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International Conference: Research and Application

on Traditional Complementary and Alternative Medicine in Health Care (TCAM)


nd rd
June, 22 -23 2012 Surakarta Indonesia

Consumption of Jamu in Pregnant Women as A Risk Factor of Birth


Asphyxia in Bekasi

Dewi Purnamawati1*, Iwan Ariawan2


Diploma IV of Midwifery Program at STIKes Kharisma Karawang.
Pangkal Perjuangan Street, km 1 By Pass, West Karawang.
Student of Doctoral Program in Public Health Faculty University of Indonesia.

*Corresponding author email: dpw_80@yahoo.co.id

Abstract

Jamu is traditional medicine which is made by natural ingredients, which has good
effect by using several ingredients. The effectiveness and safety of traditional medicine as self
medication in health care still need to be proven, especially if it is used by pregnant women.
The goal of this study was to know the effect of consuming jamu for pregnant women with
birth asphyxia in Bekasi in 2008. Quantitative and qualitative study designs were used in this
study. We used case control design to see the odds ratio of the mothers who have experience
of consuming jamu during pregnancy. The result showed that there were relationship and risk
of consuming jamu with birth asphyxia (p=0,000, OR=7,1) and frequency of antenatal care
with birth asphyxia (48 times during pregnancy, p=0,052, OR=1,68 and less than 4 times
during pregnancy, p=0,019, OR=3.02). The result of in-depth interview told us that the
majority of the mothers did not know about the health attitude during pregnancy and didnt
have enough information from providers about it. We suggest increasing the quality of health
service during pregnancies and deliveries, and establishing a standard of using jamu for
pregnant women.

Key words : traditional medicine, jamu, asphyxia

assessment, research and testing various


INTRODUCTION types of traditional medicine. Based on
Health is an important element in the National Economic Census data in 2001,
development of human resources. there is an increase use of traditional
According to the National Health System medicine from 15.6% in 2000 to 30.2% in
(1998) one of the important factors in 2001 (Rai, 1995). Although, the success of
realizing the ability to live a healthy life is traditional medicine as health care effort
a drug, so that to achieve the goal of health still need to be proved in terms of the
development we need to provide drugs effectiveness and side effects, especially
with different types and amounts. It is when it is used by pregnant women. This
quite suitable for community needs, it safe needs to be considered because the
and use efficacious, and has quality that mortality and morbidity resulted from
has established requirements affordable for consumption of jamu by pregnant women
all community. is high enough and the effects of
Strengthening the traditional consuming drug for the fetal has a long-
medicine will be more enhanced and term risk and impact more than short term
developed by prioritizing the existing risk to maternal and fetal systems (Katno,
resources in Indonesia, starting from 2006).
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

Currently there are about 60% of The research was carried out in
pregnant women and lactating mothers several places in maternal care in Bekasi,
who use drugs or suplemen (Dwiprahasto, including Bekasi General Hospital,
2006). Research on the consumption of Maternity hospital, and Private Midwives
traditional medicines and their effects on Practice from January to May 2008. The
the fetus is not yet clinically proven, but number of cases that needed are 103 cases
from studies conducted in experimental and 309 controls. The data were collected
animals, it appeared that some medicinal using questionnaires and in-depth
plants used as herbal medicine for pregnant interviews conducted to the mothers. Each
women is oksitosik (stimulates the uterus), mother was accompanied by two
resulting in uterine and intestinal bleeding, informants support, which consists of
fetal death and abnormal fetal growth labor helper (midwives), as well as
(slow), therefore the use of traditional traditional medicine sellers (traders
medicines by pregnant women should be carrying herbs). Statistical data analysis
controlled. Some natural ingredients of using software included the univariate
traditional medicine that is often consumed analysis, bivariate (chi-square test) and
as a herbal medicine for pregnant women multivariate (multiple logistic regression
appeared to have oksitoksik effect, thus test) to assess the relationship of
affecting the health of the fetus in the independent variables or major exposures.
uterus (Katno, 2006).
Author's experience in hospital and RESULT AND DISCUSSION
maternity hospital, in Bekasi, showed that Result
most infants with asphyxia have a history Univariate analysis. Results show-
of maternal consumption of traditional ed that 25% of infants are born with
medicines such as herbs from the asphyxia diagnoses and 75% are without
beginning of pregnancy, gestational age of asphyxia. The average value of the first
3 months, 7 months up to a week ahead of minute Apgar score was 7.68 and Apgar
the delivery process. This study aims to see score after 5 minutes was 8.75. The
the influence of jamu consumption in average age of the mothers was 28.7 years
pregnant women in the incidence of old. Meanwhile, the education backrounds
asphyxia on the newborn babies in Bekasi. were as follows: 8.65% respondents came
from high education and there were still
MATERIALS AND METHODS 0,48% of respondents who were not
This study uses a case-control design educated. Fifty six point zero one percent
using two approaches namely quantitative of respondents came from a high
and qualitative. Quantitative approach socioeconomic level. The majority of
aims to assess the role of herbs in the respondents (81.87%) did routine antenatal
exposure of pregnant women against the care (ANC). only 6.73% does the ANC
occurrence of asphyxia in newborns. After less than 4 times. The majority of
that it is followed by qualitative approach respondents (77.4%) said they never toke
with in-depth interview method that aims drugs and consumed herbs during
to explore information about the reasons pregnancy, and only 22.6% of respondents
why a pregnant woman consumes the had a history of taking herbal medicine
herbs, about the perception whether or not during pregnancy.
they consume a herbal medicine for From 22.6% of respondents who
pregnancy and its effect on pregnancy and consume herbal medicine, 61.7% said they
about the response from traditional regularly consume herbal medicine during
medicine sellers and health provider pregnancy. 60.64% of respondents
regarding to the consumption of herbal consumed herbs in the third trimester of
medicine for the pregnant women. pregnancy. And 90.62% respondent con-
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

Table 1. Distribution of Research variable


Variable Category n %
Asphyxia No 312 75
Yes 104 25

Education High Education 36 8,65


Senior High School 221 53,13
Junior High School 101 24,28
Primary School 56 13,46
Not Educated 2 0,48

Economic level High 233 56,01


Low 183 43,99
Nutritional State Good 364 87,5
Less 52 12,5
Age >35 Year 54 12,98
< 20 year 5 0,96
20-35 year 357 85,82

ANC Frequency >8 times 179 43,03


4-8 times 209 50,24
<4 times 28 6,73

Drug Consumption No 372 89,42


Yes 44 10,58
Herbs Consumption No 322 77,40
Yes 94 22,60

Table 2. Distribution Consumption Jamu On Pregnant women


Variable Category N %
Type of jamu Medicinal plants 1 1,06
Herbs wrapped 5 5,32
Carrying herbs 88 93,62

Frequency of consuming jamu No 58 61,70


Yes 36 38,30
Time of consuming jamu Third Trimester 57 60,64
Second Trimester 19 20,21
First Trimester 18 19,15

Advise for consuming jamu Your self 26 27,66


Family 39 41,49
Neighbor 25 26,60
Herbalist 4 4,26
The reason for consuming Jamu Blood not fishy during 36 38,3
Others 58 61,7

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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

sume the types of herbs which is jamu jamu after controlled by a variable ANC
gendong (sellers carrying herbs). frequency. The same thing happen to the
41.49% of respondents consume herbal variable number of ANC, value 4-8 times that
medicine based on the recommendation has odds ratio 1.68, it means the number of
from the family. The reasons of pregnant women has 4-8 times frequency
respondents for taking herbal medicine ANC, has a risk 1.68 times to deliver a baby
are varied, but for 38.3% of respondents with asphyxia than those who did the ANC
said that taking herbal medicine during more than 8 times. Pregnant women with a
pregnancy can caused that the blood is number of ANC less than 4 times has a risk
not fishy when delivery. The reason of 3.02 times to deliver a baby with asphyxia
46.58% respondents who did not than those who did the ANC more than 8
consume jamu, is afraid. times. Attributable fraction in the herbal
Bivariate analysis showed that group 0.85, meaning 85% of cases of
there is no significant relationship asphyxia does not occur if the mother does
between the consumption of herbal not consume jamu. Attributable fraction in a
medicine with the incidence of asphyxia population of 0.43 means that 43% of cases
on the newborn baby in Bekasi (p = are populated asphyxia caused by taking
0.000 OR = 6.89, 95% CI = 4.14 to herbal medicine.
11.38). There is significant relationship The results of in-depth interviews
between the level of education and conducted in the mother's case, health
asphyxia (p = 0.046 OR = 3.9 for the provider and herbalist, it is known that most
low education and OR = 2.7 for of the mothers said that they consulted their
medium education) and there is pregnancy to a midwife after having late of
significant relationship between menstruation. Only one mother who checked
frequency of ANC with asphyxia (p = to the midwives' in 6 months gestation. This
0.030 OR = 2.98 for frequency of ANC was done because the mother did not expect
<4 times and OR = 1.45 for 4-8 times of her pregnancy so she did not try to check it to
the frequency ANC). Meanwhile for the health provider (mother 2). Only a minority of
level of socioeconomic variables, age mothers did not know how many times a
and nutritional status, each did not show pregnant woman should be checked by health
significant relationship with the provider. The rest said that it was better to
incidence of asphyxia in newborns with check the pregnancy during pregnancy.
p values greater than alpha. According to mothers, healthy
Multivariate analysis conducted behaviors during pregnancy is to drink milk,
with the participation of all konfounder eat vitamin and drink herbal (mother 1) which
and effect modifiers, the final model is beneficial for the baby development in the
obtained showed a significant uterus. However most of them have already
association between the consumption of implemented the health behavior by having
herbal medicine with asphyxia and enough rest, eating, not taking random drug
asphyxia on the frequency of the ANC and drinking vitamin given by a midwife.
with newborn baby. However, only a small amount of mothers
The analysis is based on odds who know about nutrition.
ratio value, the value of the largest odds Most of the mothers gave true answers
ratio was 7.10 for the variable consume about the herbs, the other mentioned types of
jamu, it is mean that pregnant women herbal medicine. Special herbs for pregnant
who drink jamu will have more risky women, the three mothers did not know for
7.10 times to deliver a asphyxia baby sure, they only know jamu kunyit asam
than pregnant women who do not drink (turmeric sour herbs). Besides that, all the
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

mothers do not know what kind of herbs and he made herbal free from side effects.
are best consumed by pregnant women,
because they consume it based on the DISCUSSION
advice from family and neighbors to fill Herbs should be readily available to
fresh and not to smell fishy when. Most meet the criteria, known by many people,
of the mothers consume jamu in the process simple of storage, easy to use and is
second trimester of pregnancy until the not harmful to use .4 this should really be
baby is born, only a minority of mothers considered, especially if its use by pregnant
who consumed jamu in the first mothers.
trimester of pregnancy until the second The results of this study of 416 mothers
trimester. Almost all mothers said that in childbirth in Bekasi from January to May
in taking herbal has no standard rules showed that mothers who consume herbal
and they dot know the effects of jamu. medicine during pregnancy have seven times
According to the health provider the risk odds to give birth with asphyxia
(midwives), a pregnant woman should compared with mothers who did not consume
take care the pregnancy with nutrition jamu during pregnancy. Pregnant women
and regular, antenatal care (ANC), should avoid herbal drink containing cayenne
balanced nutrition and the need of pepper puyang Java (piper retrofractum vahl)
family support. According to the continously, because it has the effect of
midwife, a pregnant women typically inhibiting muscle contractions during labor.
consume jamu due to family habits and Chili Java contains alkaloids piperine inhibits
culture factors, especially, the Javanes the effect of muscle contraction, so it will be
people, socioeconomic factors and difficult to deliver. Beside herbs chili Puyang,
knowledge. but there is also reason to turmeric acid should be avoided is, the
abort is the an unwanted pregnancy. amount of turmeric (curcuma domestica val)
About the effects, one midwife told that is dominant in strong turmeric sour when
she did not know the effect, she only using it, because turmeric extract has a
heard from a doctor. while the second stimulant effect on uterine contractions and
and third midwife said that taking the effect abortivum.2
herbal medicine can affect the health of One thing of concern is the possibility
the fetus and all midwifes said that a deposition of material jamu in amniotic fluid.
pregnant woman should not consume Amniotic fluid is mixed with herbs to make
jamu. residual amniotic fluid becomes cloudy and
From interviews with herbalist cause the infant hypoxia thereby disrupting
seller we know that there are 2 types of fetal airway. It is said by informants that
herbs for pregnant women. Which there is relationship between taking jamu and
names of package are sorok I and sorok asphyxia in newborns. The possibility of
II, and herbs turmeric acid. The deposition of material in the amniotic fluid of
beneficial of turmeric acid makes the herbal medicine is very dependent of the dose
blood is not fishy when delivery, and and duration of consumption of herbs, but in
makes the pregnancy clean and can also this study the relationship between dose and
make the baby healthy "because for the duration of consumption of herbs is not
mother is for her baby too, and then it is conducted due to the various answers from
to smoothen the menstruation." the respondents and lack of standard rules for
According to the herbalist seller, taking herbal medicine. Herbal viscosity it
pregnant women should take jamu from self varies according to experience each
5 months of gestation to delivery, but herbalist, because they make only
the herbalist seller did not give a reason approximate and based on feedback from
why it should be in age of pregnancy customers. According Suharmiati in the
process of carrying herbs, the only difference
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

lies in the composition and variety of that can not be revealed in this study the
additional materials and there is no diagnosis of asphyxia in newborns, such as
standard dose for one type of jamu exposure time with exposure both in terms of
gendong (Suharmiati, 1998). regularity in eating, dose, viscosity, etc. Then
On traditional medicine, the condition of the newborn is closely
especially herbal medicine, the associated with the helper labor skills. Babies
government has not issued a fixed should be born healthy, but due to poor
requirement, but there is only coaching management of labor and unskilled labor
for jamu seller, the government has helper can also cause birth asphyxia.
issued several directions namely, 1) the Neonaturum own asphyxia is a
water contents of not more than 10%, condition of newborns who failed to breath
this is to prevent the breeding of spontaneously and regularly soon after birth,
bacteria, molds and yeasts (yeast). 2) so it can reduce oxygen (O2) and may
The number of molds and yeasts are not increase the carbon dioxide (CO2) which lead
more than 10,000. 3) The number of to bad consequences in the lives further. With
non-pathogenic bacteria are not more good management of the actual incidence of
than 1 million. 4) free of pathogenic birth asphyxia in newborns can be minimized.
bacteria such as salmonella. 5) The It is like what one informant said as follows:
herbs in the form of pills or tablets,
crushed the power of not more than 15 "I think the biggest factor that led
minutes. Tolerance to 45 minutes. And infants born with birth asphyxia is a
the last 6) it should not be polluted or long time so the baby is experiencing
beneficial chemical intervented hypoxia in utero, while in the hospital
(Santoso, 1990). the average case of asphyxia is the
This is very worrying, because referral case. It feels when handling the
more than 90% of mothers with a asphyxia is good, I think the asphyxia
history of taking herbal medicine during does not happen, for example of good
pregnancy, usually takes herbal drink. labor leader, not too fast leading labor
One disadvantage of this herb is not and good labor position. she was told to
standardized, carrying raw materials sleep a side there's also because of the
and easily contaminated with various factors of health care workers, so that
microorganisms. Research conducted from the health workers must know a lot
by Pratiwi against bacterial about it, most treatment is done after
contamination testing and mold the baby is born, the right thing is after
contamination in herbal products carry the head is born with the ABC
the Special Region of Yogyakarta technique. "(informant 1)
(DIY) found that of 20 makers of herbal
medicine in the three districts and one Spontaneous breathing of newborns
municipality in the province most of the depends on the state of the fetus during
samples were contaminated with pregnancy and childbirth. Random drug
bacteria that exceed the threshold habits and behavior of mothers during
required by Ministry of Health in 1992 pregnancy can be a factor increasing the risk
(Pratiwi, 2005). of congenital malformations in population
Although from the survey results (Koren, 1998). Commonly using drugs that
revealed that mothers who have a can cross the placenta of pregnant women as
history of taking jamu during pregnancy well as provide exposure to the growing
has a risk of 7 times the odds to give embryo and fetus to the effects of
birth asphyxia. But these results can not pharmacologic and teratogenik. Use of
be concluded that the jamu can cause medication during pregnancy is always
asphyxia, because there are some things accompanied by risk of adverse effects both
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

on the fetus, the mother or the CONCLUSION


pregnancy. The size of the risk varies Mothers who consume jamu during
depending on the type of drug, as well pregnancy are at risk 7 times greater to give
as how to use a variety of biological birth asphyxia compared with mothers who
characteristics of the individual. did not consume jamu during pregnancy after
Pregnancy testing is done to controlled by a variable number of the ANC.
check the state of pregnant women and Pregnant women with a number of ANC less
fetuses on a regular basis, The goal of than 4 times during her pregnancy had 3 times
prenatal care is the first to monitor the the risk odds to give birth asphyxia compared
progress of pregnancy. Besides the with mothers who number more than 8 times.
examination of ANC we also examine Similarly, for mothers who have a 4-8 times
the frequency of the ANC. In the amount odds 1.68 times the risk for birth
accordance with the policy program, the asphyxia infants compared with mothers who
antenatal visits should be conducted at number more than 8 times.
least four times during pregnancy
(Saifudin, 2000). Mothers with SUGGESTION
adequate prenatal frequencies are Asphyxia on the newborn baby is rare,
expected to know more about the health however asphyxia is the biggest factor leading
of her pregnancy, thus avoiding to infant mortality in Indonesia, because of
behaviors that can harm the fetus in the that, it is needed to improved the quality of
womb, including the habit of taking health services related to pregnancy and the
drugs or herbs . risk of pregnancy and pregnant women are
From the survey results revealed expected to pay more attention to healthy
that there is a relationship between the behaviors and pay attention to food or
ANC and the incidence of asphyxia in beverages should be consumed as it can affect
newborns in Bekasi. Mothers who had the fetus in the womb.
ANC between 4-8 times the risk odds to In addition there is need for
give birth asphyxia of 1.6 times standardization of the use of herbs for
compared with mothers who did the pregnant women, especially packaged herbs
ANC more than 8 times during (herbs from the manufacturers of traditional
pregnancy. Similarly, mothers with a medicines that have been registered). Given
number of ANC less than 4 times the considerable public interest in the use of
during pregnancy have a risk three herbs in particular are usually consumed by
times the odds to give birth asphyxia pregnant women.
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International Conference: Research and Application
on Traditional Complementary and Alternative Medicine in Health Care (TCAM)
nd rd
June, 22 -23 2012 Surakarta Indonesia

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