The biggest problem in the

maternity area and the

breakthrough point
Dr. Ns. Ratna Hidayati, M.Kep., Sp.Mat.
 The biggest problem in the maternity area In
Indonesia

Important issues in Indonesia (2012)

Every 3 minutes = 1 toddler dies.
Every hour = 1 woman dies during
childbirth / causes related to pregnancy
Trends in Infant and Under-five Mortality Rates in
Indonesia In 1991-2015
• The improvement of maternal health in Indonesia, which is
the fifth MDGs, has been slow in recent years
 The problem of maternal death is
large in Indonesia
Indonesia Malaysia Singapura Thailand Filiphine

359 41 6 40 170

MMR is still despite the fact that almost all (97%)

of women accept prenatal care and birth by health
professionals in hospital
 Indonesian Government
Solutions ?
The government policy :
Safe motherhood (4 pillars: family planning, ANC,
Clean & Safe Delivery, Obstetric Essential Care)
Affection for giving-birth mother
Early Breastfeeding
Expanding Maternal and Newborn Survival
(EMAS)

Mothers’ Welfare and Safety

Why MMR is still high ???

 Let's learn !! How Success of developing
countries reducing the MMR

Sri Lanka & Thailand (MMR 30 and 40/100.000 of live

births), intervention strategy :
Family Planning Program
Prevent / minimize the chances of women with
complications of pregnancy / childbirth → Prevent
/ minimize the death
Improving utilization and quality of care which
emphasis on giving free life-saving care
Expanding access to more effective maternity care
by midwives and doctors
The World Bank, 2003
 Differences in The Pattern of Decline
in MMR
 Swedia : adherence to use aseptic technique
 Japan : professionalization of deliveries at
home
 Malaysia: growing the socio-economic system,
supporting the efforts of Safe Motherhood
management policies and using the health
care facility as well
 North Europe : well coordination among ANC-
delivery-postpartum
 Why are they success ?

1. Improving the role of professional

personnel
2. Giving accurate and continuous
information
3. Improving the professional skill to
make them professional
Learning from the failure of developed
countries reducing the MMR!

In the past century United States

has
"Profession Arrogance " bringing
bad effect on the acceleration of
declined MMR
 THE CAUSE OF MATERNAL MORTALITY
(Pregnancy, Childbirth and Postpartum)
The direct 1. Hemorrhage 28% 2. Preeclampsia 24%
causes of 3. Infection11 % 3. Complications of puerperium 8%
4. Prolonged labor 5% 5. Abortion 5%
death
Indirect 1. Late recognition of dangerous signs and decisions making
Causes 2. Late to reach health facility
(3 late) 3. Too late to get help from professional personil

1. Too young childbirth (<20 th), 0.3 5

Risk Factors 2. Too often breeds (>3 children) 37%
(4 T) 3. Too Close Birth spacing (< 2th) 9.4%
4. Too old to give birth (>35 th) 13.9%

Other Nutritional status; deficiency Fe (causes bleeding, LBW):40%

indirect
Chronic Energy Deficiency (Left arm circle < 23.5 cm)
causes
The main target of SDGs
is "to eradicate poverty"

Targets for effectiveness

improvement of poverty

Increased Access of the Poor

to Basic Services
 So
All pregnant women
need Access to*
Emergency Obstetric
Care
(EmOC)
 IMPROVING PARTICIPATION of
FAMILY and COMMUNITY

Begin from planning, implementation and

monitoring / assessment for pregnancy
Participation is directed to :

  knowledge and awareness dangerous

signs
  family & community preparation to face
the labor and the danger that may occur
 provision and utilization of MCH services
 guarding quality of care
 General
standards
of care for
healthy
pregnancy
and
childbirth
 The Standards for Maternal and Neonatal
Care are part of the WHO Integrated
Management of Pregnancy and Childbirth
Care (IMPAC) Package
Purpose :
 to improve access and quality of maternal
and neonatal health services;
 provide effective maternal and neonatal
health services;
 use existing resources to achieve the
optimal health care outcomes; and
 improve individuals', families' and
community's satisfaction and utilization of
maternal and neonatal health services
How are the Standards for Maternal and Neonatal Care
structured?

1. General standards of care for healthy pregnancy

and childbirth
2. Standards for safe care in childbirth and the
immediate postpartum period
3. Standards for postnatal care
4. Standards of care for managing major complications
in pregnancy, childbirth and after birth
5. Standards of care for managing major complications
in the newborn
6. Health service delivery standards
 Recommendations on ANC were
5 groups areas :
A. Nutritional interventions
B. Maternal and fetal assessment
C. Health systems interventions to improve
the utilization and quality of ANC
D. Preventive measures
E. Interventions for common physiological
symptoms
Partly that recommendations relevant to routine ANC
from other WHO guidelines
 Maternal and fetal
complications Birth Asphyxia
•Prevention of mother to
child transmission of HIV •Resuscitation
•M/M or referral of •Post resuscitation care
obstetrics & neonatal •Referral if necessary
complications
SPECIAL CARE
Low birth weight Infection, malformation,
and other problems
•Special warmth , KMC •Antibiotics
•Hygiene, Cord care •Supportive care
•Assisted feeding, if •ART if in need
necessary Referral if necessary
RELATED SUPPORT UNITS Improvement Collaborative
• Is a partnership in an
effort to obtain the best
results and benefit all
parties
KEMENTERIAN KESEHATAN PUSKESMAS PONED
• The principle of
togetherness in working
and achieving the desired
PROGRAM PONEK
POKJA goals
PEMDA
Di RS Satgas GSI
Prop / Kab • Can be applied to various
Termasuk fields, including health
Regulasi dana
services

Profesi terkait
• Establish network of
(JNPK-KR,POGI, IDAI, IBI, PPNI) cooperation, service and
communication
RS Swasta, RB
Dr / Bidan prakarsa • Changes or improvements
swasta termasuk obtained must be
Hospital By Law
replicated to other facilities
WHAT's NEW?
 The role of universities in reducing
maternal mortality
Model Integrated Maternity Management
Through Promotive and Preventive Promotion
as Effort Reduce Mortality Rate
A collaborative effort of government, health
professionals, communities and colleges as
transfasilitator
 seeking people at risk of maternal and infant
mortality conditions have a better awareness
of emergency emergencies in pregnancy
Model Integrated Maternity
Management
 • Efforts to
improve the
understanding
and active role
of nurses in
improving
maternal and
child health