FACTORS DESCRIPTION OF PREGNANT WOMEN IN BPM pregnancy exercise Nanik Sulistyowati, Amd.Keb DS. WARUNGERING
KEC. KEDUNGPRINGLAMONGAN

                                                                    CHAPTER 1
                                                              INTRODUCTION

1.1 Background Problem    
     All contain some risk of pregnancy for the mother or baby and it is important to prevent, detect and manage complications become life-threatening emergencies (WHO, 2003). During pregnancy maintenance efforts and increase maternal health requires extra attention. Matters that require attention, among others, nutrition, preparation of lactation, regular prenatal care, improved personal and environmental hygiene, sexual life, rest and sleep, stop harmful habits affect health and the fetus (such as smoking) carry out the movement and pregnancy exercise (MOH, 1992).       Pregnancy exercise is exercise performed during pregnancy in order to prepare for the physical and mental health of pregnant women, with the hope of the birth process will run smoothly and safely. Pregnancy exercise workout is done on a regular basis either at home or place of exercise in leisure time pregnant women can lead to the physiological delivery as long as no pathological conditions that accompany pregnancy. Pregnant women who perform regular pregnancy exercise during pregnancy has been reported to provide benefits at the time of delivery is in the active stage (stage II) becomes shorter, prevent and reduce the incidence of breech position insinden sectio Caesaria. (Daily Independent Voice, 2008)

      Based on research in 2003 showed that Supriadmaja long confinement in cases that do not perform pregnancy exercise was 15.1% and in cases that do gymnastics pregnancy was 1.9%. Confinement time in the pregnancy exercise group were statistically smaller than the group that was not pregnancy exercise. Long second stage of labor in women who have pregnancy exercise was statistically shorter when compared with women who are pregnant do not do gymnastics. (Andrew, 2008)       Based on the initial survey the number of pregnant women in BPM Nanik S. Amd.Keb in 2012 as many as 10 people. Of the number of pregnant women are 60% who do not perform pregnancy exercise. So there are many women who have not been doing gymnastics pregnant because of ignorance.Some factors that can affect pregnant women in making pregnancy exercise include: Age, Education, Employment, Environmental, Social and Cultural Experience and Knowledge. (Nursalam, 2003)Age is counted from the time of birth (Nursalam, 2003). Age is just the start or enter a period of marriage and pregnancy whether a person in maturity in dealing with the issue or problem, in this case deal with pregnancy and the changes during pregnancy. And vice versa with less than 16 years of age then the chances of maturity of mind and behavior are less well in advance to deal with changes and adaptations during pregnancy.

        All planned educational efforts to influence other people, both individuals, families or communities, so they do what is expected by the perpetrator (Soekidjo Notoatmodjo, 2003). The higher the education the more knowledge and more aware of the conditions they experienced pregnancy. And a pregnant woman who knows will kebutuahannya it will automatically do the exercises pregnant with her self-awareness.The work may also affect pregnant women for pregnancy exercise melakuakan. The work is an act done for a living (Dessy Anwar, 2001). Pregnant women who work as a career woman then chances are they are busy with work, so the more tired and reluctant to do gymnastics pregnant. Instead pregnant women only as housewives, day-to-day activities only take care of the household, then chances are they have more spare time to melekukan including pregnancy exercise.       Environment is all that is around the human condition and its effects can affect the behavior of individuals or groups (Nursalam, 2003). Environment in the village are still many women who have not received information about pregnancy exercise. And consider pregnancy exercise is not necessary.Experience is a good teacher, this experience is a source of knowledge or experience that is a way to obtain truth pengatahuan (Soekidjo Notoatmodjo, 2003). Primigravida or multigravida pregnant women have never had experience doing pregnancy exercise. So have never know about pregnancy exercise, and inexperienced.       The social or socio-cultural community groups and cultural life in the form of the result of human cultivation. People living in the community producing arts, customs, and traditions for behavioral attitudes. (Anwar S, 2000). Can affect the social and cultural lifestyle of the people and can give an idea to implement the action. Socio-cultural influences can be both positive and negative, culture positive effect is likely to assist women to adapt to pregnancy exercise.         Negative impact if they do not perform pregnancy exercise that affects the state of the mother and fetus. These impacts include, pervagina bleeding, slow down the delivery process, prone to premature birth, signs of abnormality in the fetus, eclampsia / pre-eclampsia, and so on. Meanwhile, when do pregnancy exercise pregnant women can lead to the physiological delivery as long as no pathological conditions that accompany pregnancy. Pregnant women who perform regular pregnancy exercise during pregnancy has been reported to provide benefits at the time of delivery is in the active stage (stage II) becomes shorter, the location of the breech prevent and reduce the incidence of sectio Caesaria.       Efforts to resolve the issue, midwives can provide maximum service to provide information and knowledge about pregnancy exercise, which is given through counseling to motivate pregnant women to follow pregnancy exercise. It is therefore beneficial role of midwives as educators to solve this problem, by providing counseling exercise pregnant while ANC.         Given the above data, knowledge about pregnancy exercise is lacking, so researchers wanted to know how the image of knowledge about pregnancy exercise pregnant women in the BPM Nanik S. Amd.Keb warungering village, district kedungpring, Lamongan district.

  1.2 Formulation of Research Problems        
        Based on the background described, then the problem can be described as follows: "What a picture of knowledge about pregnancy exercise pregnant women in the BPM Nanik S. Amd.Keb warungering village, district kedungpring, Lamongan district in 2012 ".1.3 Research Objectives      
       To know the description of the knowledge of pregnant women about pregnancy exercise in BPM Nanik S. Amd.Keb warungering village, district kedungpring, Lamongan district in 2012.

1.4 Benefits 
1.4.1 Academic     
     Education institutions are expected to be used as additional insight into the science that can be developed 
1.4.2 Practitioners 
1). For the RespondentsResearch benefits for pregnant women, which is to provide information about pregnancy exercise goals, the benefits of pregnancy exercise, pregnancy exercise procedures and requirements that must be considered for pregnant women in making pregnancy exercise. 
2). For the ProfessionThe results of this study midwifery personnel are expected to provide health services as much as possible, especially in pregnant women. 
3). For InstitutionsThe results of this study is expected to provide input information about pregnancy exercise diwilayahnya so it can be used as a basis for improving the quality of maternal care. 
4). For ResearchersFor further information material for researchers who will conduct a more in-depth enelitian about pregnancy exercise.

MIDWIFERY CARE ON Ny. "S" G1 P1000 UK 15 WEEKS PHYSIOLOGICAL

CHAPTER 1
INTRODUCTION

1.1 BackgroundDevelopment in the health sector is shown to improve the quality of human resources and quality of life and life expectancy. Improved quality of life needs to start from early that since being in the womb. Therefore, a healthy pregnancy greatly affects the potential of offspring in the future successor. (Manuaba: 1998).Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) is one of the most sensitive factor which describes the health of mothers and children. MMR and IMR in Indonesia is still very high, as evidenced by the presence of maternal mortality vary widely from 5 to 100,000 per live births. And perinatal mortality which ranged from 25 to 750 per live births. Maternal mortality should be reduced to 225 per live births and infant deaths should be reduced to 49.8 per 1,000 live births.Therefore, antenatal testing should be done to ensure that once the mother and fetus at regular intervals and to find out how early when there are deviations or abnormalities found with the aim that can pregnant women through pregnancy, childbirth and postpartum well and safe and healthy babies .Regular prenatal care which followed technically be controlled by each MCH program implementers in the field so that the quality of service can be guaranteed. If in pregnant women with primigravida / multigravida, generally a lot of problems associated with pregnancy because of a lack of knowledge of mothers about the pregnancy. It is therefore important for pregnant women to carry out checks because of possible high risk can be found.

1.2 Objectives1.2.1 General PurposeAfter studying about 'Obstetric Care in Ny. "S" GIIIP2002 UK 20 Sunday H / Q / IU / My mother and fetus baikdengan SPR 2 ", it is expected that students get real experience in providing midwifery care in accordance with the standard.
1.2.2 Specific ObjectivesAfter learning about midwifery care in Ny. "S" GIIIP2002 UK 20 Sunday H / Q / IU / My mother and fetus baikdengan SPR 2 ", students are expected to be able to:1.Melaksanakan assessment on the client2.Menginterpretasi client data base3.Antisipasi potential problem on the client4.Mengidentifikasi immediate needs of the client5.Membuat care plan would do6.Melaksanakan care planned7.Mengevaluasi midwifery care that has been done1.3Metode Discussion
1.3.1 The method of this paper is the literature in the form of case study that is looking for a clear picture and midwifery process that occurs at this time.
1.3.2 Data collection techniques: interviews / anamnesa, examination, assessment of medical records and literature.
1.4 Systematics of WritingIn midwifery care is structured as follows:CHAPTER I: Introduction of Background, Objectives, Methods Discussion, Writing and Systematics.CHAPTER II: Review of TheoryCHAPTER III: Case OverviewCHAPTER IV: DiscussionCHAPTER V: ClosingREFERENCES

CHAPTER 2
REVIEW OF THEORY

2.1 CONCEPT OF PREGNANCY2.1.1 Understanding1) Pregnancy is the process of growth and development of the fetus from the time of conception and lasts until the beginning of labor (Kasdu, 2004).2) The period of pregnancy at the beginning of conception to the birth of the fetus. The duration of normal pregnancy is 280 days (9 months 7 days) was calculated from the first day of last menstrual period (Saifuddin, 2006: 89).3) Pregnancy is meeting the egg with sperm followed by nidasi or conception (Mochtar Rustam, 1998: 17)
2.1.2 Terms - the terms of pregnancy1) A healthy sperm can live in a woman's body 24-72 hours (1-3 days) and normal numbers.2) A healthy egg can live 48 hours and can be fertilized 12-18 hours after ovulation.3) The meeting of egg and sperm cells4) The ovaries and uterus of healthy5) The existence of the hormonal system
2.1.3 Physiology of PregnancyThe process of pregnancy is an ongoing chain and consists of:1) Ovulation2) Migration of spermatozoa and ova3) The conception and growth of the zygote4) Nidasi (implantation) of the uterus5) The establishment of the placenta / placentation6) Grow the placenta / placentationEvery month a woman let go 1 or 2 eggs (ova) from the ovary which was captured by fimbrie and into the fallopian tubes, at the time of insertion of sperm into the vagina and spilling millions - millions of sperm cells move into the uterine cavity and into the fallopian tubes. Fertilization occurs in the fallopian tube. Ova that have been in self-defense buahi soon as he moves toward the womb of space, then attached to the uterine mucosa. Peristuiwa is called nidasi (implantation), the blood supply and the food prepared by the placenta.
2.1.4 Signs of pregnancy1) Presumptive Signsa. Amenorrheab. Nausea vomitingc. Craved. Does not hold odorse. Faintingf. Anorexiag. Tired (fatigue)h. Enlarged breastsi. Frequent urinationj. Constipationk. Skin pigmentl. Epulism. Varicose veinsn. Hypersalivation
2) Signs chances of becoming pregnant(1) Stomach dilated(2) enlarged uterus: a change in shape, large, and the consistency of the uterus(3) The existence of Hegar sign: The consistency of the uterus that turned into a soft, especially the isthmus   uteri, so that if we put two fingers in the posterior fornik and his other hand on the abdominal wall above sympisis as if - if the two hands meet.(4) The existence of Chadwick's sign: The color of the mucous membranes of the vulva and vagina become bluish purple(5) There Goodel sign: Cervical increased vaskularisasinya and such soft lips.(6) There piscacek signs: Enlarged uterus palpable soft and uneven(7) The existence of Braxton sob: uterus to contract when stimulated.(8) palpable ballottement: Occur when the uterus lentingan swaying.(9) Test / positive pregnancy reaction
3) Signs must be pregnant(1) fetal movement can be seen, felt or touched parts of her fetus.(2) There was a DJJ(3) Visible bones of the fetus in the ultrasound(Manuaba, Ida Bagus Gede, 1998: 126)


2.1.2 Anatomical and Physiological Changes in Pregnancy1. Uterus and uterineUterus which was originally the size or weight of 30 grams sejempol would experience hypertrophy and hyperplasia, which will be weighing 1000 grams at the end of pregnancy. Changes in the isthmus uteri which becomes longer and so soft on the examination as if the two fingers can touch each other and it is called with a Hegar. Strain the uterine wall due to the large growth and development of the fetus causes more interested isthmus uteri upward and thinning-called lower uterine segment (SBR).The growth of the uterus was not the same as all these directions, but there was a rapid growth area implantation of the placenta, so that the uterus is not the same shape and is referred to as a sign piskacek.Along with the growth and development of the fetus in the womb, followed by the ever increasing blood flow to the uterus from the uterine arteries and ovarian arteries. Uterine muscle has a special arrangement of longitudinal, circular, and oblikasehingga whole webbing that can make blood vessels close to perfection. Increased blood vessels to the uterus affects the cervix that would have perlunakan.At the opening of the cervix during labor occurs passively, due to strong muscle contractions of the uterus. Immediately after delivery, the cervix which have little muscle, will fold and downsizing occur passively. Cervix who have less muscle, remains open, without sphincter mechanism, thus providing the opportunity to issue lokia.

2. VaginaVagina and Vulva increased blood vessel due to the influence of estrogen so that it looks more red and bluish (Chadwicks sign).

3. OvaryThe occurrence of pregnancy, the ovary containing the corpus luteum gravidarum will continue its functions until the perfect formation of the placenta at 16 weeks. This incident can not be separated from the ability korealis villi that secrete hormones chorionic gonadotropin which is similar to the anterior pituitary hormones luteotropik.

4. BreastHormone function in preparing the breast for breastfeeding, namely:(1) estrogen: - Creates a channel system of breast hypertrophy.Cause the accumulation of fat and water and salt so that the breasts look more bigger.Pressure of nerve fibers due to accumulation of fat, water, and salt, causing pain in the breast.(2) Progesterone: - Preparing the acini so it can function.Increase the number of acini cells.(3) Somatomammotropin:Affect the acini cells to make casein, lactalbumin, and laktoglobulin.Accumulation of fat around the alveoli of the breast.Induced stimulation of colostrum in pregnancy.Changes in the breast(1) Breasts become larger(2) areola breasts getting hyperpigmentation(3) Montgomery glands more visible(4) The nipple more prominent(5) Expenditures breast milk has not lasted because prolactin does not work, because the resistance of PIH (Prolactine inhibiting hormone) to remove the milk.(6) After childbirth, prolactin barriers do not exist so that milk production can take place.5. Maternal blood circulationMaternal blood circulation is affected by:(1) The growing need for blood circulation so as to meet the needs of development and growth of the fetus in the womb.(2) The occurrence of a direct connection between arteries and veins in the circulation of retro-plasenter.Effect of estrogen and progesterone hormone increasedAs a result of these factors circulatory changes:(1) The volume of bloodIncreased blood volume in which the amount of blood serum is greater than the growth of blood cells, resulting in dilution of blood (hemodilution), with a peak at 32 weeks gestation. Blood serum (blood volume) increased by 25 to 30% while blood cells increased by about 20%. Cardiac output will increase about 30%. Increased hemodilution of blood began to appear around the age of 16 weeks gestation. In the postpartum occurred hemoconcentration with a peak until the third day of the fifth.(2) blood cellsRed blood cells increased in number to be able to offset the growth of the fetus in the womb, but the increase of blood cells are not balanced by an increase in blood volume resulting in hemodilution is accompanied by physiological anemia. White blood cells increases with the number of 10.000/ml reach.

6. The respiratory systemIn pregnancy there is a change for the respiratory system can meet the needs of O2, resulting in a boost pressure diaphragm because the enlarged uterus at 32 weeks gestation. As compensation for pregnant women would breathe in about 20-25% more than usual.

7. Digestive SystemDue to the influence of estrogen, increased spending on gastric acid that can cause:(1) hypersalivation(2) The hull was hot(3) Morning sickness(4) emesis gravidarum(5) Hyperemesis gravidarum(6) Progesterone cause of bowel movements and can lead dwindle obstipasi.a. Urinary tractDue to the influence of pressure and falling pregnant young pregnant the baby's head on micturition disturbances in the form of frequent urination and causing bladder feels penuh.Terjadinya hemodilution causes rapid metabolism lancer more water resulting in the formation of urine will increase. In pregnancy the ureter enlarged to accommodate the number of urine formation, especially on the right ureter due to ureteral peristaltic hampered due to the influence of hormones progesterone, the pressure of the enlarged uterus and rotation occur to right, and there is a colon and the sigmoid on the left which causes the uterus to right rotation.b. Changes in skinIn the skin pigment deposit changes and hyperpigmentation due to the influence of melanophore stimulating hormone and the anterior lobe of the pituitary gland influences suprarenalis. Hyperpigmentation occurs pad striae gravidarum (livide or albicans), mammary areola, papilla mammae, linea nigra, sometimes cloasma gravidarum. After delivery of hyperpigmentation will disappear.

8. MetabolismChanges in metabolism:(1) basal metabolism is increased by 15% -20% of the original, especially in TMIII.(2) acid-base balance has decreased from 155 to 145 mEq per liter5 mEq per liter of blood due to hemodilution and mineral needs are required fetus.(3) Pregnant women need higher protein for growth and development of the fetus, pregnancy organ development, and preparation for lactation.(4) The need of calories derived from carbohydrates, fats, and proteins.(5) The need minerals for pregnant women:Calcium, 1.5 grams per day, 30-40 grams for fetal bone formation.Phosphorus, an average of 2 grams a day.Iron, 800 mgr or mgr 30 to 50 a dayWater, Pregnant women need plenty of water and water retention can occur.(6) Weight of pregnant women increases.(Manuaba, Ida Bagus Gede, 1998: 106)
2.1.6 Psychological Changes in Pregnancy1) I TrimesterThe first trimester is often regarded as an adjustment period. Adjustments made to the fact that a woman is she was pregnant. Most women feel sad and ambivalent. The uniformity of these needs should be discussed because it tends to hide the ambivalence or negative feelings because feelings are contrary to what he thinks he should feel. If he had not helped to understand and accept ambivalence and negative feelings as a normal thing in pregnancy, then he will feel very guilty if he was the biological child later died when her baby was born or born with disabilities. This can be avoided if he can accept these thoughts as well. These ambivalent feelings usually end in itself as the mother receives her pregnancy. This acceptance usually occurs at the end of the first trimester and facilitated by her own feelings that feel safe enough to begin to express the feelings that give rise to conflicts that he experienced.But some women, especially those who have been planning a pregnancy or have been trying hard to conceive, feel joy at the same time do not believe that she was pregnant and looking for evidence of pregnancy in every inch of her body. The first trimester is often a very exciting time to see whether the pregnancy will develop well. In this woman was very impatient to wait for the end of the first trimester as a stepping stone so that after this trimester bypassed, they can feel relaxed and trusting entirely to their pregnancy.(Textbook Midwifery Care volume 1, Varney: 501)

2) Second TrimesterThe second trimester is often known as a period of good health, ie the period when women feel comfortable and free from any discomfort normally experienced while pregnant. However, the second trimester is also the phase when wanitamenelusur into and most experienced setbacks. The second trimester is actually divided into two phases: pre-and post-quickening quickening. Quickening indicates a separate reality of life, which became the impetus for women in the main psychological task in the second trimester, which is developing an identity as a mother for himself, which is different from her mother.With the onset of quickening, appeared a number of changes due to pregnancy has become clear in his mind. Changing social contacts, more mothers socialize with pregnant women and the interests and activities focusing on pregnancy, child-raising, and preparing to accept new roles. Shifting social values ​​raises the need for a process of grief, which later became the catalyst in estimating his new role. Grief arose because he had to give up the relationship, proximity, and events as well as certain aspects of what he has in previous roles will be affected by the presence of the baby and her new role.(Textbook Midwifery Care volume 1, Varney: 502)

3) Third TrimesterThe third trimester is often called the period of waiting with great vigilance. During this period she began to notice the baby as a separate creature, so she became impatient waiting for the baby's presence. There are misgivings considering the baby can be born at any time. This made him watch while he watched and waited for signs and symptoms of labor emerged.Some fear appears in the third trimester. Women may feel anxious about the baby's life and his own life, such as: whether the baby will be born abnormal, associated labor and delivery (pain, loss of control, other things are not known), whether he will realize that he would be maternity, or baby not able to get out because his stomach was unusually large, or whether his vital organs will experience an injury due to kick babies.He also experienced another grief process when he anticipates the loss of attention and privileges khususlain during her pregnancy, separation between her and the baby that can not be avoided, and the sense of loss because of her womb full of sudden will deflate and the space becomes vacant. Mild depression is common and women can become more dependent on other people more and more resistant because of feelings of vulnerability.(Textbook Midwifery Care volume 1, Varney: 503)

2.1.6 Pregnancy Discomfort1) NauseaOften occurs in the afternoon or in the afternoon hariatau even throughout the day. Nausea is a common problem experienced by more than partially to three-quarters of pregnant women. The number of peak nausea and vomiting in pregnant women are at the age of onset of the womb 11 weeks with an average of between 5 to 6 weeks. Nausea thought to arise due to biological factors, psychological, and sociocultural who have a complicated relationship with nausea and vomiting.Actions that can be used to overcome the nausea are:(1) Eat smaller meals, often, even every 2 hours as this is more easily maintained than eating large portions three times a day.(2) Eating biscuits or dry toast before getting out of bed in the morning.(3) Do not brush your teeth immediately after eating to avoid the gag reflex stimulation.(4) Drink beverages containing carbonate, especially gingerale.(5) Avoid strong smelling foods or stinging.(6) Limit fat in your diet.(7) Try to wear arm pads that act as acupressure.(8) Always remember that the nausea most likely end up in the second trimester.(9) Rest.(10) Use of drugs, but should be alert to the effects of the drug.
2) FatigueFatigue experienced in the first trimester, but the reason is unknown. One conjecture is that the fatigue caused by a drastic decrease in basal metabolic rate in early pregnancy, but the reason this happens is unclear. Another allegation is that an increase in progesterone has the effect of causing sleep.Methods to ease it is to reassure her that fatigue is normal and that fatigue will disappear spontaneously in the second trimester. This knowledge will help women to often rest during the day if possible until exhaustion disappeared. Light exercise and good nutrition can also help overcome fatigue.
3) Ptialisme (excessive salivation)Ptialisme is a condition that can be caused by increased acidity in the mouth or increased intake of starch, which stimulates the salivary glands in women who are prone to excessive secretion. In women who experience ptialisme usually also experience nausea.
4) upper back painThis occurred during the first trimester due to an increase in breast size to weight. This enlargement can lead to the pull of the muscle if the breast is not adequately supported.To reduce this pain is to use a bra that is sized to fit the size of the breast. By reducing the mobility of the breast, the right bra size advocates also reduce discomfort due to tenderness in the breast that can result from breast augmentation.
5) leukoreaIs a large amount of vaginal secretions, with the consistency of condensed or liquid, which began in the first trimester. These secretions are acidic due to the conversion of large amounts of glycogen in the vaginal epithelial cells into lactic acid by Doderlein bacillus. Efforts to overcome leukorea is to consider cleaning the body in the area and replace the cotton panty with frequently. Women should not do douch or use a spray to keep the genital area clean.
6) Increased frequency of urinationThe frequency of urination during the first trimester due to increased weight on the fundus uteri. Increased weight on the fundus uteri makes a soft isthmus (Hegar sign), causing antefleksi the enlarged uterus. This raises the immediate pressure on the bladder. This pressure will decrease as the uterus continues to enlarge and get out of the pelvis to become one of the abdominal organs, while the bladder remains a pelvic organ. Frequency of micturition in the third trimester most often experienced by women primigravida after lightening occurs. Lightening effect is part of the presentation will be dropped into the pelvis and cause direct pressure on the bladder. The only method that can be done to reduce the frequency of urination is to explain why it happens and reduce fluid intake before bedtime so that women do not need to go back and forth to the bathroom while trying to sleep.
7) HeartburnIs the discomfort that often starts towards the end of the second trimester and last until the third trimester. The cause of heartburn is as follows:(1) Relaxation cardiac sphincter of the stomach due to the influence brought about an increase in the amount of progesterone.(2) decrease in gastrointestinal motility that occurs due to relaxation of smooth muscle which is likely due to increased number of progesterone and uterine pressure.(3) There is no room for the stomach due to functional changes in place and emphasis by the enlarged uterus.
Ways to reduce heartburn, namely:(1) Eat small meals, but often, to avoid stomach becomes too full.(2) Maintain a good posture so that there is greater room for your stomach to perform its functions.(3) Stretch your arms beyond the head to make room for your stomach to function.(4) Avoid fatty foods.(5) Avoid drinking with meals because the fluid tends to inhibit gastric acid.(6) Avoid cold foods.(7) Avoid spicy foods or other foods that can cause indigestion.(8) Strive to drink whole milk instead of sweet milk.(9) Drinking milk and skim or low fat ice cream consumption.(10) Avoid heavy meals or a full meal just before bedtime.
8) FlatulenIt is thought to occur due to decreased gastrointestinal motility. The only way to reduce flatulen is the pattern has a regular daily bowel movement and avoid foods that produce gas. Knee-chest position will help the discomfort caused by gas trapped inside.
9) ConstipationConstipation allegedly caused due to a decrease peristaltic smooth muscle relaxation in the colon when there is an increase in the number of progesterone. How to handle:(1) adequate fluid intake, the drinking water at least 8 glasses / day.(2) Consumption of prunes or prune juice because prune is a natural mild laxative.(3) get enough sleep.(4) Drinking warm water when rising from bed to stimulate peristaltic.(5) Eating fibrous food.(6) Have a good bowel habit and regular.(7) Perform the exercise in general, walking every day, maintain good posture, proper body mechanisms, bottom ototabdomen contraction exercise regularly.(8) Consumption of mild laxatives, stool softeners, and or glycerin suppositories if indicated.
10) HaemorrhoidsOften preceded by constipation. Therefore, all potential causes of constipation caused haemoroid. The fix:(1) Avoid constipation.(2) Avoid straining during defecation.(3) bath soak.(4) Apply witch hazel.(5) Apply ice.(6) Compress Epsom salts.(7) Enter haemoroid back into the rectum.(8) Bed rest with the way mengelevasi pelvis and lower extremities.(9) and analgesic ointments or topical anesthesia.(10) Preparation H.
11) leg crampsOne of the alleged caused by the enlarging uterus putting pressure both on the pelvic blood vessels, thereby disrupting the circulation, or on the nerve while it passes neural foramen obsturator the way to the lower extremities. The fix:(1) Ask her to stretch my legs cramped and pressed his heel.(2) Encourage the woman to do general practice and has a habit of maintaining a good body mechanism to improve blood circulation.(3) Instruct the elevation feet regularly throughout the day.(4) Encourage a diet containing calcium and phosphorus.
12) Edema dependentDependent edema in the legs arising from the venous circulation disorders and increased venous pressure in the lower extremities. Impaired circulation is caused by the pressure of the enlarged uterus on pelvic veins when the woman is sitting or standing and on the inferior vana cava while he was in the supine position. How to handle:(1) Avoid using tight clothing.(2) Elevation feet regularly throughout the day.(3) The position of facing laterally when lying down.(4) The use of an advocate or a corset on the maternal abdomen to loosen the pressure on the pelvic veins.
13) Varicose veinsVaricose veins can be caused by impaired venous circulation and increased venous pressure in the lower extremities. This change is due to the enlarged uterus presses on the pelvic veins when the woman is sitting or standing and the emphasis on the inferior vena cava as she lay. Varicose veins that occur during pregnancy is most prominent in the area or the legs and vulva. How to handle:(1) Wear socks backers, a good bandage or elastic socks.(2) Avoid wearing tight clothing.(3) Avoid standing for long.(4) Provide rest periods, with the legs elevated periodically throughout the day.(5) Lying by taking a right angle position several times a day.(6) Take the inclination position several times a day.(7) Keep your legs are not crossed when sitting.(8) Sit whenever possible, especially with both legs elevated, minimizing stand.(9) Maintain posture and good body mechanisms.(10) Apply a light workout and run regularly to facilitate the increased circulation.(11) Give a physical support on the vulva varicose veins using rubber pads associated with the belt clean.(12) Wear a proponent of the maternal abdomen or corset to relieve pressure on your pelvic veins.(13) Perform Kegel exercises to reduce varicose veins vulva or haemoroid to improve circulation.(14) Perform a soothing hot bath.
14) DyspareuniaPain during intercourse can be derived from a number of causes during pregnancy. Physiological changes can be the cause, such as congestion vagina / pelvis due to impaired circulation due to pressure of an enlarged uterus or pressure of the presenting part. Psychological factors can cause any dispareuniakarena misconceptions and fears of hurting the baby even though this concern is not unreasonable unless there is perdaran vagina or rupture of membranes. The fix:(1) Changes in position can reduce the problems caused by enlargement of the abdomen or pain due to a too deep penetration.(2) Apply ice to reduce the congestion that can be handled, it also poses its own inconveniences.(3) Discuss the wrong idea and fear that is felt and give facts can calm the woman.(4) Couples usually welcomes information about alternative ways to satisfy the sexual desires of each pasanngannya.
15) InsomniaInsomnia, both in yng women pregnant or not, can be caused by a number of causes, such as fears, anxieties, too excited to welcome an event for the next day. Pregnant women have an additional physical reasons include other discomforts during pregnancy and fetal movement, particularly the fetus is active. How to handle:(1) warm water bath.(2) Drinking water as warm as milk, decaffeinated tea mixed with milk.(3) Conducting activities that do not cause stimulus before bed.(4) Take a position of relaxation.(5) Use of progressive relaxation techniques.
16) Pain in the ligamentum teres uteriPain in the ligamentum teres uteri could be due to stretching and possibly due to heavy emphasis on the rapidly increasing uterine ligament. How to handle:(1) Flexion of the knee to the abdomen.(2) The bending direction to reduce stretching pain in the ligament.(3) Tilt the pelvis.(4) Make a warm bath.(5) Apply a warm compress on the painful area.(6) prop the uterus by using the right pillow underneath and a pillow between your knees when lying on her side.(7) Wear a backer or maternal abdominal girdle.(Textbook Midwifery Care volume 1, Varney: 536-542)
2.1.7 Distribution Trimester1) TM I: 0-14 weeks2) TM II: 14-29 Sunday3) TM III: 28 to delivery(Saifuddin, 2002: N-2)
2.1.9 Minimum Visits During Pregnancy1) One-time visit of the first trimester (before 14 weeks)2) One-time visit of the second trimester (between weeks 14-28)3) One-time visit of the third trimester (between weeks 28-36 and after week 36.(Saifuddin, 2002: N-2)

.1.10 Schedule of Antenatal Care Inspection1) Trimester I and II(1) Each month once(2) On the capture of data on laboratory(3) Ultrasound(4) Menasehat diet about four of five perfectly healthy, an additional ½ g protein / kg body weight: One egg / day.(5) Observation of a disease that can affect pregnancy, complications of pregnancy.(6) Plan for the treatment of disease, requires the occurrence of pregnancy complications, and tetanus immunization I.
2) Third Trimester(1) Every two weeks until there is a birth mark.(2) Evaluation of laboratory data to see the outcome of treatment.(3) four of five perfectly healthy diet.(4) ultrasound examination.(5) Immunization against tetanus II.(6) Observation of diseases that accompany pregnancy, third trimester pregnancy complications.(Saifuddin, 2006: 98)
Purpose of visit ANC:(1) Monitor the progress of the pregnancy to ensure maternal health and fetal growth and development.(2) Improve and maintain physical, mental, and social mother and baby.(3) Recognize early abnormalities or complications that occur during pregnancy.(4) Prepare a fairly month labor, birth mother and her baby survived the trauma as early as possible.(5) Preparing the mother in the puerperium can walk normally and exclusive breastfeeding.(6) Preparing for the role of mothers and families in order to receive the birth of a baby in an optimal growth and development.(Saifuddin, 2006: 90)
Midwifery care Refokusing 01/02/111) TM I, I visit before the 14th week.(1) Establishing a trusting relationship between midwives and mothers.(2) Detecting the problem can be treated before a life-threatening.(3) Preventing Tetanus Neonatorum such problems, anemia, iron deficiency, and the use of harmful traditional practices.(4) Encourage healthy behaviors, including: nutrition, exercise / sports, and recess.
2) TM II, II's visit before the 28th week and the third visit at week 32.(1) Introduction of complications due to pregnancy and its treatment.(2) Be aware of complications: preeklampsi, gemeli pregnancy, UTI, and IMS.(3) Repeating a birth plan.
3) TM III, IV's visit at week 36 until birth.(1) Just like the visit I and II(2) Identify the location and presentation abnormalities(3) Confirming the birth plan(4) Recognize the signs of labor.(Saifuddin, 2002: N-2)
2.1.11 Minimum Care StandardsThere are 14 T, namely:1) Ask sapa2) Abnormalities of the face3) TB, BB4) TD5) Abnormalities of the mammary6) Abnormalities of liver and spleen7) SFH8) STD / STIs9) TT10) Hb, reduction of urine protein urine &11) Freshness of physical12) danger signs of pregnancy13) Tablet FE14) Temuwicara

CHAPTER IIICASE REVIEW 3.1 ASSESSMENTDate: 12 September 2011 Time: 17:00 pmBy: Eprilia hex Setyaningtyas3.1.1 Subjective Data1) BiosName of Wife: Mrs. "S" Husband Name: Mr. "Z"Age: 23 years Age: 26 thReligion: Islam Religion: IslamTribes / Nations: Java / Indonesia Tribe / Nation: Java / IndonesiaEducation: PT Education: PTOccupation: Teacher Job: TeacherAddress: Ds. TlanakKedungpring2) Main ComplaintMom said to feel nausea, vomiting and decreased appetite3) History of chief complaintMother felt nausea and vomiting since 1 month of pregnancy nausea, vomiting and felt in the morning. Nausea and vomiting often in its feel and reduced meals when made a break.4) Menstrual HistoryMenarche: 14 yearsCycle: 28 daysRegular / not: RegularLong: 5-6 daysThe numbers: 1-3 days out 2-3 pads / day, 3-7 days to run out 1-2 pads / dayProperties of liquids: a liquid does not bergumpalanColor: maroonFlour Albus: before and after menstruationDisminorhoe: the first day of menstrualLMP: 12 - 06-2011HPL: 19 - 03-20125) History of Obstetricsa. Pregnancy History NowMother says the first pregnancy with gestational age 5 months. Mother said fetal movement was felt first in the 5th of this month.History of the ANC.

	TM I	TM II	TM III
Spot check	Midwife	Midwife	Not done
Complaint	Without complaint	Without complaint	Not done
Extension in the can	Regarding the nutritional needs during pregnancy Patterns of sexual relations	The pattern of nutrient The pattern breaks	Not done
Vit / drugs in the can	Folic Acid	Fe Kalk
TT		1 x	Not done

6) History GeneklogiMom says do not suffer from sexually transmitted diseases (STDs), such as gonorhea, syphilis, HIV / AIDS, never had a tumor on her pregnancy and never do a pap smear.7) Family Health HistoryIn the family never suffered from the disease declined as DM, hypertension, and infectious diseases like TB, like diabetes, hypertension and no chronic illnesses such as asthma.8) Past Medical HistoryMother said never suffer decline as DM, hypertension, and infectious diseases such as tuberculosis, hepatitis, and no chronic illnesses such as asthma.9) History of ContraceptionMother said that had never used contraceptives before.10) Psychosocial and spiritual stateMother says the first pregnancy, the pregnancy is planned. Hope the family of this pregnancy is a healthy child, born safely, male or female alike, in please by midwives in the midwife.11) Cultural background- Aid in childbirth in keuarga please by midwives- In the family there is no habit which inhibits pregnancy such as incontinence eating- In a family celebration usually held 7 monthly- The husband of pregnant mothers support12) functional health patternsa.Pola NutritionBefore pregnancy: Eating 3x/hr with the composition of rice, side dishes. vegetables, fruits, drinking water ± 5 GLS / hr.During pregnancy: Eating 2x/hr ½ servings with the composition of rice, side dishes, vegetables, fruits, drinking water ± 5-7 GLS / hr, plus milk 2 GLS / hr.b.Pola rest and sleepBefore pregnancy: Take a nap 2 jm / hr, and slept the night 6-7 jm / hr.During pregnancy: Take a nap 2 jm / hr, and slept the night 6-8 jm / hr.c.Pola activityBefore and during pregnancy the mother doing homework everyday such as: sweeping, ngepel, washing clothes, and cooking, and during pregnancy do so with the help of her husband.d.Pola EliminationBefore pregnancy: CHAPTER 1x/hr. BAK 4-5x/hr.During pregnancy: CHAPTER 1x / hr. BAK 5-7x / hr.e.Pola sexualBefore pregnancy: Mother says husband and wife do pinnacle 3x a week.During pregnancy: the mother says marital relationship 1x a week.f.Pola personal hygieneBefore pregnancy: Bathroom 3x/hr, 2x/hr brush your teeth, wash 3x a week, change of clothes and CDs every bath.During pregnancy: Bathroom 3x/hr, 2x/hr brush your teeth, wash 3x a week, change of clothes and CDs every bath. 13) Knowledge and Ability Moma.Pola NutritionMother said it is not understood about the patterns of nutrition during pregnancy.b.Personal HygieneMom already understand how to keep it clean.c. The pattern of activityMother is understood to reduce its activity during pregnancy so that there is no interruption of pregnancy.d. Patterns of sexualMother said it was understood about sexual patterns, thereby reducing its activity to avoid maternal uterine contractions.e. Danger signs of pregnancyMother said it is not understood about the danger signs of pregnancy 3.1.2 Objective Data1) a general examinationGeneral condition: GoodAwareness: ComposmetisTB: 151 cmPre-pregnancy weight: 45 kgBB during pregnancy: 47 kgLila: 24 cmTTVBlood pressure: 120/80 mmHgTemperature: 36.3 ° CNadi: 84 x / mntRR: 20 x / mnt 2. Physical examinationHead: black hair, not fall, uneven distribution, clean scalp, no dandruff and lice, there are no abnormal lumps.Face: Shape oval, symmetrical, there cloasma gravidarum, not odema.Eyes: symmetrical, there is a picture of a thin white sclera blood vessels, conjungtiva pink, no hematoma on palpebra, no pitosis, no strabismus / squint, blink reflex normal, pupils isokor, wide field of view normally.Nose: There is no breathing nostrils, nasal mucosa moist, pink, clean, no discharge, no polyps, no sinus tenderness.Mouth: lips moist, pink, no stomatitis, no dental caries, tongue cleaner, there is no bleeding of the gums, there is no enlargement of the tonsils.Ears: symmetrical, mucosa moist, pink, clean, no wax / foreign body, the tympanic membrane intact, shiny whiteNeck: There is no neck stiffness, no enlargement of lymph nodes / thyroid, there is no dam jugular vein.Chest: flat round shape, there is no traction intercoste, vesicular breath sounds, no Ronchi / wheezing, BJ I heard "loop", BJ II sound "dup", no crepitus.Breast: Simertis, Hyperpigmentation areola and nipple, nipple stand, there is no abnormal lumps, no tendernessAbdomen: no scars operation stitches, no enlargement of the spleen and liver, no epigastric pain, no appendik, no skibala palpable, empty bladderGenetalia: Spread evenly pubic hair, no redness and inflammation odemaAnus: No hemorrhoids, anal lesions and cleanEkstermitasAbove: The number of fingers 10, no odema, free movement, no cyanosis, pink nail color, no polidaktil or sindaktil, skin turgor returned less than 1detikBottom: The number of fingers 10, no Odem, as well as varicose veins, skin turgor returned <1 second. 3. Special physical examination (obstetric)a) Inspection (breast and abdomen)Hyperpigmentation of the areola and nippleThere is no surgical scar on abdomenAccordance with the abdominal enlargement of pregnancyFetal movement seen on the right side of abdomenb) PalpationLeopold I: SFH simpisis halfway between the center of the pubis, pregnancy 15 weeks. Ballottement (+)Leopold II: Not assessedLeopold II: Not assessedLeopold IV: Not assessedc) Auscultation: Not assessedd) Percussion: Not assessede) Check In: ​​Not assessedf) Examination Support: Not assessedg) outside the Pelvic ExaminationDistansia spinarum: not assessedDistansia critarum: not assessedConjungata external: not assessedHip circumference: not in the reviewh) In Pelvic Examination: not assessed 3.2 INTERPRETATION OF DATADx: Ny "S" G2 P1001 UK 15 weeks with emisis gravidarum. Impression of a normal pelvis.Unmet needs:1) The pattern of nutrient2) The cause nausea, vomiting and how to cope3) danger signs of pregnancy4) Immunization Ds: My mother said that the two women, gestational age of 3 months. Mother said it was not felt fetal movement. Do: The general condition: GoodAwareness: ComposmetisTB: 151 cmPre-pregnancy weight: 45 kgBB during pregnancy: 47 kgLila: 24 cmTTVBlood pressure: 120/80 mmHgTemperature: 36.3 ° CNadi: 84 x / mntRR: 20 x / mnt Leopold I: SFH simpisis halfway between the center of the pubis, gestational age 15 weeks. Ballottement (+).Leopold II: Not assessedLeopold II: Not assessedLeopold IV: Not assessed Auscultation: Not assessedScore Poedji Rochati:Number of scores A + B = 2Low-risk pregnanciesGreen Percussion: Not assessedExamination In: Not assessedExamination Support: Not assessed 3.3 POTENTIAL PROBLEM OF ANTICIPATION-3.4 IDENTIFICATION OF NEEDS IMMEDIATE-3.5 INTERVENTIONDx: Ny "S" G2 P1001 UK 15 / Ballotemen (+) with emesis gravidarum.Short-term goalsAfter midwifery care for ± 30 minutes expected mother will be able to receive an explanation of the midwife with the results criteria:K: the mother is able to understand and explain:Meeting the nutritional needsCauses nausea, vomiting and how to handleDanger signs of pregnancyimmunization A: The mother would do ajnuran from midwives about:Mothers can meet the nutritional needsMothers can recognize danger signs of pregnancy and what if you catch these symptoms immediately come to the health worker.Breast care during pregnancyControl back to the midwife again a month or at any time if there are complaintsP: -P: -Long-term goalsAfter midwifery care for ± 1 month the state is expected to keep both mother and fetus with the criteria results:General state of both mother and fetusSFH: In accordance with gestational ageDJJ: within normal limits (120-160 x / minute)BP: systolic 90-120 mmHg 60-90 mmHg DiastoleTemperature: 36.5 ° C - 37.5 ° CNadi: 72-88 times / minuteRR: 16 - 24 x / minuteBB: ± 1 kg per month Intervention1. Perform therapeutic approach with clientsR / a trusting relationship between midwives and clients2. Explain to the mothers about the causes of nausea, vomiting, and how to overcome them.R / With a good knowledge of women are more cooperative in providing midwifery care3. Advise the mother to consume a balanced dietR / Food provides energy and helps balance the growth of the fetus4. Tell us about the danger signs in pregnancy youngR / With a good knowledge, in order to detect any abnormalities5. Collaboration with physicians in prescribing and B6 B ComplekR / Function interdependent in the provision of B Complek and B66. Advise the mother to control back again a month or any time there are complaints  R / Monitoring developments and state of maternal and fetal 4.2ImplementasiDate: 12 September 2011Date / hourImplementationInitials17:15 17. 20 17:2517:29 Terapiutik approach to greeting the clients and ask for news of her pregnancy. Explain to the mother about the pregnancy, the causes of nausea, vomiting and how to copeMother can understand the explanations given Explaining that eating balanced meals with foods that interesting, eat little but often, eat meals on time masi warm.Mother understands and is willing to consume food  Are recommended.Explain the danger signs in early pregnancy: excessive vomiting, bleeding pervaginan, more than usual headaches, visual disturbances, swelling of the face / hands, pain in abdomenMothers may mention signs of pregnancy danger signs correctly Giving oral therapy and vitamin B6 B Complek. Encourage the mother to return again / back control again a month or at any time if there are complaints. IV.EvaluasiDate: 12 September 2011Hours: 17:30 amS: She said it was understood explanations that have been delivered by midwives about:Condition and current objec fetusNutritional needsOvercome the nausea and vomitingDanger signs of pregnancyMother was willing to do the recommendation of the midwife about:Recognizing the danger signs of pregnancyMeet the nutritional needsControl back to the midwife again a month or at any time if there are complaintsO: the mother was able to explain again about:Condition and current objec fetusHow to cope with nausea, vomitingDanger signs of pregnancyMeet the nutritional needsControl back to the midwife again a month or at any time if there are complaintsA: G2 P1001 UK 15 weeks, My good mother. Short-term goal is achieved entirely.Q:-Stop the intervention-Encourage regular medicationAdvocated control over one month longer or return control immediately if there are signs of danger. CHAPTER IVDISCUSSIONReview of midwifery care with antenatal care treatments that are used physiologically based management through the 7 steps of diagnosis obtained Varney Ny "S" G1 P1000 UK 15 weeks, the general state of both mother and fetus with emesis gravidarum.To facilitate the preparation of this discussion the author will start discussing it with classifying problems according to the stages of the process of midwifery care, the assessment stage, the analysis of diagnosis / problem, the potential diagnosis, immediate action, planning and action, as well as assessment and evaluation stage.4.1 Assessment PhaseAt this stage of the assessment of subjective data and objective data, the authors found no difficulty either through direct interviews and through observation of the client and his family. This is because clients are easy to communication and cooperation with bothIn the case of Ny. "S" with pregnancy TM II data in the case of subjective and objective assessment in accordance with the data found in the theory.4.2 Analysis Diagnosis / ProblemHaving performed the analysis can not get a problem in the Ny "S" experienced emesis gravidarum ..Potential 4.3MasalahPotential problem in the case of Mrs "S" is not found because there is no supporting data that point to potential problems4.4Identifikasi Immediate NeedsIn this case immediate action is performed on the mother was not there because the condition of mother and fetus fine.4.5Tahap PlanningIn accordance with the diagnosis, the authors perform an action plan midwifery care to clients in accordance with the theory. In this planning stage there are no barriers encountered due to the means, working paper, the resources of the client, and a place to carry out midwifery care possible in principle to make an action plan in accordance obstetrics and protab available. Planning can be prepared based on diagnoses / problems and needs of clients.4.6PelaksanaanAt this stage the authors carry out the implementation of midwifery care in accordance with the plans that have been made or established diagnosis of Mrs "S" G1 P1000 UK 15 weeks of the general state of good mother. This is because of good cooperation between staff, clients, families that can carry a good midwifery care.4.7EvaluasiAfter implementation of the actions carried out an evaluation of actions and results, the mother understood the explanation of the officers about the current condition of pregnancy, the mother responds with good explanations and state officials on the current capitalIn this case there is no gap between theory review with a review of cases. This stage is performed after assessment of midwifery care provided to clients. The authors note the final results obtained in accordance with the purpose of the evaluation criteria contained in the review of the literature. CHAPTER VCLOSING5.1KESIMPULANAfter doing midwifery care become pregnant at Mrs. "A" P0000 G1 UK 15 Sunday with emesis gravidarum obtained the conclusion that the assessment has been carried out data collection that includes subjective and objective data. From the assessment was taken of a diagnosis that Mrs. "S" in good condition. Evaluation is done after the implementation done that show that Mrs. "S" is able to understand and comprehend all the explanations of health workers.In pregnancy care antenatul care is very important because it can control the symptoms experienced and know the development of the fetus, thus a midwife should be able to provide midwifery care of pregnant women to exactly fit the standard midwifery profession so that pregnancy can proceed smoothly 5.2KRITIK AND ADVICEStudents 5.2.1BagiStudents should be able to apply the science of logic and science penetahuan in executing and implementing midwifery care is good and right5.2.2Bagi Educational InstitutionsCan adjust between theory and practice of midwifery care, especially in pregnant women and further improve the quality of learning Askeb I.5.2.3Bagi patientsTo be able to better maintain and kehahamilanya regard to the situation as well as regular visits every month / minimum standards of midwifery care (4x visits during pregnancy) to the nearest midwife REFERENCES Concerned. Sarwono P: 2002. Maternal and Neonatal Health Services: New YorkConcerned. Sarwono P: 2002. Obstetrics: JakartaDr. Rustam Mukhtar Mpit: 2002. Synopsis Opstetri Volume 2: New York: EGCHelen Varney, M. Krebs Hours. Ge L Carolya Gor. 2007. Midwifery Care Textbook Volume 1: New York: EGCProf. Sastrawinata Solomon. 1983. Physiological Obstetrics: New YorkIda Bagus Gde Manuaba SpOG. Prof. Dr. 1998. Of Obstetrics Gynecology and Family Planning, for Midwife Education: New York: EGCMaternal and Child Health Book Surabaya. 2008