THE DEVELOPMENT OF ALMIGHTY PAY 2B PSYCHEDOCATION OF MORNING SICKNESS SYMPTOMS IN PREGNANT MOTHER AND HOW TO OVERCOME IT
All praise is due to Allah SWT for making it easy for us to complete this psychoeducation activity report in a timely manner. Of course without His help we would not be able and able to complete this psychoeducation activity report properly. Prayers and greetings may be abundantly given to the great Prophet Muhammad SAW whom we are looking forward to the Shariah in the hereafter. We are very grateful for completing this psychoeducation activity report. We also want to say thank you to all those who have helped us in completing the task of this psychoeducation activity. We thank you very much for your guidance and direction to our lecturer, Mrs. Sitawaty Tjiptorino, MBA, M.Psi. Thus we can convey, hopefully this psychoeducation activity report can provide information for us all and the benefits that can be felt together. Bogor, 14 May 2020 CHAPTER I INTRODUCTION 1.1 Background Pregnancy is a continuous chain process consisting of ovulation, release of eggs, spermatozoa and ovum migration, zygote conception and growth, nidation (implantation) of the uterus, formation of the placenta, and growth and development results conception to term. In pregnancy will experience changes both physiologically and psychologically, psychological changes usually occur in pregnancy during the first trimester (Kamariyah, Yasi, and Siti, 2014). While in trimester 2 (4-6 months), psychological changes that occur begin to worry about body shape changes so that confidence decreases, it requires more attention from the environment with spoiled conditions and increased sexual drive and always questions the presence of a partner who needed in this trimester is to strengthen positive communication, don’t bury or assume things, do fun activities with your partner, and pamper yourself and improve your appearance, like pedicure or manicure, just do it while making a happy mood. In the last trimester, pregnant women are usually afraid to hear “Ah not a real woman if the delivery is not normal”. So pregnant women are afraid of not being able to meet the expectations of those around. Moreover, the fear of facing pain during childbirth begins to haunt. Psychologically, pregnant women who are less than 20 years old are not ready to accept their pregnancy, their emotions are not yet mature, tend to be unstable, and not ready to become parents. This can trigger mental conflict or stress that makes a mother not pay attention to her nutritional intake which continues to nausea and vomiting. While nausea, vomiting that occurs in pregnant women aged over 35 years is due to psychological conditions due to fear of having children in old age, so that these emotional changes trigger excessive vomiting. Symptoms that occur early in pregnancy include amenorrhea, nausea and vomiting (morning sickness), breast feeling full and sensitive, frequent urination, feeling weak and tired, weight gain, and mood changes (Fauziah and Sutejo, 2012). With these symptoms the mother feels unwell and often hates her pregnancy. Morning sickness is one of the earliest, most common and most stressful symptoms associated with pregnancy. The problem is that many pregnant women consider nausea and vomiting to be natural and do not need to seek treatment to cause emotional tension, discomfort, psychological stress, and delay in determining the appropriate treatment, especially if the condition becomes pathological. Morning sickness is often a very frightening day for pregnant women which causes decreased appetite and lack of healthy food intake, even though this period is an important period for fetal development (Nursanto, 2004). Sometimes morning sickness can be very severe, called hyperemesis gravidarum (excessive vomiting during pregnancy). Someone who experiences nausea and vomiting during
during pregnancy with severe symptoms can become dehydrated to less than 5% of pregnancy weight. Hyperemesis gravidarum requires hospital treatment and is given care by administering intravenous fluids, medications and food delivery tubes (nasogastric tubes). In serious cases because it is not treated nausea, vomiting often reaches a state of hyperemesis gravidarum. Hyperemesis gravidarum is nausea, vomiting that persists until weight loss, dehydration, poor skin turgor, weakness, pale face (Tiran, 2008). Of most pregnant women who experience morning sickness or better known as morning sickness, will experience changes in the hormones progesterone and ecogenogen in the body increases that is what causes morning sickness in the first trimester of pregnancy. But the frequency of occurrence of morning sickness is not only in the morning but can be day and even night (Aritonang, 2010). Nausea, vomiting can be overcome by creating behaviors to reduce complaints (Ward & Hisley, 2009). Creating behavior for a healthy life according to the patient’s condition is part of self management. There are two things in self management, first, treatment management and second, maintaining, changing, and creating new healthy behaviors that are appropriate to the patient’s condition (Corbin & Straus in Kate & Halsted, 2003). 1.2 Objectives To expedite the process of pregnancy by providing direction on good nutrition for pregnant women in order to reduce the habits of morning sickness and provide natural efforts to instill positive intentions so that during pregnancy a person does not experience stress. CHAPTER II THEORY REVIEW 2.1 Explanation Morning sickness theory is a feeling of nausea and vomiting that occurs in pregnant women, usually in first trimester pregnant women (1-3 months). About pregnant women experience nausea and vomiting, to varying degrees. It is usually quite mild and occurs mainly in the morning. But sometimes it’s quite severe and can last all day. Nausea and vomiting occur approximately 2 weeks after menstruation does not come again and lasts approximately for 6 to 8 weeks. The cause of morning sickness is the increase in the hormone HCG (human chorionic gonadhotropin). This hormone is only produced by pregnant women, because this hormone serves as an indication of the presence or absence of pregnancy and is useful for maintaining pregnancy. This hormone is produced by trophoblast cells (the result of fertilization), this hormone will increase at the age of 12-16 weeks of pregnancy. In addition to hormonal factors, maternal psychological factors also influence to trigger nausea and vomiting experienced by pregnant women. Called morning sickness because it occurs in the morning when you wake up in the morning with complaints of headaches, mild nausea to vomiting, after sitting for a while the situation can be overcome. This situation is caused by carbohydrate metabolism disorders. Nausea and vomiting (morning sickness) during pregnancy are usually caused by changes in the endocrine system that occur during pregnancy, mainly due to high fluctuations in levels of hCG (chorionic gonadotrophin hormone), especially due to the most common period of gestational nausea and vomiting is at 12-16 weeks First, at that time, hCG reached its highest level. hCG is the same as LH (luteining hormone) and is secreted by trophoblast cells. The corpus luteum continues to produce estrogen and progesterone, a fungus that is later taken over by the placental chorionic layer. hCG can be detected in a woman’s blood from about 3 weeks of gestation (ie 1 week after fertilization), a fact that forms the basis of a pregnancy test. The theory that nausea during pregnancy may be a natural way to protect the fetus by preventing the mother from eating harmful food It has also been proposed, with women becoming nauseous when they see, smell or taste food that may potentially affect the fetus, and if food eaten causes women to vomit to eat out. Women who have hCG levels below the normal range are more likely to experience poor pregnancy outcomes, including miscarriage, premature birth or intrauterine growth retardation (IUGR). 1. Changes in pregnant women (1) First trimester immediately after an increase in the hormones estrogen and progesterone
in the body, it will appear various kinds of physiological discomfort in the mother such as nausea, vomiting, fatigue, and enlargement in the breast. This will trigger psychological changes like the following: a) Mothers to hate pregnancy, feel disappointment, rejection, anxiety, and sadness. b) Actively find out if it’s really pregnant by paying attention to changes in her body and often tells others what she has kept secret. c) The desire to have sex is different for each woman. d) As for the husband as father-to-be, pride will arise, but it is mixed with concerns about readiness to make a living for the family. (2) Second trimester Second trimester usually the mother feels healthy and is accustomed to high hormone levels, and discomfort due to pregnancy has begun to decrease. Mother’s stomach is not too big so that the mother has not felt as a burden. The mother has accepted her pregnancy and can begin to use her energy and thoughts more constructively. In this trimester the mother can feel the movement of the fetus and the mother begins to feel the presence of her baby as someone outside of herself and herself. Many mothers feel free from anxiety and discomfort as they did in the first trimester and feel an increase in libido (Elisabeth, 2015; p.77). (3) Third trimester a) back pain caused by the increased weight you are carrying, the baby in the womb. b) Breathing, in pregnancy 33 to 36 weeks many pregnant women who have difficulty breathing, this is because the pressure of the baby under the diaphragm presses on the mother’s lungs, but after the baby’s head has dropped down the pelvic cavity is usually at 2 to 3 weeks before delivery it will feel relief and breathe younger. c) Frequent urination, enlargement of the uterus, and reduction of the baby to PAP create pressure on the mother’s bladder. d) Stomach contractions, brackton hicks false contractions in the form of mild pain, irregular and sometimes disappear when sitting or resting. e) Vaginal fluid, an increase in vaginal fluid during pregnancy is normal. Fluid is usually clear, at the beginning of pregnancy is usually rather thick and more fluid in labor (Elisabeth, 2015; p.78). 2. Signs of danger to pregnant women According to Elisabeth (2015; p.78) there are 7 danger signs of pregnancy, namely: (1) vaginal bleeding (2) Severe headaches (3) Blurred vision (4) Swelling of face and fingers – fingers (5) Vervaginam discharge (6) Fetal movements are not felt (7) Abdominal pain 3. Pregnancy hormones According to Elisabeth (2015; p.75) hormones are chemicals (commonly called messenger chemicals) which is directly released into the bloodstream by the glands, and in pregnancy hormones bring about various changes, concentrated in various parts of a woman’s body. The hormones most related to pregnancy are: Changes in hormonal changes during pregnancy (trimester I to trimester III). (1) Estrogen Placental extrogen production continues to increase during pregnancy and at the end of pregnancy the levels are approximately 100 times before pregnancy. (2) Progesterone Production of progesterone production is even more than extrogen, at the end of pregnancy its production is approximately 250 mg / day. (3) Human Chorionic Gonadotropin (HCG) Peak secretion occurs approximately 60 days after conception, its function is to maintain the corpus luteum. (4) Human Placenta Lactogen (HPL) This hormone is produced continuously up and at term reaches 2 grams / day. It is diabetogenic, so the insulin needs of pregnant women rise. (5) Pituitary Gonadotropin FSH and LH are in a very low state during pregnancy because they are suppressed by extrogen and progesterone placenta. (6) Prolactin Production continues to increase, as a result of an increase in extrogen secretion. Secretion of breast milk itself is inhibited by extrogen at the target organ level 4. Pregnancy with high risk According to Poedjhi Rochyati (Manuaba 2010: 241) criteria for high risk pregnancy are: (1) Young primipara aged less than 16 years, old primipara with age over 35 years, and secondary primiparas with the age of the youngest children over 5 years. (2) Height less than 145 cm (3) History of bad pregnancy a) Having had a miscarriage b) Having experienced premature labor c) History of stillbirth d) History of childbirth by action e) Preeclampsia, eclampsia f) Gravid serotinus g) Pregnancy with bleeding antepartum h) Pregnancy with abnormalities i) Diseases of the mother in pregnancy that affect
pregnancy 5. Complications in pregnancy According to Mochtar (2012; p.139-169) complications of pregnancy, namely: (1) Hyperimesis gravidarum Is excessive nausea and vomiting in pregnant women to interfere with daily work because conditions generally become worse, due to dehydration . Prevention by providing information and education about pregnancy to mothers with the intention of eliminating psychological factors of fear, but drugs using sedaciva (luminal, stable), vitamins (B1 and B6), anti-mutah. (2) Topsenia gravidarum Pre-eclampsia and eclampsia are symptoms arising from trias: hypertension, protuenuri and edema. Prevention, regular and quality and thorough antenatal checks, provide information about the benefits of rest and sleep, calmness. (3) Abortion (miscarriage and abnormalities in old pregnancy) Miscarriage is the release of the conception before the fetus can live outside the womb. Handling, administer drugs with the intention to occur so that vetus and decidua can be removed, if not successful, do dilate curettage. The sufferer should also be given tomica and antibiotics. (4) Abnormalities of the location of the pregnancy (ectopic pregnancy) Is a pregnancy with the results of the conception of perimplentation outside the uterine endometrium. Handling improve general conditions, blood transfusion and immediately do lapatorium exploration to stop the source of bleeding. (5) Tropoblast disease Tropoblast disease due to pregnancy originating from growth abnormalities of the placoblast tropenta. CHAPTER III DESIGN OF IMPLEMENTATION PROGRAM A. Overview 1. Program name: Psychoeducation of Morning Sickness Symptoms in Pregnant Women and How to Overcome it 2. Presenters: Septiana Hargiyanti 3. Target: Pregnant women around the surroundings of Group 1 members 4. Tools and Materials: Laptops, Mobile, Books, and Pens 5. Program Technical Guidance: Activity Objectives Duration Information Preparation Prepare tools and materials for implementation. 15 Minutes All members prepare tools and materials in the form of laptops, cellphones, books, and pens. Opening For psychoeducation participants to get to know the speakers of the event. 20 Minutes Reading of greetings and self-introduction. Provision of material So that participants can understand what morning sickness is, what its symptoms are like, and how to deal with the symptoms of morning sickness. 30 Minutes Performed to explain the understanding of the symptoms of morning sickness, how the forms of its symptoms, and how to overcome the symptoms of morning sickness itself. Closing Closing psycho-educational activities. 10 Minutes Closing is done by all members of group 1 B. Time and place Day / Date: Monday, June 1, 2020 Time: 10:00 – 11:45 Place: Via WhatsApp C. The description of the program implementation of this psychoeducation program is held through one of the social media namely the WhatsApp group due circumstances that do not allow for direct interaction because there is a corona virus outbreak that occurred in Indonesia and the government is implementing a lock down system. This psychoeducation is given to pregnant women and we will run this psychoeducation program via WhatsApp at 10:00 to 11:45. The psychoeducation program starts from the process of self-introduction, giving material that contains explanations about what morning sickness is, how to deal with the symptoms of morning sickness itself, to the closing read by the speaker. D. Budget 1. Income No. Description of Unit Price Volume Amount 1. Member Dues 6 Rp 50,000 Rp 300,000 2. Expenditures No. Description of Unit Price Volume Amount 1. Fruit Parcel 3 Rp 85,000 Rp 255,000 CHAPTER IV CONCLUSIONS AND SUGGESTIONS 4.1 Conclusion Ginger is believed in addition to cooking ingredients can also be used as an alternative to relieve morning sickness. The ingredients contained by ginger are thought to be the same as those contained in placebo and vitamin B6. One cause of morning sickness is vitamin B6 deficiency aside from increasing levels of estrogen and HCG, therefore ginger can also be used as an alternative to relieve symptoms of morning sickness such as nausea, vomiting, lack of appetite, weight loss, and etc. 4.2 Suggestions Hopefully this psychoeduction report can be useful for its readers and can provide knowledge about morning sickness especially in early trimester pregnant women. REFERENCES Latifah, L. (2017). The Effectiveness of Self Management Module in Overcoming Morning Sickness. Department of Nursing FIKes UNSOED, 5, 9. Riyanti, E. (2017). Comprehensive Midwifery Care. (1), 85. Sadiah, A. (2014). LEVELS OF HUSBANDXY ANXIETY TO MORNING SICKNESS DISORDERS PREGNANTED PRIMIGRAVID TRIMESTER MOTHER IN EAST CIPUTAT DISTRICT AREA. (1), 109. siwi, p. o. (2017). efforts to treat morning sickness in pregnant women such as 1. Nursing study program at the Faculty of Health Sciences, Muhammadiyah University, Surakarta