly when I called them.
 14.The staff treated me with kindness and respect.
 15. I was able to hold the baby immediately after the birth if I wanted to.
 16.I was told of my options and choicesbefore procedures were decided
upon.
Items Derived from Perceived Control of
Healthcare Scale (PCON)
When I was told about the proceduresduring
labor and delivery I felt…..
 17. That I was unable to influence the
treatment I received during labor and
delivery.
 18. That I was in control of the situation.
 19. That I was just told what to do.
 20. That I could get all my questions
answered.
 21. That I was able to play an active role in
my labor and delivery care.
 22. That what I said or did madeno
difference in what occurred.
From the time I arrived at the hospital/birth
center, I felt….
 23. Very much “on top” of the situation.
 24. At a loss to know what I would be
experiencing.
 25. If I wanted to, I could changethe
procedures I was receiving.
 26. I knew how the labor and delivery
procedures would affect me.

in the following items, the phrases“routine

procedures” and “routine parts” refer to standard
procedures such as IVs and fetal monitoring as
well as non-technical parts of your care such as
freedom to move in labor, freedom to eat or
drink, or the ability to have whom you want in the
labor and delivery room.
In regards to the routine parts of my care…
 27. I was given as much control over my activities in
the hospital/birth center as I have at home.
 28. I could change when and how routine
procedures were done.
 29. I was unable to have a say in what the routines
were during my stay at the
 hospital/birth center.
 30. I could tell the staff about my preferences for my
care.
 31. I was given choices about the routine parts of my
labor and delivery care.
 32. If I asked the staff to do something differently
during my labor and delivery, they usually did it.
 33. I did not know in advance what routine
treatments I would have or when they
 would occur.