Kamis, 12 Juli 2007

psiKOLOGI pADA iBU yang mengalami Persalinan, nifas dan menopause

PSIKOLOGI PADA IBU YANG MENGALAMI
PERSALINAN, NIFAS DAN MENOPAUSE



I. PSIKOLOGI PADA IBU YANG MENGALAMI PERSALINAN
Kegiatan komunikasi terapeutik pada ibu melahirkan merupakan pemberian bantuan pada ibu yang akan melahirkan dengan kegiatan bimbingan proses persalinan.
A. Tujuan Komunikasi terapeutik Pada Ibu Dengan Gangguan Psikologi Saat Persalinan.
1. Membantu pasien memperjelas serta mengurangi beban perasaan dan pikiran selamam proses persalinan.
2. Membantu mengambil tindakan yang efektif untuk pasien.
3. Membantu mempengaruhi orang lain, lingkungan fisik dan diri sendiri untuk kesejahteraan ibu dan proses persalinan agar dapat berjalan dengan semestinya.
B. Pendekatan Komunikasi Terapeutik.
1. Menjalin hubungan yang mengenakkan (rapport) dengan klien.
Bidan menerima klien apa adanya dan memberikan dorongan verbal yang positif.
2. Kehadiran.
Kehadiran merupakan bentuk tindakan aktif ketrampilan yang meliputi mengayasi semua kekacauan/kebingungan, memberikan perhatian total pada klien. Bila memungkinkan anjurkan pendamping untuk mengambil peran aktif dalam asuhan.
3. Mendengarkan.
Bidan selalu mendengarkan dan memperhatikan keluhan klien.
4. Sentuhan dalam pendampinganklien yang bersalin.
Komunikasi non verbal kadang-kadang lebih bernilai dari pada kata-kata. Sentuhan bidan terhadap klien akan memberi rasa nyaman dan dapat membantu relaksasi.
5. Memberi informasi tentang kemajuan persalinan.
Hal ini diupayakan untuk memberi rasa percaya diri bahwa klien dapat menyelesaikan persalinan. Pemahaman dapat mengerangi kecemasan dan dapat mempersiapkan diri untuk menghadapi apa yang akan terjadi. Informasi yang diberikan diulang beberapa kali dan jika mungkin berikan secara tertulis.
6. Memandu persalinan dengan memandu intruksi khusus tentang bernafas, berelaksasi dan posisi postur tubuh.
Misalnya : bidan meminta klien ketika ada his untuk meneran. Ketika his menghilang, bidan mengatakan pada ibu untuk bernafas pajang dan rileks.
7. Mengadakan kontak fisik dengan klien.
Kontak fisik dapat dilakukan dengan menggosok punggung, memeluk dan menyeka keringat serta membersihkan wajah klien.
8. Memberikan pujian.
Pujian diberikan pada klien atas usaha yang telah dilakukannya.
9. Memberikan ucapan selamat pada klien atas kelahiran putranya dan menyatakan ikut berbahagia.
Komunikasi terapeutik pada ibu dengan gangguan psikologi saat persalinan dilaksanakan oleh bidan dengan sikap sebagai seorang tua dewasa, karena suatu ketika bidan harus memberikan perimbangan.

II. PSIKOLOGI PADA IBU YANG MENGALAMI NIFAS.

A. Pengertian.
Masa nifas adalah masa 2 jam setelah lahirnya placenta sampai enam minggu berikutnya. Waktu yang tepat dalam rangka pengaeasan Post Partum adalah 2-6 jam, 2jam-6hari, 2jam-6minggu (atau boleh juga disebut 6 jam, 6 hari dan 6 minggu ).
Pengawasan dan asuhan post partum masa nifas sangat diperlukan yang tujuanya adalah sebagai berikut :
1. Menjaga kesehatan ibu dan batinya, baik fisik maupun psikologi.
2. Melaksanakan sekrining yang komprehensif, mendeteksi masalah mengobati, atau merujuk bila terjadi komplikasi pada ibu maupun bayinya.
3. Memberikan pendidikan kesehatan tentang perawatan kesehatan diri, nutrisi, KB, menyusui, pemberian imunisasi pada saat bayi sehat.
4. Meberikan pelanyanan KB.
Gangguan yang sering terjadi pada masa nifas berupa gangguan psikologis seperti Post Partum Blues (PPS), depresi post partum dan post partum psikologi.
B. BABY BLUE (POST PARTUM BLUES)
Merupakan kesedihan atau kemurungan setelh melahirkan, biasanya hanya muncul sementara waktu yakni sekitar dua hari hingga dua minggu sejak kelahiran bayi yang diyandain dengan gejala-gejala sbb:
 Cemas tanpa sebab
 Menangis tanpa sebab
 Tidak sabar
 Tidak percaya diri
 Sensitive
 Mudah tersinggung
 Merasa kurang menyayangi bayinya
Jika hal ini dianggap enteng, keadaan ini bisa serius dan bisa bertahan dua minggu sampai satu tahun dan akan berlanjut menjadi Post Partum Sindrome.
Cara mengatasi gangguan psikologi pada nifas dengan post partum blues ada dua cara yaitu :
1. Dengan cara pendekatan komunikasi terapeutik.
2. Dengan cara peningkatan support mental/ dukungan keluarga.
C. KOMUNIKASI TERAPEUTIK
Tujuan dari komunikasi terapeutik adalah menciptakan hubungan baik antara bidan dengan pasien dalam rangka kesembuhannya dengan cara :
1. Mendorong pasien mampu meredakan segala ketegangan emosi.
2. Dapat memahami dirinya
3. Dapat mendukung tindakan konstruktif.
D. PENINGKATAN SUPPORT MENTAL/DUKUNGAN KELUARGA DALAM MENGATASI GANGGUAN PSIKOLOGIS YANG BERHUBUNGAN DENGAN MASA NIFAS.
Dalam menjalani adaptasi setelah melahirkan, ibu akan mengalami fase-fase sbb :
a. Fase Taking in yaiyu periode ketergantungan yang berlangsung pada hari pertama sampai hari kedua setelah melahirkan. Pada saat itu focus perhatian ibu terutama pada dirinya sendiri. Pengalaman selama proses persalinan sering berulang diceritakannya. Hal ini membuat cenderung inu menjadi pasif terhadap lingkungannya.
b. Fase taking hold Yaitu periode yang berlangsung antara 3-10 hari setelah melahirkan. Pada fase ini ibu merasa khawatir akan ketidakmampuannya dan rasa tanggung jawabnya dalam merawat bayi. Pada fase ini ibu memerlukan dukungan karena saat ini merupakan kesempatan yang baik untuk menerima berbagai penyuluhan dalam merawat diri dan bayinya sehingga timbul percaya diri.
c. Fase letting go merupakan fase menerima tanggung jawab akan peran barunya yang verlangsung sepuluh hari setelah melahirkan. Ibu sudah dapat menyesuaikan diri, merawat diri dan bayinya sudah meningkat.
Ada kalanya, ibu mengalami perasaan sedih yang berkaitan dengan bayinya keadaan ini disebut baby blues. Jika hal ini terjadi, disarankan untuk melakukan hal-hal berikut ini :
 Minta bantuan suami atau keluarga yang lain, jika membutuhkan istirahat untuk menghilangkan kelelahan.
 Beritahu suami mengenai apa yang sedang ibu rasakan. Mintalah dukungan dan pertolongannya.
 Buang rasa cemas dan kekhawatiran akan kemampuan merawat bayi karena semakin sering merawat bayi, ibu akan semakin terampil dan percaya diri.
 Carilah hiburan dan luangkan waktu untuk diri sendiri.
III. PSIKOLOGI PADA IBU YANG MENGALAMI MENOPAUSE
A.Gangguan Psikologis Pada Wanita Menopause
Menurut Kartini (1992) beberapa gangguan yang terjadi adalah :
1. .Depresi Menstrual
Keadaan ini pernah timbul pada masa adolesens yang kemudian hilang dengan sedirinya selama periode reproduktif (menjadi ibu) dan timbul lagi pada usia klimakteris. Pada saat ini sekalipun wanita tersebut tidak haid lagi, namun rasa depresif itu selalu saja timbul dengan interval waktu tidak tetap. Dan selalu tiba bersamaan dengan datangnya siklus haid. Tampaknya depresi tadi merupakan manifestasi dari kepedihan hati dan kekecewaan, bahwa wanita yabg bersangkutan menjadi kurang lengkap dan sempurna disebabkan oleh berhentinya fungsi reproduksi dan haid.
Cara mengatasi gangguan psikologis yang berhubungan dengan depresi menstrual yaitu :
a) Dukungan Informatif
 Memberikan konseling bahwa berhentinya haid adalah hal yang fisiologis dan akan dialami oleh semua wanita.
 Memberikan nasehat agar wanita tersebut mau dan bisa menerimastatus quo.
 Memberi nasehat agar dapat menerima keadaannya dengan lapang dada.
 Memberikan informasi agar selalu mengkomunikasikan setiap masalah atau perubahan yang terjadi kepada suaminya.
 Memberi nasehat untuk mencari tahu lebih banyak tentang hal yang dihadapi melalui media cetak, elektronik dan lain-lain.
 Memberi nasehat untuk mencari dukungan spiritual.
 Memberi contoh-contoh pengalaman poditif tentang wanita menopause.
 Menganjurkan untuk berolahraga.
 Memberi latihan penanganan stress.
 Memberi nasehat uabtuh konsultasi ke dr. Obgyn atau psikolog bila perlu.
b) Dukungan Emosional
 Mempunyai rasa empati terhadap hal yang dialami oleh wanita menopause.
 Melibatkan anggota keluarga terutama suami dalam memahami kandisi istrinya.
 Memberikan perhatian dan kepedulian kepada wanita tersebut.
 Menciptakan lingkungan kelurga yang nyaman, tenang, harmonis dan saling pengertian.
c) Dukungan Penghargaan
 Memberi penghormatan sehingga wanita tersebut merasa dihargai.
 Memberi dorongan/support sehingga wanita tersebut bisa percaya diri.
d) Dukungan Instrumental
 Memberi bantuan tenaga terhadap apa yang dibutuhkan oleh wanita menopause.
 Memberi bantuan materi (yang dilakukan keluarga )
2. Ide Delirius
Biasanya gejala tersebut berisikan ide delirus (kegilaan, nafsu-nafsu petualangan). Cara mengatasi gangguan psikologis yang berhubungan dengan ide delirius yaitu :
• Memberi nasehat agar lebih mendekatkan diri pada Tuhan.
• Memberi nasehat mengembangkan pikiran atau ide yang positif dalam hidup.
3. Masturbasi Klitoris
Ada kalanya pada wanita menopause timbul semacam seksual yang luar biasa hangat membara lagi dan ia sensitive sekali sengga wanita tersebut melakukan masturbasi klitoris (onani kelentir). Cara mengatasi gangguan psikologis masturbasi :
 Memberi nasehat untuk memenuhi kebutuhan sex secara sehat.
 Memberi nasehat untuk konsultasi ke ahli kebidanan untuk mendapat terapi.
 Memberi konseling bahwa wanita menopause bisa melakukan hubungan sex.
 Mengkomunikasikan masalah pada suami dan diharapkan suami mau membantu memecahkan masalah, mamberi dukungan kepada isrinya.



4. Aktifitas Hipomanis Semu
Wanita ini merasaklan seolah-olah vitalitas hidupnya jadi bertambah. Cara mengatasi gangguan psikologis ini yaitu :
o Memberi nasehat agar aktifitas yang dilakukan dapat mengarah ke hal-hal positif.
o Mengisi kegiatan dengan memperdalam kebudayaan atau bakat.
B. CARA MENGATASI INSOMIA, GANGGUAN KONSEP DIRI DAN INFATILE PADA MASA MENOPAUSE DENGAN KONSELING DAN KOLABORASI
Pada masa menopause terjadi perubahan yang menimbulkan gangguan diataranya insomia, gangguan konsep diri dan infantile. Cara mengatasinya adalah :
1. Kembangkan kebiasaan tidur dan mentaatinya, membaca bacaan ringan, nonton TV, acara santai, musik yang menyenangkan.
2. Makanlah jangan terlalu banyak/kemyang dan jangan kurang karena akan mengganggu tidur.
3. Atur kenyamanan diri, pastikan ruangan jangan terlalu panas/dingin dan kamar harus bersih juga rapih.
4. Dapatkan udara segar, jangan tidur dengan selimut menutupi kepala akan mengurangi oksigen dan menambah karbodioksida yang dihirup.
5. Batasi minum/cairan setelah jam 16.00 karena akan bak waktu malam hari.
6. Jernihkan pikiran, cobalah menyelesaikan masalah pada siang dan singkirkan semua kecemasan sebelum tidur.
7. Menunda jam tidur dan tidak tidur siang.
8. Mengerti dan menerima diri sendiri tulus ikhlas merupakan fitrah dari Tuhan.
9. Aktifitas social dan agama dapat memberikan kepuasan batin, memperkaya iman dan memberikan rasa berserah diri kepada-Nya.
10. Ketenangan dalam keluarga yaitu adanya pengeryian dan dorongan anggota kelurga akan membantu mengurangi gejala yang timbul, terasa ringan dan membawa kebahagiaan.
11. Pengobatan dengan esterogen dan kombinasi psikoterapi.


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