THE RELATIONSHIP TO MIDWIFE PLACEMENT HEALTH VILLAGE ...

THE RELATIONSHIP TO MIDWIFE PLACEMENT HEALTH VILLAGE
COVERAGE IN LABOR HELP IN KONAWE DISTRICT
L
Thesis Summary
To Fulfill a Partial Requirement
To Obtain a Master’s Degree
Maternal and Child Health – Reproductive Health
Study Program of Public Health Sciences
MISNAWATI TOMBILI
NIM: 08/285807/PKU/10507
POST GRADUATE PROGRAM
FACULTY OF MEDICINE
UNIVERSITAS GADJAH MADA
YOGYAKARTA
2012

THE RELLATIONSHIP
TO MIDWWIFE
PLAC CEMENT HHEALTH
VIILLAGE
COVERAGEE
IN LABORR
HELP IN KONAWEE
DISTRICT T
AAdvisor
I
ddr.
Ova Emmilia,
SpOGG(K),
M.M.EEd,
Ph.D.
AAdvisor
II
ddr.
Lutfan Lazuardi, M.Kes, Ph.D.
APPRROVAL
SHEET
Prroposed
byy:
MISNAAWATI
TOMMBILI
NIM: 08/2285807/PKU
U/10507
Appproved
byy:
Dated, …… ……….
Dated, …… ……….

THE RELATIONSHIP OF THE PLACEMENT OF VILLAGE MIDWIVES
TO THE COVERAGE OF DELIVERY ASSISTANCE BY SKILLED BIRTH
ATTENDANTS IN KONAWE DISTRICT
CHAPTER I
BACKGROUND
Maternal Mortality Rate (MMR) in Indonesia is 228 per 100,000 live
births and in Southeast Sulawesi Province is 279 per 100,000 live births
(CBS and Macro International, 2007). Based on data in 2009, the number
of maternal and infant mortality in Konawe District was 5 and 34 cases,
respectively, from 2449 deliveries (Konawe District Health Office, 2009).
This was related to the inequity of the midwife placements.
In Konawe, the number of midwives is 155 people spreading over
364 villages. This situation shows that the ratio of midwives to the working
area is 1:2. This means that almost 57.5% of villages in Konawe do not
have a village midwife (Konawe District Health Office, 2009).
Based on the background, the formulated problem in this study was
"whether there is any relation of the village midwife placement to the
coverage of delivery assistance by health personnel in Konawe District?"
The aim of this study was to determine the relationship of the placement of
village midwives to the coverage of delivery assisted by skilled birth
attendant in Konawe.
CHAPTER II
LITERATURE REVIEW
The high maternal and perinatal mortality rates indicate poor
service to the community during pregnancy and childbirth. One dominant
factor is antenatal care in which there are lack of quality service in labor
and delivery and lack of regulation about obstetric procedures
(Manandhar, 2004). This situation is related to the skills of birth attendant
during childbirth process and to the women themselves (Harvey et al.,
2007).
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The placement of village midwives could reduce maternal and
neonatal mortality. The high maternal and neonatal mortality in Indonesia
can be attributed that most women living in the rural areas have deliveries
at home assisted by a traditional birth attendant, so that delivery
complications are not addressed comprehensively (Shrestha, 2010). The
provision of primary health care in rural communities and the utilization of
services by the community are the indicators of the health program
success. Ease access to health services makes the birth-related risk
factors can be easily overcome (Kruk et al., 2009). Services done by
midwives can improve referral for delivery with complications and reduce
maternal and infant mortality (Lassi et al., 2010).
CHAPTER III
METHODS
This was an observational study with a cross-sectional study
design, i.e. research that makes the measurement of independent and
dependent variables simultaneously. The research was conducted in the
working area of Konawe Health Office, while the unit of analysis of this
study was the village that received village midwife services.
The population of this study was the village midwives who provided
services to rural communities in the working area of Konawe Health Office
District by a decree of the head of Health Office. The inclusion criteria
were midwives living in the working area of Konawe Health Office and the
village midwives assisting villages under the decree of the head of Health
Office. The exclusion criterion was the village midwives who were
undergoing their further education. The qualitative samples were the head
of Health Office, the head of the Regional Human Resources Agency
(BKD), the head of the Indonesian Midwives Association (IBI) of Konawe
District and village midwives.
The number of samples in this study was the entire study
population comprising 155 midwives serving in the working area of
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Konawe Health Office. For qualitative data, the number of samples
consisted of three heads of institutions, namely Health Office, BKD, IBI
and a midwife.
The variables of this study were the independent variable which
was the placement of village midwife, the dependent variables which were
indicator of the delivery coverage and complications of childbirth and the
extraneous variables which were the residence, length of work, and
delivery service facilities. The instruments used were a questionnaire and
a check list of research and in-depth interviews to the research subjects in
accordance with the in-depth interview guidelines.
Data processing used the following steps: editing, coding, entry,
and cleaning. After that, the data analysis was carried out including:
univariable, bivariable, and multivariable. The statistic test used chi-square
and logistic regression with confidence interval (CI) 95% and the level of
significance with p value

low coverage of delivery assistance by midwives like in Lambuya sub
District which only had 2 midwives.
The results showed that there was a significant relationship
between midwives’ residence and the coverage of delivery by skilled birth
attendant with p =

The results of this study found a significant relationship between
facility and the coverage of delivery by skilled birth attendant with p =

the rules, regulations, budgets, system improvements, facilities and
infrastructure. The support of the government increased the performance
of midwives in childbirth assistance. This situation was related to the
situation in Konawe in which there were no regulations in in the
implementation of delivery assistance and there were no local regulations.
There was no significant relationship between facility and complications of
childbirth. The occurrence of complications in this study was more likely to
be caused by other factors such as midwife’s skill.
Based on multivariable analysis on the variable of the service
coverage by health personnel, the more dominant variable in predicting
the coverage of delivery by health personnel was facilities with OR = 5.47.
The availability of health care facilities greatly affected the scope of
delivery. Rural communities tended to utilize services within easy reach.
This situation was appropriate to the circumstances in which some areas
in Konawe are islands so the location of the access to service utilization
tends to be chosen closest to the population.
Based on complications of childbirth, the more dominant variable
affecting the non occurrence of complications of labor was length of
service. This situation suggests that the experience and skills in delivery
assistance is the important state in preventing the complications of
childbirth.
Midwives who had long worked and resided in the village led to the
ease of interaction with the community so pregnancy and childbirth could
be known by the village midwife. Information about pregnancy and
childbirth by midwives had an impact on the detection of complications
that could be readily handled. Handling of the complications could be
through a labor referral mechanism. The success deliveries by midwives
needed strong political support from local governments. Political support
could increase capacity and strengthen the system with a focus on
delivery quality by increasing the number of midwives.
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CHAPTER V
CONCLUSIONS AND RECOMMENDATIONS
From the above results, it can be concluded that the distribution of
the placement of village midwives are largely in urban region. The
coverage of delivery by health workers is higher in villages with midwives
compared with the villages without village midwives. The more dominant
factor that impacts on the coverage of labor is a factor of health care
facilities. The factor of length of service is not dominant to the occurrence
of complications in childbirth. Delivery bleeding is the complication that
often occurs in births attended by midwives in Konawe.
Suggestions that can be submitted are as follows: 1) the need for
the addition of village midwives in Konawe especially for village which
have not received midwives, 2) the provision of service facilities to the
village such as village clinics, and 3) the need to increase the ability of
midwives in assisting labors through training and seminars on delivery
bleeding management.
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