KEMAS 13 (3) (2018) 356-365

Jurnal Kesehatan Masyarakat

http://journal.unnes.ac.id/nju/index.php/kemas

BENEFIT OF CHILDBIRTH CARE COUNSELING FOR MOOD OF

POSTPARTUM PERIOD

Yuni Purwati1, Kustiningsih1

1Faculty of Health Science, Universitas ‘Aisyiyah Yogyakarta

Article Info Abstract

Article History:
Submitted September 2017
Accepted October 2017
Published March 2018
Keywords:
Counseling, Mood Disor-
der, Postpartum Mothers
control
DOI
https://doi.org/10.15294/
kemas.v13i3.11275
Postpartum mood disorder experienced by mothers was characterized by severe
fatigue, poor concentration, tiredness, sadness, and anger at her husband. This
postpartum mood disorders could progress to postpartum depression and
postpartum psychosis. Childbirth care counseling was an attempt to allow mothers
to adapt to her postpar- tum condition. The objective of this research was to
identify the effect of childbirth care counseling on postpartum mood changes at
Wates General Hospital, Kulonprogo. This research used pre-experimental design
with post test. We used purposive sampling to
obtain 20 respondents in the experimental group and 20 respondents in the
group. Moreover, EPDS instruments were also used in this research. Saphiro-Wilk
nor- mality test resulted in SD=0.000<0.05. The Mann-Whitney test resulted Z-
2.054>t-table, α=0.040<0.05. We found that there was a significant benefit of
childbirth care counseling on postpartum mood changes at Wates General
Hospital, Kulonprogo. The significance of this research is that health workers in
prenatal units should provide counseling about postpartum care to mothers in
their third trimester.

Introduction a woman feels eager but also makes her

Pregnancy and childbirth are an
important experience for mothers and it
have different meanings for every mother
and her family. This occasion is a very
positive and pleasant transition phase to a
new stage in the life cycle for mothers.
However, this can also inflict stress resulting
in anxiety, disappointment, and other
psychological changes (Castalino, 2014).
Pregnancy also highly depresses some
mothers in spite of giving extraordinary
happiness. The role of becoming a mother
not only makes her feel fully steady in living
her life and increases her confidence, but
can also undergo several other roles both
in the family and in the social environment.
Broadly speaking, becoming a mother not
only make

Correspondence Address:
Ring Road Barat Street No.63 Mlangi Nogotirto Gamping Sleman
55292. Email : ibudafa@gmail.com
care for her baby. However, some mothers
actually feel sad, angry, upset, tired,
meaningless, and desperate in the days
after childbirth. Continuous fatigue reduces
the physical and mental capacity. This
could developed to reluctance in looking
after the baby or even desire to murder
the baby. These various stress indicators
cause psychological problems during
pregnancy until birth (Reitmanova, 2009).
Westall (2011), stated that postpartum mood
disorder and postpartum depression are
triggered by the mothers being anxious and
not getting a good support system.
Postpartum mood disorder is a
temporary disorder experienced by mothers
who have just given birth. It often occurs
in
pISSN 1858-1196
eISSN 2355-3596
 KEMAS 13 (3) (2018) 356-
365
first childbirth during the first 1-10 days infanticide.
or 2 weeks, and causes postpartum Kusumastuti (2013), reported that 10%
depression. Signs and symptoms of mood of mothers have post-partum psychological
disorder are sadness, irritation, liability, and disorder, 50-58% experiences a type of
headache. If the condition lasts longer, it will post-
develop into severe postpartum disorder. The
symptoms are profound sadness, anger,
depression, sensitivity, guilt, fatigue, anxiety,
and carelessness toward baby and self
(Reitmanova, 2009).
The effects of postpartum mood
disorder are anxiety in socializing with
others, failing to look after themselves and
their babies, and failure in breastfeeding.
These conditions cause problems in the
relationship between mothers and their
babies, such as the psycho-pathological
disorders and late development of babies.
The tendency of profound sadness emerges
that they becomes less sensitive to provide
positive care for their babies. Consequently,
the babies did not learn to develop
positive effects and felt discomfort in their
development process. The babies tend to
have orientation disorder, depression
effects, irregular sleep, verbal development
problems, behavioral disorders, delay of
scholasticism development, and other types of
physical disorders. If postpartum mood
disorder progress into postpartum depression,
the atmosphere of sadness becomes more
intense than postpartum blues. Postpartum
blues symptoms have adverse effects on
mothers, babies, and family members, causing
difficulty in social participation. The
symptoms not only affect mothers in the
form of suicide attempt or desire to murder
the baby, but also adversely affects the
whole family because the mother tends to
withdraw and refuse to care for the baby
that the baby suffers from lack of affection.
According to Westall (2011), postpartum mood
disorder influences interaction between babies
and their mothers during the first year i.e.,
the baby does not received enough
stimulation, the mothers failed to undergo
daily activities, relationship difficulties from
others (family and friends), increased risk of
using drugs which increase the risk of
postpartum psychotic depression. The
effects on babies are that they cry more, had
sleeping and eating problems, and suffered

357
Yuni Purwati, Kustiningsih / Benefit of Childbirth Care Counseling for Mood of Postpartum
Period
partum blues, and 12% who have show severe fatigue, poor concentration,
postpartum blues developed postpartum lost of sensitivity, deep sadness, and
depression during the postpartum hostility to her husband. Kusumastuti
period. Hormonal and postpartum (2013), reported relationship between
maternal life changes are considered a husband and wife became difficult due to
trigger for depression. It is estimated that severe postpartum blues and postpartum
about 50-70% of mothers showed early depression.
postpartum blues symptoms. However, it Researchers refuses to care for
sowly disappears due to appropriate her baby. She was
adaptation and family support. The National have sleepy if she had to
Mental Health Association (2009) in Segre take care of her baby
(2010), stated that 80% of mothers who give proposed at midnight so her
birth for the first time have these husband look after
symptoms. several solutions to the baby instead. The
Another causes of postpartum reduce postpartum mother said she has
mood disorder in Taking In Phase is a depression never received
psychological factor in the process of information from
, such as antenatal
pregnancy and childbirth, that is the health education, health workers on
emotional mother at the time of house infant care, how to care for the
childbirth. According to Lesser and and baby and herself after
Keane, there are four maternal wishes in postpartum giving
childbirth: being accompanied by the depression birth.
dearest person, received pain-reducing information through Based on the
means, have a sense of security from the booklets and background
nearest person to the baby and receives the learning methods on described above, we
baby, and gets attention, affection, and appropriate caring of are interested in
appreciation by the nearest person when babies, and conducting a study
giving birth. When the desire of the mother important support by on “The
is unmet, it will affect the psychological husband from Implementation of
condition of the mother after childbirth. pregnancy until Childbirth Care
The period of taking in phase is the infant care. In Counseling on
beginning of the crisis period; new addition, counseling Postpartum Mood
responsibilities arise and often require is also important to Disorder in the Wates
modification or addition of previous prepare the maternal General Hospital,
behaviors. This phase is also a transition psychology in Kulonprogo.” The
from before being a parent to becoming accepting the change general objective of
parents. The period of parenthood is more of role (Setiawati, this study was to
accurately considered a process rather 2016). Counseling is identify the effect of
than a state; a process that begins during a process of childbirth care
pregnancy and develops rapidly after discussion counseling on
birth (Kirana, 2015). conducted by postpartum mood
Postpartum blues is the most counselor and disorder patients in
common type of depression in postpartum counselee to find Wates General
period. It is an adaptation disorder on the right solution to Hospital,
childbirth incident that mothers have a overcome problems. Kulonprogo.
depression mood. This reaction can occur Based on Moreover, the specific
any time after the mothers gave birth. preliminary study objective was to
However, it often occurs on day 3 or 4 in Flamboyan Room identify the changes
after postpartum. Moreover, 3 out of at Wates General in postpartum mood
4 mothers have postpartum blues. Hospital, disorder patients
Mothers feel overwhelmed and easily cry Kulonprogo, 1 after
without any apparent reason. Mothers postpartum mother implementation of

358
 KEMAS 13 (3) (2018) 356-
365
counseling in Childbirth respondents were respondents of the
Wates General care counseling also asked to fill experimental group
Hospital, was information out the Edinburgh and 20 people as
Kulonprogo. The provision by Postnatal the control group
changes in educating about Depression Scale respondents.
postpartum mood technique on (EPDS) Respondents of this
disorder patients childbirth care and questionnaire at the research were
appear through baby care. It is same time as the parturial mothers
childbirth for carried out by treatment group with a normal
postpartum care in health workers with provided childbirth and
Wates General accompanied by the guidance without caesarean section at
Hospital, mother’s husbands. any postnatal day- 0 postpartum.
Kulonprogo. We The counseling gymnastic training. The tool used
expect our study included self-care, The assessment to collect postpartum
can increase the perineum, criteria were as mood data was
nursing science gymnastics, breast follows: 66-90 was Edinburgh Postnatal
database, which is care, nutrition considered good Depression Scale
not only related to fulfillment, and mood; 42-66 was (EPDS)
postpartum mood sexual fulfillment. poor mood (mild questionnaire. This
disorder on The mothers and mood); and 18-42 questionnaire was
maternity care but is their husbands were was bad mood given to the
also related to the taught about (severe experimental group
standard bathing, umbilical depression). two days after
operational cord care, changing The postpartum care
procedure on clothes, and population of this counseling. The
maternity care breastfeeding or research is all control groups was
service unit. immunization. postpartum mother also given the
Method These were carried in PKU EPDS
The method out for 60 minutes Muhammadiyah questionnaire but
of this research was on every mother Bantul Hospital. did not received
experimental who gave birth for The sampling postpartum care
method with the the first time at day- technique was counseling
aim of identifying 0 in the purposive sampling beforehand.
arising symptoms or experimental based on Parametric
effects from a group. requirements or analysis test was
particular criteria set by conducted with the
Changes on
treatment. This postpartum mood researchers. The assumption that
research used post- were measured number of samples each variable was
test only design using the in this research analyzed through
where we compared Edinburgh was 40 postpartum normal distribution.
and tested the Postnatal mothers consisting of Prior to
differences between Depression Scale 20 people as
groups after the (EPDS) parametric statistical the data had normal
treatment was questionnaire. The test, data normality distribution,
given. experimental test was conducted therefore,
group respondents using one sample independent t-test
were asked to fill Kolmogorov- was used. If the data
out the Smirnov test. The was not normally
questionnaire on result was α>0.05 so distributed, Mann-
the 2nd day of Ho was accepted Whitney test was
postpartum. The and Ha was used instead.
control group rejected. It meant Result and

359
Yuni Purwati, Kustiningsih / Benefit of Childbirth Care Counseling for Mood of Postpartum
Period
Discussion or less than 20 years regarding parental conditions affected
There were 16 is a trigger factor of readiness, role mood disorders in
(80%) and 11 postpartum mood burden in the social the current
respondents (55%) disorder. Situational environment can parturient period
in healthy crisis situations, cause problems in and their baby care
productive age experiences women giving (Castalino, 2014).
category in the birth, including One
experimental and Table 1. those younger than respondent with a
the control group, Characteristics of 20 years old. good mood was a
respectively, as the Respondent primipara mother.
Postpartum
shown in Table 1. maternal parity were Irawati (2014),
The respondents in based on the showed that 63.6%
the healthy postpartum respondents who
productive age maternal parity experienced
category were 20-35 status on the postpartum blues
years old. Most experimental were primipara.
mothers who were group and There is a
pregnant and gave primipara parity relationship
birth were in this status on the between parity and
age category. controlled group. postpartum
Respondents in this There were 15 incidence with
age category were (75%) and 16 (80%) p=0.027. This is
also more prepared primipara in the because the
to face pregnancy experimental and duration,
and childbirth. control group, complication and
Furthermore, an respectively. the labor itself can
optimal period to Postpartum mood psychologically affect
take care of the was related to the mother; the
baby was at the age parity status. greater the physical
of 20-35 years, so Primipara mothers trauma, the greater
the mothers were had less experience the psychological
mentally-prepared in facing childbirth trauma that arises.
in having childbirth, and looking after And this is
self-care, and baby their baby care increasingly felt in
care (Kusumastuti, compared to women who gave
2013). multipara mothers birth for the first
In this study, who have had time. Changes
respondents aged 20 experienced during pregnancy,
years had good childbirth and especially hormone
mood, likely baby care. However, increase, can
because the age is a past childbirth increase anxiety
risky age for women experienced and and fear of
to give birth. Our poor parturient
result indicated an
influence between Age Characteristics
age and mood
Experimental Group
disorder during
childbirth. This is in
accordance with a Control Group
study by Irawati
Less than 20 years old 4 20%
(2014), which
reported that the Age 20-35 years old 16 80%
age of adolescence Total 20 100%
358
 Freq % Freq
%
KEMAS 13 (3) (2018) 356-
365
Primipara 15
Parity Multipara 5
Total 20
Spontaneous labour 8
Type of Cesarean delivery 12
labor Total 20
Mood Passable 1
Good 19
Total 20

100% 20

100%
S
o
u
r
c
e

P
r
i
m
a
r
y

D
a
t
a

361
Table 2. Mann Whitney Statistical Analysis Result
Postpartum Mood on Mothers in Experimental and Control Group
Mann-Whitney U 150.000
Wilcoxon W 360.000
Z -2.054
Asymp. Sig. (2-tailed) .040
Exact Sig. [2*(1-tailed Sig.)] .
183a Source : Primary Data

accepting new roles into situational crises before delivery had decreased maternal
that can lead to postpartum mood anxiety and fear
problems.
The age of 35 years is often referred
to as the deadline, as beyond that age,
pregnancy pose a greater risk. The maternal
mortality rate rises steadily from 9 per
100,000 at the age of 25-29 years to 66 per
100,000 after the age of 40 years. This
indicates that the risk of maternal mortality
increases rapidly with increasing age of the
mother. Older mothers are more
susceptible to diabetes and high blood
pressure. Infant from an older mother had
increased likelihood of chromosomal
defects, such as Down syndrome. Mothers
who deliver their first child over the age of
35 are more likely to have difficulty in
labor, unlike older women who have
previously gave birth (Ichsan, 2015).
In this study, 12 and 13 respondents
in the experimental and control group,
respectively, have spontaneous labor. The
adaptation process of spontaneous postpartum
mothers is relatively faster than post-caesarean
section mothers. Spontaneous postpartum
mothers have faster early mobilization. They
can immediately breastfeed their baby, and
they have more optimal husband assistance.
This activity can also speed up mother’s
recovery and uterine involution process.
This results in better maternal psychological
adaptation during childbirth.
However, in cesarean delivery,
postpartum pain and physical limitations
will hinder postpartum mother in taking
care of themselves and their babies. Mothers
often feel fearful and anxious about their
physical condition, thus reducing the desire
to immediately care for her baby. Asmuji
(2016), mentioned that postpartum mother
of post caesarean section who received
information about self and baby care
361
until childbirth. In addition, the
husband’s continuous support can improve
psychological readiness in mothers. In this
study, we proved that post caesarean
section respondent can have good mood;
1 post-caesarean section respondent had
good mood because her age was under 20
years old.
Postpartum mood changes on the
experimental and control groups appeared
after counseling was given on postpartum
and baby care. There were 19 respondents
(95%) who showed good mood, but 1
respondent (5%) showed good enough
mood. In the control group, there were 14
respondents (70%) who showed good
mood, but 6 respondents (30%) showed
good enough mood.
Prior to statistical tests, data
normality test using Saphiro-Wilk was
conducted on both group. The result for
both group was 0.00, which was lesser than
α=0.05, so the data did not have normal
provided comfort to the postpartum mother.
According to Ichsan (2015), husband and
family support could foster self-confidence
in postpartum mothers to face childbirth
and to care for the baby. There are families
who were always ready to help for
postpartum recovery and care of the baby.
It reduced feelings of anxiety, depression,
and lack of attention from the family.
Family social support from close
person such as husbands, parents and
siblings who care for, respect, and love
them is beneficial. Education support
about postpartum and baby care is needed
by mothers because they have no experience
in caring for their babies. Instrumental
support is needed for the mother to provide
ease in self and baby care. Social support is
also needed for postpartum mothers,
especially at their first time giving birth.
Assessment support in the form of feedback
on how they take care of themselves and their
baby is also needed in the first time mothers.
Anxiety that occurs in the puerperal mother
generally occurs in primipara. This
condition requires support from the closest
person. The closest person emotionally is
the husband. Support from the husband will
be perceived positively and make the
360
distribution. Therefore, a non- parametric test,
that is Mann-Whitney test, was carried out as
shown in the following table:
Based on the tendency of cross
tabulation result in Table 2, the Mann
Whitney statistical analysis result was Z–
2.054. This score was greater than the t-table.
The significance level (0.040) was smaller
than α=0.05. According to this result, we
concluded that Ho was rejected and Ha was
accepted. It indicated that childbirth and
baby care counseling significantly affect
postpartum mood changes for the better.
We found 14 respondents (70%) in
the control group and 19 respondents
(95%) in the experimental group with
good mood, indicating that postpartum
maternal mood was in good condition.
Basically, respondents had good mood
because mothers who suffered from
postpartum mood disorder were supported
by her husband and mother. Family support
mother felt comfortable, appreciated, and
loved (Marmer, 2016). So in this study,
counseling package about parenting and infant
care is given to postpartum mother
accompanied by her husband.
We analyzed the difference in post-
test score between experimental group,
who received childbirth care and baby care
counselling, an the control group who was
not given the counselling. The score of the
experimental group tend to be better.
Counseling on the respondents and her spouse
was a process of providing assistance through
an expert’s interview (counselor) to the client
who had problems. In this study, the
problems were the postpartum mother and
the care of their babies. Discussion,
interview, information, and decision
making was done between counselor and
counselee. The implementation of the
counseling process until decision making
meant that the problems experienced by the
client could be resolved and decisions had been
made in order to overcome health problems.
Counseling was carried out for the
improvement of the client because the and childbirth. Furthermore, the healthy
client’s attitude improvement through productive age was the optimal period to
interaction for a certain time was the care for a baby so that mothers can be more
priority of counseling. Through direct mentally prepared to face childbirth, self-
face-to-face approach, improvements on care, and baby care (Ichsan,
thinking, feeling, attitude, and behaviour
appeared. The client was able to
straighten the problem, realized the
lifestyle, and reduced the negative feelings
and inferiority. Moreover, it also corrected
behavior on the environment so that clients
could direct their behavior and interests in
social activities for meeting the needs of
childbirth and baby care.
This counseling helped the growth
and development of her thinking and
behavior. This condition encouraged her to
develop social skills, learn to control
emotions, and develop positive self-
concept. It reduced anxiety or mood
disorder at postpartum as indicated by
changes such as, being understandable,
positive, and caring for the baby (Basten,
2009).
The postpartum period was a period
of adaptation for mother and baby. The
mother had a responsibility to meet her
family need and to care for her baby. Failing
to understand the baby led to fatigue.
Reitmanova dan Gustafson (2009) stated that
mothers were very tired and worried about
their baby’s needs, and required a rest after
giving birth. Isni (2016), stated
postpartum mood disorders and
postpartum depression emerge when
mothers felt a sense of anxiety and lacked
good support.
Suryani (2008), in Kusumastuti
(2013), stated that mothers could have
psychological problems and postpartum
depression because they were socially
alienated and easily felt uneasy in every
daily activity. In this study, family
assistance played an active role to
improve mood during the postpartum
period through counseling. As the family
grew confident, especially the husbands,
postpartum mothers could anticipate
normal parturient period.
Healthy productive age (20-35 years
old) were the right time to conceive and
gave birth. At this age group, respondents
were better prepared to face pregnancy
361
2015). In addition, increasing maternal daily activities and interactions with the
age affected not only emotional maturity baby. Mothers were also still in a weak
but also engagement and satisfaction to care condition because of exhaustion after
for mothers and their baby. Similarly, low childbirth. Rubin (1963) in Purwati (2015),
parity (primipara mothers) tends to explained that
experience psychological problems, since
multipara mothers have had previous
experiences of pregnancy and childbirth.
However, the psychological problems of
multiparous mothers were not only due to
troublesome and traumatic childbirth but
also due to the many children they have, the
birth of the baby not meeting their
expectation, fear in looking after and
educating the child properly, being unable to
care for their children, and worry about
their future (Kirana, 2015).
In our study, we found 6
respondents (30%) with good mood in the
control group without counseling, and 1
respondent (5%) with good enough mood
in the experimental group. This was the
respondents who answered the first item
(feeling nervous and restless, especially
when caring for the baby). Moreover, these
respondents also answered the second item
(having fear and worries about their
condition and the baby.
Respondents also answered the
sixth (feeling stomachache) and the
seventh item (feeling weak and tired in
recent days). This was consistent with
Larson-Meyer’s statement, he said that
mothers were in fear-tension- pain cycle
after giving birth. The pain during uterine
contractions caused tension. Tension lead to
the release of biogenic amine enzymes
(three catecholamines) and serotonin that
stimulated central nervous neurotransmitters
which lead to a state of stress. Stress
caused fear, which increased pain and can
eventually triggers mood disorders.
Symptoms of mood disorder are as follows:
poor appetite, sadness, insomnia, anorexia,
disturbed by physical changes, difficulty
concentrating, self-injury, anhedonia, guilt,
weakness in will, hopelessness of the future,
and not wanting to relate to others (Rusli,
2011).
Postpartum mother experienced
physiological adaptation (abdominal pain)
due to uterine involution which disturbed

362
respondents were still having acceptance.
psychological adaptation on the first day The development of a positive self-
of postpartum. Consequently, the mother attitude appeared in line with the ability
become selfish and passive to her to explain the experience that had always been
environment, focuses on fatigue, had no the subject of self-criticism and rejection, to
desire to take the initiative to interact initiate the movement toward the potential
with the baby, and desperately needing fulfillment
others in their daily lives. or integration is provided before
Inability to adapt to the new roles acceptance of mothers give birth.
and activities is likely due to a previous self- As the mothers have
psychological disorders with varying conflict, and to help not faced childbirth
symptoms that are usually called the client achieve a yet, they can
postpartum mood disorders. This often higher state of carefully plan how
occurred to mothers too young of age. In spiritual and who will help
this study, there were 4 and 9 mothers aged consciousness, and take care of herself
less than 20 year in the experimental to find specific and her baby and
group and in the control group, decision that could prepare for
respectively. Physically, adolescents are not be solved on its postpartum
ready to conceive and give birth. own. psychological
However, they are psychologically Thasim in problems. The nurses
unprepared to take care of their baby, as Woro (2017), stated provided continuous
well as their household. Adolescence is a that one could grasp health counseling to
time someone began to be interested in the ideas and techniques the patients for 24
environment outside the family. Teenage used for hours so that anxiety,
mothers at this time certainly have different understanding and restlessness, and other
activities compared to before becoming a controlling behavior postpartum maternal
mother. For example, a teenage mother is by learning and psychological
busy with her baby when she is previously mastering social and disorders are
free to play and hang out with other interpersonal skills overcome during the
teenagers. This preoccupation with her so that irrational postpartum (Segre,
baby may exert emotional pressure to her, beliefs or 2010).
increasing her risk of postpartum mood unadjusted thought Postpartum
disorders (Segre, 2010). patterns could be mothers who
The differences in the experimental modified to avoid receive counseling
and control groups on postpartum mood self-destructive on postpartum care
disorder were consistent with Purwati behavior. will behave well in
(2015) and Musfiroh (2014) study. It Duman taking care of herself
meant that the provision of well-planned (2012), explained and her baby. By
information with clear media could that postpartum maintaining personal
improve a person’s attitudes and mothers who received hygiene, nutritious
behaviors. It was also linked to the postpartum food, early
counseling of the experimental group in counseling were mobilization and
this study. The understanding given to able to deal with breastfeeding exercise,
patients with emotional problems and self-care and baby mother can recovery
incomprehension led to rational instead of care through quickly and
emotional control. Patients became more breastfeeding and facilitate
capable of forming and maintaining a preparation in breastfeeding. Early
meaningful and satisfying relationship overcoming anxiety. mobilization of the
with others. Moreover, they also became According to puerperium is useful
more sensitive on how to think or feel. Spaulding (2016), in ensuring
Furthermore, they were also able to childbirth counseling breastfeeding success.
develop a more accurate sense of self- was more useful if it Immediate

363
mobilization will the behavior of the support or positive is needed by women
involve physical family and the attitude of the after experiencing
activity that will respondents spouse and family childbirth (Irawati,
increase the muscle experiencing post- will give its own 2014).
demand oxygen. childbirth and strength for the We are faced
Meeting this demand childbirth. postpartum with unpredicted
requires an increase Counseling for the mother. The obstacles in this
in circulation which respondents and husband plays an study. In the
will involve the the support of important role in planning, the
nervous system. husband helped the occurrence of respondents were
Intermediaries will reduce postpartum postpartum blues. postpartum
connect to the mood disorder and The husband is mothers
hypothalamus, provided a sense of expected to realize (primiparas
specifically posterior comfort and that the wife respondents).
pituitary, to release happiness that the desperately need However, we also
oxytocin which will mothers went support at a certain added multiparous
be transported by through childbirth moment and to be respondents who
blood to the breast well (Isni, 2016). present when the had a history of
to stimulate the wife needs him. abortion in the
This
myoepithelial cells counseling is Aside from previous
to form the ductus performed on psychological pregnancies or
dialveoli so postpartum mother support, postpartum mothers
colostrum and milk who was physiological, who had a second
may pass more accompanied by assessment, child more than 7
smoothly (Kendall, their husband. information and years ago. In
2013 in Sunesni, Husband’s support financial support is addition, we are
2015). is a form of social needed by the unable to implement
Setiawati interaction in wife. The counselling in an
(2016), said that a which there is a provision of all ideal way (the
healthy counseling mutual relationship those should make counseling
had an important where they help each the wife feels atmosphere should
role in cognitive other. The aid will comfortable and can be calm and
process. It is place the deliver well. counselors and
important in individuals Husband support is counselees could
understanding, involved in the an important directly talk to each
attitudes, and social system that coping strategy other, but these
changes in behavior, they will eventually when under stress conditions were
including be able to give love, and serves as a unfulfilled due to the
attention and sense preventive strategy room being in a
of attachment to to reduce stress and class 3 setting where
both the family or its negative multiple patients
spouse. Husband consequences. were in the same
support is very Therefore, the room). We
important and can support of husbands
not be modify and instead of using a
underestimated in eventually conduct mannequin as in the
building a positive the counseling in the planning.
atmosphere when care room. Moreover, Respondents were
the wife felt the caring process accompanied by
exhausted in the for the baby was husband while
first few days. also directly done attending counseling
Therefore, the with the baby activities. The

364
majority of the Health respondents of Maternity Care
respondents were workers in prenatal postpartum mothers Model as the
patients who units should who have been Strategy to
underwent provide willing to be Optimize
caesarean section. information involved in this Competent
This was through study. Mothering.
related to the postpartum and References Faculty of
provision of Health infant care Asmuji & Indriyani, Health Sciences
Muhammadiyah
Social Insurance counseling for each D. 2016. Family
University. Ners,
Agency (BPJS) prenatal client in Centered
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