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Journal of Midwifery & Women's Health

Model Evaluation of "Traditional Midwifery Care Training" as
Potential Agent of Change In Implementation of Early
Initation of Breasfeeding In Minasate'ne District, Pangkep
Regency

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Journal:

Manuscript ID:
Wiley - Manuscript type:

Draft

Original Review

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Keywords:

Journal of Midwifery & Women's Health

Midwifery Education, Midwifery Workforce, Environmental Health

Abstract:

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ABSTRACT
The study aims at finding out the effect of Traditional Midwifery Care
Training model in an effort to improve knowledge, attitude and practice of
traditional midwife with her potential capability of being "agent of change"
in implementation of early initation of breastfeeding (IEB) for pregnant and
postpartum women. The study on traditional midwife empowerment as
"agent of change" for implementation of IEB is carried out by quasiexperimental research (experimental pre post test one design group). This
IEB training applies a module arranged and designed specially for a target
group who has limited literacy (a group with limitation of ability to read
and write). Subject matter presentation method uses some performance
aids like video, pocket book containing pictures of IEB and poster. The
findings reveal that Traditional Midwifery Care Training has an effect on
traditional midwives' Knowledge, Attitude, and Practice improvement. It is
proved that they are potential to be agent of change for IEB
implementation; the findings found that research hypothesis is proved.
Application to the findings hopefully can make public health condition
better, especially for moms and babies. Expectedly, the study can suggest
the head of the Health Office in Pangkep and South Sulawesi to make
decision and policy in decreasing maternal and infant mortality rate.

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On

which had 19 child deaths per 1000 live births. Emotional closeness traditionally makes contribution of pregnant female to employ tradition midwife as delivery helper. Suchi Avnalurini Sharif ABSTRACT The study aims at finding out the effect of Traditional Midwifery Care Training model in an effort to improve knowledge. 2012). and Practice improvement. It is proved that they are potential to be agent of change for IEB implementation. especially for moms and babies. attitude and practice of traditional midwife with her potential capability of being "agent of change" in implementation of early initation of breastfeeding (IEB) for pregnant and postpartum women. Makassar Email:yusriani. the findings found that research hypothesis is proved. Application to the findings hopefully can make public health condition better. According to Indonesia Demographic and Health Survey (IDHS) in 2007. Moslem University of Indonesia.68%. and the lowest rate was in Special Region of Yogyakarta. Attitude.umi46@yahoo. Suchi Avnalurini Sharif Faculty of Public Health. According to IDHS in 2012. the Ministry of Health of Indonesia. The findings reveal that Traditional Midwifery Care Training has an effect on traditional midwives' Knowledge.000 women. and national infant mortality rate (IMR) is 34 deaths per 1000 live births. which had 74 child deaths per 1000 live births. r Fo problem coming up to the surface. infant mortality rate in South Sulawesi was 25 deaths per 1000 live births. This IEB training applies a module arranged and designed specially for a target group who has limited literacy (a group with limitation of ability to read and write). One of prominent issues in maternal and infant mortality rate is traditional midwife involvement during birth process. and 37 deaths of child under age 5 per 1000 live births (the Centre for Health Data and Information (CHDI). The study on traditional midwife empowerment as "agent of change" for implementation of IEB is carried out by quasi-experimental research (experimental pre post test one design group). Expectedly. Pangkep Regency Yusriani. pocket book containing pictures of IEB and poster.Page 1 of 11 Model Evaluation of "Traditional Midwifery Care Training" as Potential Agent of Change In Implementation of Early Initation of Breasfeeding In Minasate'ne District.com 1 . but it is just a small part of the On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Journal of Midwifery & Women's Health Address correspondence: Yusriani. The highest IMR was in West Sulawesi. Recent progress in Indonesia reports that birth rate coverage helped by medical officer in 2012 was increasing by 89. This closeness creates hereditary belief in society on work qualification of a traditional midwife. Subject matter presentation method uses some performance aids like video. the study can suggest the head of the Health Office in Pangkep and South Sulawesi to make decision and policy in decreasing maternal and infant mortality rate. This rate comes at strategic plan target set by the ew vi Re ly INTRODUCTION Infant and maternal mortality is a kind of tip of the iceberg since there are so many cases about it. maternal mortality rate (MMRate) in Indonesia is 228 deaths per 100.

Syamala 2004). 1988. the lowest birth rate helped by labor assistant from medical officer is in the North Toraja Regency (86. the Ministri of Health of Indonesia. it becomes an ideal condition if traditional midwife is trained to be the agent of change. 2007). attitude. which is set at 88% in 2012. r Fo unsuitable training method and subject matter.68%) and the highest is in Parepare Town (105. Based on provincial percentage.57%) and in Pangkep Regency (90. traditional midwife in rural area. A study in Ghana proves that all causes of infant mortality and pain at 22% can be declined by IEB. behavior and advice improvement of trained traditional midwife compared to untrained one. As explored above. ew vi Re ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 2 of 11 2 . the lowest birth rate helped by labor assistant from medical officer is in Papua Province (32.org. IEB in this case. Morse.68%. and it could not decrease IMR and MMRate. The same notion is thought by WHO. traditional midwifery training relates significantly to knowledge. (the General Directorate of Nutrition and Mothers and Children Health. expectedly the traditional midwife is comfortable that allow her to acquire training subject matter well and easily and then put them into practice in society. Such background can make traditional midwife as an agent of change (Stevenson. lack of monitoring and evaluation during and post training (Kruske & Barclay. Specifically in South Sulawesi Province.jhpiego. Okubagzhi (1988) also found improvement of indicator for maternal and child health service when traditional midwifery training finished. 2004. 2013). 2008). if it is observed based on regency/town level. socio-cultural aspect of traditional midwife. Behavior change and advice giving by trained traditional midwife affect neonatal health. is the closest person to mothers and society. Traditional midwife can give mother psychological power. 2008). IEB is a new program promoted by the government as one of information to be propagated through community empowerment. Since 1970 to 1990. One of the ways to decrease infant mortality rate is early initiation of breastfeeding or IEB (PAHO. one of the methods is by employing traditional midwife who has significant role in neonatal care. According to Sibley & Sipe (2004).85%) while the higest rate is in Special Region of Yogyakarta (99. 2004). empathy and psycho-social support since her position represents culture and social structure in society in addition to her status as honorable or respected person as well her power to affect public (mnh. which usually midwife cannot do. Therefore. Okubagzhi. based on the findings concerning on the effect of traditional midwifery training found in some countries. Traditional midwifery training shall notice and adapt characteristic.Journal of Midwifery & Women's Health Ministry of Health of Indonesia. the training was a failure. Therefore. The indicators are traditional midwife's behavior change in assisting delivery process and maternal and child care. it held training for traditional midwife as a strategy to decrease MMRate and IMR (Sibley. she has significant role when she talks about cultural competency.85%). in purpose to encourage mothers to do IEB when the baby is born. Besides. socio-cultural background and capability of traditional midwife. 2003. culturally. IEB relates directly to breast milk period and exclusive breast milk.85%). In addition to that IEB practice is profitable to prevent infant mortality and pain. for example lack of preparation and studies on characteristic. Strategy failure to break IMR and MMRate through traditional midwifery training is caused by some matters. labor assistant coverage by medical officer is 93. If Traditional Midwifery Care Training method is made suitable.

Population and Sample Research design applied herein is experimental pre post test one design group with longitudinal approach in purpose to find out degrees of traditional midwife's knowledge. and to find out partnership between traditional and modern midwives before and after Traditional Midwifery Care Training on IEB.6 33.3 9 3 75 25 9 3 75 25 Number of Pregnant Mother Check Into Shaman / Month <3 people >3 people Partnering With Midwives Yes No 75.0 50.0 25.7 41. i. Distribution of Research Respondent Characteristic Karacteristik Education Total (N=12) Percentase (%=100) 5 5 5 41. coding and the making/transfer of questionnaire codes to the code table (master table).7 3 6 2 1 25. Research site selection is done purposively. Direct observation is also carried out.0 3 . Research Design. When the study is conducted in 2014. FINDINGS Below is the outcome of data processing which is presented systematically. Research Site The study is carried out in Minasate'ne District. Pangkep Regency. Population in this study is all midwives living in Minasate'ne District. Data processing is carried out in computer in which data processing steps consist of editing. thus sample is 12 people. an area with 18 traditional midwives and delivery assistance count in great quantities. Data analysis is aimed at finding out the effect of independent variable on dependent variable by applying Wilcoxon test.7 16. Pangkep Regency. r Fo Data Collection and Analysis Data is obtained by direct interview given to respondents through observation and by questionnaire as an instrument prepared by taking the arranged variables based on research objectives.7 8. attitude and practice on IEB.3 ly Not Schools Not The End Elementary Complete Primary School Not The End Junior Being old Shaman On ew Age 40-59 years 60-79 years >=80 years vi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Journal of Midwifery & Women's Health 10-20 years >20 years 9 3 Originally Science Being Shaman derivative The number attending births per month 12 100 <3 people >3 people 8 4 66.Page 3 of 11 MATERIAL AND METHOD there are 18 people. Traditional midwife sampling is given to those who meet inclusive and exclusive criteria.0 16.e. Re Table 1.

7 75.3 16. Traditional midwife's attitude to IEB before the training is 25% negative and 75% positive.7% fair. and the percentage is changing into 8. ew vi Re ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 4 of 11 Table 2.0 1 8.0 0 0 Positive 9 75. Table 2 shows that traditional midwife's knowledge before the training is 50% poor and 50% fair.3% poor and 66.3 8.7 25. and when the training is 1 2 9 8.3% poor and 91.7% fair after the training.0 12 100.7 Negative 3 25.7%).0 8.7% good after the training.3 25.0 5 1 1 1 1 3 41.0 carried out. while minority group is more than 80 years old (16.3% poor and 91.0 11 91.3 25. Most of birth attendants and pregnancy examiners are <3 people at 66. wash clothes Massage and female circumcision Massage and care for the child's fever None Number of other services / Month 3 4 6 None Primary Data Source r Fo Table 1 shows that the largest respondent group ranges between 40 and 59 years old and 60 to 69 years old (41. while 100% of them becomes traditional midwife because of ascribed status.3 Knowledge category IMD 4 .0 5 3 1 3 41. IEB Promotion and Implementation Practices by traditional midwife before training is 50% poor and 50% good.7% respectively).7% and 75%.3 enough 6 50.3 8.3 8. and it increases to be 8. becoming traditional midwife for a long time around 10–20 years (75%).7% fair. Distribution of traditional midwife's knowledge on IEB before and after "Traditional Midwifery Care Training" Before Training iabel After Training (n=12) (%=100) (n=12) (%=100) less 6 50.0 poorly 6 50. Most of them are graduating from elementary school (50%).0 1 8.3% poor and 91. the knowledge is 8.Journal of Midwifery & Women's Health Work apart TBAs Farmer Merchant Housewife Work apart TBAs Massage Care for sick children Sort. and it turns to be 100% positive after the training.7 8. Traditional midwife's knowledge on partnership between modern midwife and traditional midwife before the training is 33. Overall.

0 11 91. Based on Wilcoxon test.7 0 0 positive 10 83.92 ±6.778 Value p 0.05).036 ±1. Traditional midwife's attitude on IEB before and after training is 10.3% good. Re Table 3.Page 5 of 11 good 6 50. attitude and practice on IEB before and after "Traditional Midwifery Care Training" Shaman knowledge Babies About IMD before Training Shaman Attitude Babies About IMD Mean Range (SD) 11.431 20.7 Category Attitudes Regarding Baby Shaman Partnership negative 2 16.67 Value p 0.871 0.033<α 0.193 Range (SD) ly before Training 10. there is significant difference between traditional midwife's knowledge pre and post training (p=0. IEB promotion and implementation practices by traditional midwife before training is 3. Based on Wilcoxon test result. it changes into 16. Partnership practice between modern and traditional midwives before the training is 41.7 11 91.7% negative and 83.42 5.67±2.676 Mean Range (SD) ew after Training vi before Training after Training Practice Shaman Baby About IMD after Training 13.25±6.05). Average comparison table for traditional midwife's knowledge. and it reaches 100% positive after the training.92±6.50 Value p ±2.033 On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Journal of Midwifery & Women's Health ±2.7 Category Knowledge Partnership Regarding Shaman Shaman Baby Baby With Village Midwife less 4 33.42±2.431 SD which is less than average traditional midwife's knowledge after the training (20.83 Mean 3.3 12 100.7% poor and 83.871 SD.3% good.193 SD). this is lower than midwife's attitude when she is trained (13.05) Table 3 shows that traditional midwife's knowledge on IEB before the training is 11.7% poor and 58. there is significant difference between traditional midwife's attitude before and after the training (p=0.3% positive.7 good 7 58.3 enough 8 66.7 2 16.3 10 83.25 ±6.3 1 8.778 SD which is lower than average IEB promotion and implementation practices by traditional 5 .3 Source: Primary Data r Fo Traditional midwife's attitude toward partnership between modern and traditional midwives is 16.005 ±1.005<α 0.679 Information: Wilcoxon Test: It depicts meaningful difference (p<0.83±1. and after the training.0 Practice category Shaman Shaman Baby Baby Regarding Partnership With Village Midwife poorly 5 41.676 SD).

109 Mean Range (SD) Value p 8. Wilcoxon test result shows there is no significant difference between traditional midwife's attitude and the partnership between modern and traditional midwives before and after the training (p=0.e.00±1. i.476 ±1.157>α 0. Wilcoxon test result shows no any significant difference of modern-traditional midwives partnership practice before and after the training (p=0.83 4.05). Partnership practice between modern and traditional midwives before the training is 2.348SD). Almost all traditional midwives keep working as midwife amongst society.622SD. In order to make the program continue.00±0.05) vi Table 4 depicts that traditional midwife's knowledge on partnership between modern and traditional midwives before the training is 5. Hence.75±0.e.335SD.00±2.000 SD. 9.00 ±3. they can be employed to improve maternal and baby health. it is lower than the average partnership practice of both midwives after the training.00 ±2. Attitude and Practice One of the training objectives given to traditional midwives is to improve potential capability of traditional midwife as local human resource existing in rural area. attitude and practice toward Partnership between Modern and Traditional Midwives before and after the "Traditional Midwifery Care Training" Shaman knowledge Babies against Midwives Partnership With Shaman before Training after Training Attitudes towards Shaman Baby Midwife Partnership With Shaman before Training r Fo after Training Shaman Practice Midwife Babies to Partnership With Shaman before Training after Training Re Mean Range (SD) Value p 5.036<α 0.406SD. ew On DISCUSSION ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 6 of 11 The Effect of Training Intervention on Traditional Midwife's Knowledge.05).Journal of Midwifery & Women's Health midwife when the training is done (5.00 ±.622 0.50±1.05). The outcome of wilcoxon test reveals that there is no any significant differences between traditional midwife's knowledge on the partnership between modern and traditional midwives before and after the training (p=0.027<α 0. it is not far different from the average traditional midwife's attitude after the training.75 ±2. there is significant difference between IEB promotion and implementation practices by traditional midwife before and after the training is done (p=0.679 SD).406 ±.05). Traditional midwife's attitude on the partnership between modern and traditional midwives before the training is 8.000 Mean Range (SD) Value p 2.08 7. it is lower than the average traditional midwife's knowledge after the training (7.157 Information: Wilcoxon Test: It shows meaningful difference (p<0. Based on wilcoxon test.109>α 0.335 9.027 0.83±2.476SD. Purposely. Comparison table of average traditional midwife's knowledge.08±3. traditional midwife is the best choice since this person is a part of culture and society. attitude and practice toward Partnership between Modern and Traditional Midwives before and after the "Traditional Midwifery Care Training" is done: Table 4. 4. Below are average traditional midwife's knowledge. i.348 0. health program "investment" with the help of traditional 6 .

it can be handled by: a) refresh training. follow-up process. Agreeing with Rogers (1983) in Glanz. and so forth. The difference is visible from average score escalation on IEB attitude. for sure. Expectedly. environment needs and condition of the place they live in. After having assessment on traditional midwife's IEB attitude. this aspect depends on some factors: who is trained. information is delivered in simple language as well some examples in daily life. Accordingly. and assessment on the training output and outcome. There are 3 belief in research area On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Journal of Midwifery & Women's Health 7 . It depicts that "Traditional Midwifery Care Training" method can significantly upgrade traditional midwife's knowledge. attitude. where the training takes place. (2005) training approach by involving people of local community as participant will be more beneficial to spread the information than when the training is only given to some medical professionals with their limited number and participation in community. One of training needs analysis is COPE (Client-Oriented. Ethiopia. interviewing or doing observation. The training shall be initiated by comprehension on participant's capability. He found that indicator of maternal and child health is increasing as traditional midwifery training is carried out.05).67. training design shall be made suitable with local culture. According to Greent. In traditional midwifery care training. how to deliver the information. traditional midwife attends "Traditional Midwifery Care Training" packet. and it increases to 13.05).25 in the end of research. Furthermore.92 to 20. Rimer and Lewis (2002) on diffusion of innovations as stated previously. they perform persuasion step of having positive response on the IEB. will obstruct information spreading acceleration to society as the object and subject of health program. asking the participant about their satisfaction on the training they join with. The differences can be explained by looking at average knowledge score difference increasing from 11. vi Re The Effect of Intervention on Traditional Midwife's Attitude to IEB ew Pre-test and post-test traditional midwife's IEB knowledge shows significant improvement (p value of < 0. Okubagzhi also suggests that traditional midwifery training shall be continued with post-training coaching. His research objective is to find out the effect of trained traditional midwifery on the improvement of indicator for maternal and child health in Gondar area.Page 7 of 11 midwives will not be in vain. initial score is 10. This limitation. ly The Effect of Intervention on Traditional Midwife's IEB Knowledge In this study. The training covers listening and watching movies sections. differences appear due to average score escalation on traditional midwife's IEB knowledge. behavior and advice improvement given by the trained traditional midwife compared to those who are untrained. there is significant difference between pre-test and post-test attitude (p value is <0. analyzing participant attitude or practice changes in the real life. 2005). 2005). The indicator is trained traditional midwife's attitude change in assisting delivery process and maternal and baby care as well. simulation and information collection class to all about IEB. the topic learnt. Concerning on skill quality maintenance (attitude change sustainability). when traditional midwife listen to and understand the information of IEB. r Fo The findings is same as meta-analysis conducted by Sibley (2004) who makes conclusion that traditional midwifery training relates significantly to knowledge.83 in the end of study. Provider-Efficient) (Greent. The same finding is proposed by Okubagzhi (1988). to improve training effectiveness. Training evaluation is commonly carried out by: comparing pre-post training skills score. b) follow-up after the training (Greent. method and people logic run in harmony. Besides.

Journal of Midwifery & Women's Health which has become custom in society. 2008). As the agent of change. the causes are: 1) newborn baby is often fed honey. As conducted in this study. As the result. and immunization as well (Bisika. after the baby's umbilical cord is cut.05). she has to make sure that there is information or knowledge exchange about IEB. Considering that the custom is part of beliefs in society. rationally and step by step. finally. Publication on traditional midwifery training in Midwifery Today (2002) suggests that traditional midwifery training does not have a goal of replacing traditional midwife. It is unique that characteristics of and roles of traditional midwife amongst ly In some countries. it is true that traditional midwife is capable of being agent of change for IEB implementation. Simply put. It is seen from average score escalation of IEB Promotion Practice. she will be please to and plan to do IEB after delivery process. Often after a bath.50. The Effect of Intervention on IEB Promotion and Implementation Practices by Traditional Midwife ew vi Re In performing her activity like giving health advice or promoting IEB to pregnant women and society. expectedly. 3. Assessment before (pre-test) and after (posttest) the IEB promotion practice including in Traditional Midwifery Care Training shows significant difference (p value < 0. The belief can affect or make IEB fail. placed facing downwards on the mother's belly. If one of or all of the three conditions are still done. while the traditional midwife has to prevent discontinuity of IEB implementation (Roger.42 to 5. antenatal and postnatal cares (Krasovek & Anderson. traditional midwife will promote IEB to pregnant women after participating in Traditional Midwifery Care Training. If one of the three causes is continued. benefit. traditional midwife has a role to promote or give advice to women about pregnancy. adopt it. explanation on IEB shall be given correctly. even the custom is done by traditional midwife herself. traditional midwife behavioral research has significant improvement between pre and post training. r Fo Traditional midwife has a role not only as an instructor. traditional midwife also has role to distribute iron tablets and anti-malaria tablets if necessary. "klentik oil" is smeared on the baby's body (coconut oil made traditionally). the way to implement IEB and also belief about IEB. Therefore. they can make IEB fail. IEB will not be beneficial to mother and baby. It is known that a condition of IEB implementation requires newborn baby's head and body. The Role of Traditional Midwife as Agent of Change On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 8 of 11 8 . While promoting and convincing health advice. the traditional midwife has a role subconsciously as an agent of change. 2008). Pregnant women and society shall understand IEB knowledge. the pregnant women understands the definition. she has to convince pregnant women to get the best health service in addition to keep learning how to do maternal and child care (Petterson in Bisika. 2007) Based on findings and discussion on the effect of traditional midwifery care training model on improving potential strength of traditional midwife as the agent of change. 2001). but it aims at establishing traditional-modern midwife partnership to respect each other and at combining traditional and modern services. shall be cleaned and dried. Traditional-modern midwife partnership allows implementation of fact-based midwifery service and strengthens mother and children health service system in purpose to make process of childbirth safer in addition to maintaining cultural values in the process of pregnancy and delivery. which is assessed by questionnaire. and immediately. 2) newborn baby is bathed right away after delivery 3). 1991 in Bergstrom. The difference means presence of IEB promotion practice improvement by traditional midwife. including traditional midwife.

r Fo Strengths and What Has to be Noticed in Performing Intervention Model of Traditional Midwifery Care Training Re Every training design. Consequently. such as immunization. most of them are illiterate people. public figures involvement (village officials) will allow them to monitor the result of training implementation in society and to socialize the program to a broader society. This is 9 . This training model is called Traditional Midwifery Care Training. it needs serious facilitator/party who will be involved to pay attention to the training process and to identify inappropriate and unsuitable matters that can obstruct the training fluency. involvement of modern midwifery will make traditional midwife capable of practicing the knowledge with colleague. opinion. If it is possible. Subject matter is delivered little by little and reviewed to make participant easy in understanding and remembering. but they have leading position amongst the people. experience and practice they have done. organizing committee (facilitator) often misses to notice and to monitor development of training implementation. family planning program. Attitude. In order to continue this traditional midwifery care training. Accordingly. Every opening and close session will have analysis section in form of question and answer and discussion in purpose to help participant in reviewing some previous subject matters. simulation. Considering that the research targets are unique people because of their age (more than 40 years old). explanation will be delivered in rational and logic in purpose not to make them forced into a difficult position. for example group discussion. the training is designed specially by paying attention to and taking consideration to the factors mentioned. It is in conformity with opinion proposed by Stevenson (2008) that traditional midwife can be agent of change because she has the criteria of becoming agent of change. Communication is held in two-way that communication will be more balanced. However. and testimony. for sure. Training subject matters are Knowledge. Thus. accommodating every aspiration. for example patient. great empathy. it involves modern midwife employed in the village and local figures. pocket book. If there is an indication that the practice they do can harm mother. participant goes "as they are". and the upcoming discussion will identify every strength and weakness to be used as future leaning. ew vi ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Journal of Midwifery & Women's Health What Has to be Noticed in Performing Intervention Model of Traditional Midwifery Care Training This training model applies active participative approach. It is only the basic will be delivered to make it simple but still pay close attention of some important things that shall be known and implemented during IEB. This method is important considering that memory strength of research target (traditional midwife) is relatively limited. question and answer section. direct involvement in maternal and baby care by giving assistance and persuasive approach and also becoming honorable and respected person. Media used herein will not require writing and reading skills consisting of some media like video. In general. conic strips and storytelling about IEB. capable of communicating to the culture and matriarchal backgrounds. this traditional midwifery training model or form can be developed or applied with other IEB subject. without blaming people. Promotion practice and IEB practice consisting of basic principles. Expectedly. Training method will be held interactively and participatory approaches. Besides. tetanus neonatorum and other programs. one of condition to be agent of change is that traditional midwife shall respect local socio-cultural factor.Page 9 of 11 society are becoming public figure and having influence over the people to make a change. has strengths and weakness. case discussion.

De Gruyter. Germany Glanz. training site has to be close enough. & Garratt Rod & Sheehan-Connor Damien. B. 9 PAHO 2007. for example: 1) organizing committee is not enough. 3) lack of attention to the needs of local language to make communication with training participant easy and smooth. Christoph. pp. and it is as important as paying attention to some factors. & Lewis. M Kent & Mills. after attending Traditional Midwifery Care Training and understanding IEB knowledge. Ranson. F. 306 . 2. Research.K. 69. and Practice. the study can suggest the head of the Health Office in Pangkep and South Sulawesi to make decision and policy in decreasing maternal and infant mortality rate leading to MDGS 4 and 5. Diakses dari: ProQuest Health and Medical Complete [9 April 2009] ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 10 of 11 Okubagzhi. Lesly 2004. 2) lack of communication capability owned by facilitator. Therefore. 10 . Health Behaviour and Health Education. Health and Development. M. Complete and comprehensive Traditional Midwifery Care Training is necessary. Working Paper No 13 Department of Health Care Management – Technische Universitat Berlin. K. community health center ought to make good fund plan and time for the training. vol. 3rd ed. "Stem Cell Donor Matching for Patients of Mixed Race. Journal of Economic Analysis & Policy. Gericke.. July. Application to the findings hopefully can make public health condition better. Canadian Journal of Dietetic Pratctice and Research. ‘Effects of Prenatal Nutritional Intervention Program On Initiation and Duration Breastfeeding’. vol. pages 1-27. vol. Sue & Barclay. Mc. Feasibility of Scaling-up Interventions: The Role of Intervention Design.) 2002. 49.. and also sufficient time for the training season. Rimer. Disease Control Priorities Project. Boston ew vi Kruske. Therefore. REFERENCE Bergstrom Ted C. Health Program Planning an Educational and Ecological Approach 4th Ed. 2003. for example: community health center has to budget special fund which is not too big including fee of short Training for Trainer for modern midwife. Expectedly. Graw Hill. & Kreuter. Kurowski.W 2005. Gebre Selassie 1988. 12(1). Jossey Bass Green.M (ed. Beyond Survival : Integrated Delivery Care Practices For Long Term Maternal and Infant Nutrition." The B. 2012.Journal of Midwifery & Women's Health caused by some factors. Anne. r Fo Re CONCLUSION AND SUGGESTION Based on findings and discussion on the effect of traditional midwifery care training model on improving potential strength of traditional midwife as the agent of change. L. World Health Forum. can and will extend IEB to mothers and apply IEB when assisting delivery process. transportation and consumption for traditional midwife during training season. it is true that traditional midwife is capable of being agent of change for IEB implementation.311 On Leger.W. vol. 4. especially for moms and babies.E. Theory. ‘Effect of Shifting Policies on Traditional Birth Attendant Training’. no. San Francisco. ‘Fulfilling the potential of traditional birth attendants’. traditional midwife behavioral research has significant improvement between pre and post training. The American College of Nurse-Midwives. Traditional midwife. no. Christian A. Gisele 2008.

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