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Factor Analysis of Postpartum Blues on Post Partum Patients at Puskesmas Proppo Pamekasan

Post Partum Blues (PPB) is sadness or moodiness after delivery which occurs on the third day to two weeks. The incidence of PPB in Indonesia is experienced up to 50-80% of new mothers. Some factors that are suspected to be the cause of PPB are knowledge, type of delivery, husband support, and parity. The purpose of this study was to analyze the factors affecting post partum blues on post partum mothers at Puskesmas Proppo Kabupaten Pamekasan. This research type is quantitative research with cross sectional research design. The study was conducted on January 25 to February 25, 2018 at Puskesmas Pamekasan with 110 postpartum mothers. The sample size is 86 respondents taken with simple random sampling. The independent variables are knowledge, type of labor, support of husband and parity. Dependent variable is post partum blues event. Data were analyzed using logistic regression test with p = 0,05. The results showed that variable X1 (knowledge) with p = 0,007; OR = 8,149, Variable X2 (type of labor) with p = 0,485; OR =1,822, Variable X3 (husband support) with p = 0,005; OR = 4,518, Variable X4 (parity) with p = 0,749; OR = 1,153. So it can be concluded that the factors that affect Y (post partum blues events) is the factor of knowledge and support of the husband, with the most dominant factor is the support of husbands with the effect of 4.581. The low knowledge of postpartum mothers on PPB, and sufficient support of husbands led to the incidence of PPB in Puskesmas Proppo Kabupaten Pamekasan. So it needs health promotion efforts even more intense so as not to happen on PPB.


INTRODUCTION
Childbirth is a great gift for women and a very happy moment, but sometimes there are women who experience sadness and moodiness after childbirth. Post partum blues (PPB) or maternity blues or baby blues are mothers who experience sadness or moodiness after childbirth, caused by hormonal changes in a woman's body during pregnancy, as well as feelings of sadness associated with her baby after childbirth. It is marked as an unexplained anxiety symptom, crying for no reason, impatient, insecure, irritable, feels less like a baby. (Marmi, 2012). This PPB usually appears on the second day to two weeks, the ESD is experienced up to 50-80% of new mothers. The incidence of PPH incidence overseas is quite high reach 26-85%, globally estimated 20% of women give birth to MARPs. In the dutch of 2001 estimated 2-10% of mothers gave birth to this disorder (Anggraini, 2010).
A study conducted in Sweden, Australia, Italy and Indonesia using EPDS (Edingburg baby blues syndrome Postnatal Depression Scale) in 1993 showed that 73% of women had PPB. In 2008, almost 70% of new mothers suffered from PPB. Meanwhile in 2009 in Indonesia today there are almost 80% of mothers experience it at post-maternity and 75% of them occur in primigravida mother (Rahmi, 2013). While research in Singapore in 2010 got the number of post partum blues about 10% -20%. According to Ade (2011) in Indonesia the incidence of post partum blues between 50-70% of women postpartum. At Puskesmas Proppo of Pamekasan District through the temporary data collected by researchers using EPDS (Edingburg baby blues syndrome Postnatal Depression Scale) it is known that during January to August of 2017 there were 56 mothers who experienced post partum blues of Total of 373 mothers giving birth or 15% of total birth (Puskesmas Proppo data, 2017).
The cause of post partum blues can be more than one cause so that the symptoms and signs of post partum blues is actually a multifactorial mechanism. Knowledge is the result of knowing and occurs after sensing an object that is an important factor for the formation of a person's behavior (Notoadmodjo, 2003). If a person's knowledge is as low as the knowledge of post partum blues then it can affect the occurrence of post partum blues. Another factor that affects post partum blues events is the type of labor. Childbirth with some medical technology (the use of obstetric devices such as caesarea, episiotomy) can trigger post partum blues. Caesarean section surgery is a medical intervention that may lead to unexpected emotional reactions, the emergence of negative views from neighbors due to normal delivery, surgical scars, feelings of being completely female, disrupted by daily activity due to surgical wounds.
Husband support factors also affect post partum blues events. Family especially husband has a very meaningful role for each member. These roles are among others as a driver (support) between family members in particular to help mothers perform tasks in role adaptation. In a new mother who has a baby (primipara) will feel the feelings of different, perhaps not even imagined before, in this condition the support of the husband is needed..
Demographic factors such as parity can also affect the occurrence of post partum blues. Low parity (parity one), unpreparedness of the mother facing the first delivery is a factor causing the incompetence of pregnant women in dealing with complications that occur during pregnancy, labor and postnatal. The lack of experience or even the birth of an unexpected child can lead to a mother's rejection of the child (Sulistyawati, 2009).
This study aims to analyze the factors of knowledge, type of childbirth, support of husband and parity and the most dominant factors that influence post partum blues on post partum mothers at Puskesmas Propo Pamekasan.

METHODS
The design of this study was cross sectional. This study was conducted on 25 January -25 February 2018. The measured variables consisted of free variables of Knowledge, type of delivery, husband support, and parity. The dependent variable is post partum blues event. The sample consisted of 86 post partum mothers selected using simple random sampling technique. The instrument uses a questionnaire. Data analysis using logistic regression statistic test. From the above table, the majority of respondents (69.77%) "Middle" are 60 respondents. From the above table, the support of most of the respondent's husband (61.63%) got husband support "Middle" that is 53 respondents.  The result of bivariate analysis between knowledge factor and post partum blues occurrence is found that from 86 post partum mothers with enough knowledge, post partum blues were 49 respondents (56,98%). Result of analysis between type of delivery to post partum blues event, it is known that from 86 post partum mothers giving birth normally, post partum blues counted 52 respondents (60,46%). The result of analysis between husband support factor and post partum blues occurrence showed that 86 post partum mothers who received husband support were having postural blues as many as 44 respondents (51.16%).

Analisis
Factor Analysis of Postpartum Blues on Post Partum Patients….. Result of analysis between parity to post partum blues occurrence from 86 postpartum mothers obtained with primiparity parity, experiencing post partum blues counted 37 respondents (43,02%).

A. The Effect Of Knowledge On PPB at Puskesmas Proppo Kabupaten Pamekasan
From the results of Logistic Regression analysis obtained p value = 0.007 means that there is influence of mother's knowledge on post partum blues event at Puskesmas Proppo Pamekasan District. OR = 8,149 which means that if mother have less knowledge about post partum blues, hence have risk of post partum blues 8,149 times bigger than post partum mother having good knowledge.
This research is in accordance with the opinion of Notoatmodjo (2012) which states that knowledge is the result of knowing and occurs after doing the sensing of an object so that knowledge is an important factor for the formation of a person's behavior. Knowledge can be obtained either directly or indirectly and the knowledge gained will affect the development of one's behavior. Knowledge basically occurs from a number of facts and theories that enable a person to be able to solve the problem he faces, where knowledge is initiated from know, understand, application and able to decipher the material that has been studied.
Knowledge has an important role for post partum mothers in determining attitudes or actions. The better your knowledge about post partum blues, the better it will be in the post partum period. Level of education one of which affects knowledge, the higher the level of a person's education the better his knowledge, especially knowledge of post partum blues. The level of education is very influential on emotional intelligence, mothers who have higher education will have a more rational way of thinking, and the easier to receive information. Mothers who do not get adequate information about pregnancy and childbirth will generally find it difficult to adapt to their new roles and activities to allow for psychological disorders such as post partum blues. This is because the role change in a woman becomes a mother who is not ready when facing birth. The demands of the mother's role in taking care of the family, especially the children and the household, make the mother must adjust to face new role and activity as a mother especially in the first weeks or month after giving birth.

B. Effect Of Type Of Delivery To PPB at Puskesmas Proppo Kabupaten Pamekasan.
From the analysis of Logistic Regression test, there is a Sign value of 0.485 which means that there is no influence of postpartum maternal type on post partum blues incidence in Puskesmas Proppo Pamekasan District. OR = 1,822, it means that if post partum mother gave birth with normal delivery type, then post partum mother did not experience post partum blues 1,822 times bigger compared to post partum mother giving birth with SC type of labor.
One of the factors that influences the type of labor is the age of the mother. Nearly half of respondents aged 20-25 years of childbirth as normal as 27 respondents (31.40%). The age is the ideal age for pregnancy and childbirth as it reduces the risk of health problems during pregnancy and childbirth. In addition, when viewed from the development of maturity, women in this age group has a maturity of reproduction, emotional and social aspects. In addition, the age is the right age to give birth normally if the mother does not have an indication SC. This is because at that age the mother's Factor Analysis of Postpartum Blues on Post Partum Patients….. body is primed enough to give birth normally. At this age the mother has the power (power) is good enough to push and push the fetus. Pelvic cavity as the baby's birth canal has grown more maturely so that it can be passed by a baby's head whose normal size is between 9-10 cm in diameter. As well as reproductive organs such as uterus and vagina are also already strong to support childbirth. According Manuaba (2012) the most important factor in the process of labor is the power of the power of the mother as well as uterine contractions.
There are several factors that cause it to happen to the mother of post partum such as the duration of labor and problems in the baby. a prolonged labor will make the mother have a less than satisfactory labor experience. The duration of labor will make the mother have an unsatisfactory labor experience, so the mother exhibits a negative self-image and may continue to be an anger that may complicate the process of maternal adaptation to her new role and function.
In addition to the old factor of labor, the problems experienced by the baby also causes the mother to have post partum blues, because it causes the mother to lose interest to take care of her baby. Problems in these infants include birth or birth complications with sex not in accordance with expectations, or birth with congenital defects. Infant health conditions will also be an additional stressor for the mother, babies become need more attention, care and cost.

C. The Effect Of Husband Support on PPB at Puskesmas Proppo Kabupaten Pamekasan
From the results of data analysis Regesi Logistic Sign Value 0.005 means there is influence of husband support to post partum blues events at Puskesmas Proppo Pamekasan District. OR = 4,518, implies that if the post partum mother has low husbands support, the risk of having post partum blues is 4.518 times greater than mothers who have high husbands support.
The husband is the wife's spouse (father of the children), the husband has a full responsibility in a family and the husband has an important role, where the husband is demanded not only as a breadwinner but the husband as a motivator in various policies that will in deciding including family planning (Chaniago, 2010).
Husband support for post partum mother is needed so that mother can go through post partum period comfortably and to avoid post partum blues. Because the husband is the closest person to the mother in the family. Husband support is the biggest factor to trigger the Postpartum Blues. This is because the support of the husband is an important coping strategy when experiencing stress and serves as a preventive strategy to reduce stress. The role of husband in minimizing postpartum blues is to understand the needs of the wife, husband accompanying the wife in the care of the baby, the husband do the household tasks are usually done wife, the obligation of the husband to share the attention to the baby and mother. Although the presence of the baby is very pleasant and happy, it should be remembered that the mother who gave birth to physical touch in the post-birth period With the social support of a good husband then the mother does not happen postpartum blues.

D. The Effect Of Parity on PPB at Puskesmas Proppo Kabupaten Pamekasan
From the results of analysis using Logistic Regression obtained Sign value 0.749 means that there is no influence of post partum mother parity on post partum blues events at Puskesmas Proppo Pamekasan District. OR = 1,153. This implies that if the post partum mother of multiparous grande parity, then the post partum mother did not experience post partum blues 1.153 times greater than the postpartum mother with primiparity parity.
Age factor affects mother's parity. The result of research got most respondent of primipara parity counted 48 responden (55,81%). Parity with primipara in the respondents is almost half aged 20-25 years. Where age is a safe age for pregnancy and childbirth because the reproductive organs are ripe. This is consistent with Ekasari's statement that the age at which pregnancy affects the mother's readiness so that the quality of human resources is increasing and the readiness to nourish the next generation can be guaranteed.
The number of children produced has an influence on postpartum blues events, labor, length of labor and complications experienced after delivery, especially in primiparous moms can affect the psychological mother, where the greater the physical trauma experienced the greater the psychic trauma that appears, and this the more heavily felt in women who first gave birth to their child. This is Factor Analysis of Postpartum Blues on Post Partum Patients….. in line with research conducted by Paykel and Inwood (Regina, et al, 2006) says that the post partum blues are mostly found in primiparous women given that the role of a mother and everything related to her baby is a completely new situation for her and can cause stress.
Pregnancy is traditionally viewed as an emotional crisis by some psychologists. Conditions experienced by women in the first experience of pregnancy is a new condition faced so that not infrequently cause stress for him. Some women mention pregnancy with a feeling of happiness but do not rule out anxiety arise.
For that it takes a good self-preparation starting from the time of pregnancy in order to avoid post partum blues on postpartum mothers, such as self preparation during pregnancy is necessary so that the birth has a good confidence so as to reduce the risk of post partum blues. Class of pregnant women in this case is very instrumental because with active mothers come to the class of pregnant women who become the mandatory agenda of the local health center can consult directly to health workers about pregnancy and preparation of childbirth and post partum. with a special class for pregnant mothers, mother-to-child knowledge of pregnancy and preparation during pregnancy will surely increase. That way, will prevent the occurrence of things -things that are not in want during pregnancy until the birth process takes place. That way, mothers who attend this pregnancy class can avoid the risk of post partum blues attack during post partum, which will be dangerous for the child or mother.

E. The Most Dominant Factor Affecting PPB at Puskesmas Proppo Kabupaten Pamekasan.
Based on statistical test of logistic regression obtained value on knowledge factor p = 0,007; OR 8.149 and on husband support p = 0.005; OR = 4,518. This implies that the knowledge and support of the husband has the most dominant influence of other factors.
Post partum blues is a form of mild symptoms or temporary depression with a duration of 3-7 days postpartum. Where postpartum blues symptoms usually occur on the third or fourth postpartum day and peak on the fifth or seventh to fourteen post-partum days. However, if not handled properly will develop into a more severe condition. This can be characterized by feelings of irritability, sadness, loneliness or rejection, anxiety, confusion, anxiety, fatigue, forgetfulness, tend to cry easily, annoyance, feelings of despair even to the mother feel reluctant to take care of her own baby.
The most dominant factor in post partum blues events is dependent on the support of the husband. Husband support is the biggest factor to trigger the Postpartum Blues. Husband's support is taking time out for mothers if the mother is tired with her routine, intimate communication and intimate relationships, the most significant factor being the trigger for postpartum blues.
For that support is needed and very important husband by post partum mothers. Because such support can build a positive atmosphere. Support is in the form of helping the wife in the care of the baby for example when the mother breastfeed her baby, the father also helped maintain. Father can accompany mother and baby, lift baby out of bed, change baby's diaper, give baby to mother during nursing hour, and return baby to bed when baby has fallen asleep again.

CONCLUSION
It is necessary to do research to know the factor analysis of post partum blues occurrence in post partum mother with different variable that is baby condition in the form of baby's gender and also baby's health condition. Need to improve counseling on post partum and family mothers in facing post partum to avoid post partum blues events. Health education can be given when pregnant women accompanied by the husband to do ANC (Ante Natal Care) to the midwife. Health education is about post partum, newborn care, and role change in post partum.