INFLUENCE OF DELIVERY OF SECTIO CAESARIA ON POSSIBLE

POST PARTUM BLUES IN RSUD RAJA AHMAD THABIB

TANJUNGPINANG 2018

KOMALA SARI,S.Kep,Ns,M.Kep
Pediatric Nursing and Maternity
SEKOLAH TINGGI ILMU KESEHATAN HANG TUAH TANJUNGPINANG INDONESIA
+62 852 925 88881 komalasariyunandys@gmail.com

Abstract
Postpartum blues are a temporary depression mood that shortly after childbirth. Mood disorders
are manifested by a unstable mood, increased sensitivity, distractions, poor concentration,
loneliness, and despair. The occurrence of this condition is usually within 1 to 5 days after
delivery and symptoms usually last from 2 to 3 days and usually heal within 10 days. The
purpose of this research is to know the content of Sectio Caesaria tehadap kemesinan pasca
patum blues at RS Raja Ahmad Tabib Tanjung Pinang. This research use Cross Sectional design,
Sampling in this research using non probability sampling approach with sampling technique
using Purposive Sampling. Instrument measured from the Edinburgh Postpartum Depression
Scale (EPDS) to measure post partum blues. The results of the study had no effect from Sectio
Caesarea on the possibility of postpartum blues (0.089). There are other factors that are used
that is parity and social. The results of this study can be used to improve Maternity Maternity
Care during the period of Antenatal Care until Post Partum Care.

Keywords: Sectio Caesaria, Post Partum Blues, Mood Disorders

Introduction occurrence of this condition is usually within

Adjustment is needed for the postpartum
mother in the face of her new role and
activities as a mother in the first weeks or
months after delivery, both physically and
psychologically. Some postpartum mothers
manage to fit in well, but others fail to adjust
to their new life and experience
psychological disorders, one of which is
post partum blues.
Literatur Review
Postpartum blues are a temporary depression
mood experienced shortly after childbirth.
Mood disorders are manifested by a labile
mood, increased sensitivity, fatigue, poor
concentration, loneliness, and despair. The
1 to 5 days after delivery and the symptoms
usually last from 2 to 3 days and usually heal
within 10 days. Postpartum Blues usually
occur day 3 to 4 after delivery and duration of
postpartum events from several hours to
several days. It is estimated that about 50 to 80
percent of women have post partum blues.
According to psychiatric experts the mother
was diagnosed with a symptom called
postpartum depression. Mother experiences
decreased interest and interest in the baby.
Mothers are also unable to care for the baby
optimally and not eager to breastfeed, so that
hygiene, health and baby growth is also not
optimal. Infants who are not breastfed and
having problems in bond attachment

111

processes are usually experienced in infants
with mothers who are depressed
(Machmudah 2012).
Depression in the postpartum mother usually
begins with postpartum blues or baby blues
or maternity blues. Postpartum blues is a
mild affective disorder syndrome that often
occurs within the first week after delivery
but often occurs on the third or fourth day of
postpartum and peaks between the fifth day
and the fourteenth day of postpartum.
In the postpartum mother there is a sudden
hormonal change and can trigger the
occurrence of postpartum blues. This is due
to decreased levels of estrogen, progesterone
and endorphin after placental delivery, as
well as high levels of the hormone prolactin
and glucocorticoid hormone. The need for
increased estrogen hormone in the mother
during pregnancy but then decreased
suddenly after delivery makes the mother
depressed called biochemical depression.
Depression or dsyphoria in postpartum
mothers is due to a decrease in endhorpine
hormone levels. Endhorpin is a natural
morphine compound produced by the body
that cause the effect of pleasure (euphoria).
If the endorphin hormone levels decrease,
then the mother will experience depression
or dysphoria or sadness. Changes in the
hormone corticosteroids can lead to
symptoms of heart rate changes, pulse,
dizziness and fatigue (Pillitteri, 2010).
The delivery of Sectio Caesaria is one of the
supporting factors for the occurrence of post
partum blues. The mother who gave birth
with a delivery of Sectio Caesaria had a
considerable chance of developing post
partum blues. Data from Fruedenthal of 63
mothers who gave birth with a Sectio
Caesaria birth had post partum blues of 25
percent, and of 52 mothers born with vaginal
112
only 8 percent had post partum blues.
Delivery of Sectio Caesaria can affect the
psychological and mood of the mother can
even cause trauma or depression in post
partum.
Delivery with the Sectio Caesaria method
often requires longer recovery time, most of
the women who have given birth by the
Sectio Caesaria method take an average of 6
weeks or more for recovery, whereas
vaginal delivery takes just a few days to
reactivate. In addition, the lack of
opportunities for bonding or bounding
attechment in mothers who perform
childbirth Sectio Caesaria so that access or
bond between mother and child during
golden hour is not reached. (Aprillia, 2014)
Methodology
This research use Cross Sectional design,
Sampling in this research using non
probability sampling approach with
sampling technique using Purposive
Sampling. Instrument measured from the
Edinburgh Postpartum Depression Scale
(EPDS) to measure post partum blues.
Result And Discussion
Univariate Analisys
Distribution of Frequency of Respondents
by Age, Level of Education and
Employment in RSUD Raja Ahmad Thabib
Tanjungpinang 2018.
 113

No Variabel
F Persen
1 Age
<20 4 10 %
20-35 33 82,5 %
>35 3 7,5 %
Total 40 100 %
2 Education
High 28 70 %
Low 12 30 %
Total 40 100%
3 Occopation
Working 17 42,5 %
Not Working 23 57,5 %
Total 40 100 %

Based on the table above, most of the the rest were working mothers, namely 17
respondents were between 20 and 35 years people (42.5%).
old, namely 33 people (82.5%) while the
remaining 4 people (10%) were mothers aged Distribution of Respondents Based on
over 35 years and 7.5%. Most of the Parity, Pregnancy Planning, Pre
respondents who have a high level of Menstruation Syndrom History, Social
education (high school and PT) are 28 people Support and Possibility of Postpartum Blues
(70%) while the rest are low educated, namely
12 people (30%). Most of the respondents
were a housewife who did not work as many
as 23 people (57.5%), while

No Variabel
F Persen
1 Paritas
Primipara 31 77,5 %
Multipara 9 22,5 %
Total 40 100 %
2 Planing for Pregnancy
Planning 17 42,5 %
Not Planning 23 57,5 %
Total 40 100%
3 PMS history
Yes 18 45 %
No 22 55 %
Total 40 100 %
4 Social Support
Yes 14 35%
No 26 65%
 114

Total 40 100 %
5 Possible Post Partum Blues
Yes
No 29 72,5%
Total 11 27,5%
40 100%

From table above can be explained that most occurrence of postpartum blues at the King
of the respondents were primiparous Ahmad District Hospital in 2018
mothers (77.5%). Most of the pregnancy
status in pregnancy is unplanned (57.5%).
Respondents who did not have a history of
STDs were (55%). Respondents who
received social support were 32 respondents
(40%). The results of this study most
respondents experienced postpartum blues,
as many as 29 people (72.5%).

Distribution of Respondents Based on Birth

History Against the possibility of the

No Variabel
F Persen
1 Patus
Sectio Caesarea 28 70 %
Normal 11 30 %
Total 40 100 %

Based on Table above, it was found that there

was a result between delivery of Caesarean
section with the possibility of postpartum
blues, that out of 40 respondents who gave
birth to Caesarean section, 28 respondents
(70%), 11 respondents (30%) gave birth
vaginally or normally.

Distribution of Respondents by Age, Level of

Education, Employment, Parity, Pregnancy
Planning, PMS History and Social Support to
Events Possible occurrence of postpartum
blues
 115

No Variabel Frekuensi Total P Value

SC Normal
1 Age
<20 3 1 4
20-35 22 11 33 0,470
>35 28 0 3
2 Education
High 21 7 28 0,498
Low 7 5 12
3 Occupation
Working 11 6 17 0,780
Not Working 17 6 23
4 Paritas
Primipara 23 8 31 0,509
Multipara 5 4 9
5 PlanningofPregnancy
Planning 13 4 17 0,675
Not Planning 15 8 23
6 PMS History
Yes 14 4 18 0,533
No 14 8 22
7 Sosial Support
Yes 8 6 14 0,347
No 20 6 26

Based on table above it can be explained
that variables that do not have an influence
on the likelihood of postpartum blues are
variables of maternal age, education level,
maternal occupation, parity, pregnancy plan,
PMS history, social support.
The results of the analysis between maternal
age 20-35 with the type of delivery of mothers
Sectio Cararea there were 22 mothers with p
value 0.470. The results of the analysis
between the level of maternal research with
the type of delivery of Sectio Cararea mothers
were 21 mothers with tertiary education with a
p value of 0.498. The results of the analysis
between the work of mothers with the type of
delivery of mothers Sectio Cararea there were
17 mothers who did not work with p value
0.780. The results of the analysis between
maternal parity and type of delivery of Sectio
Cararea
mothers were 23 primiparous mothers with a
p value of 0.509. The results of the analysis
between the planning of pregnancy with the
type of delivery of mothers Sectio Cararea
there were 13 mothers with unplanned
pregnancies with p value 0.675. The results
of analysis between maternal PMS history
and type of delivery of Sectio Cararea
mothers were 14 mothers who had a history
of PMS with a p value of 0.533. The results
of the analysis between social support and
the type of delivery of Sectio Cararea
mothers were 20 mothers who did not get
social support with a p value of 0.347.
The results of the statistical test showed that
the p-value of 5 0.005 can be concluded that
there is no influence between age, education
level, parity work, pregnancy plan, history of

PMS and social support with the possibility
of postpartum blues.
Distribution of Maternity Births to
Occurrence Possible occurrence of
postpartum blues in RSUD Raja Ahmad
Thabib Tanjungpinang.
No Variabel
SC
1 Occurrence Possible 23
occurrence of
postpartum blues
2 Occurrence 5 6
Immpossible
occurrence of
postpartum blues
Based on table above, the results of the
analysis of the relationship between Cesarean
Caesarean delivery and the likelihood of
postpartum blues were obtained, that out of 28
respondents who gave birth to Sectio
Caesarea, 23 respondents experienced the
possibility of postpartum blues with P Value
0.089. The results of statistical tests showed
that the p-value of 5 0.005 can be concluded
that there is no influence between age,
education level, parity work, pregnancy plan,
history of PMS and social support with the
possibility of postpartum blues.
Conclusion And Recommendation
a. Effect of Childbirth History on Possible
Postpartum Blues
The results of this study explain that the
likelihood of postpartum blues occurring in
respondents who experienced Caesarean
section delivery as many as 23 respondents
82%. The results of statistical analysis
showed that there was no effect between
Caesarean section delivery on the possibility
of postpartum blues (p value = 0.089).
116
Frekuensi Total P Value
Normal
6 29
0.089
11
Childbirth is a complicated and stressful event
for a mother. Supporters of stress theory
explain that every stressful event, such as
labor, can stimulate reactions to blues (Bobak,
2000). Postpartum blues is a mild affective
disorder syndrome that often occurs in the first
week, ie days 1-10 after delivery. most often
occurs on the third or fourth day of postpartum
and peaks between the fifth
and fourteenth days postpartum
(Lowdermilk, Perry & Bobak, 2000;
Pillitteri, 2013).
Labor seen from a physiological perspective
will dramatically change hormonal circulation
(progesterone and estrogen). This hormonal
change will biologically affect a woman's
emotional condition. Decreased estrogen
levels and progesterone during the period of
release of the placenta can cause dysforia
(Ismail, 2012). Whereas seen from a symbolic
perspective, with the birth process and the
birth of a baby will cause important changes in
the mother, namely the perception of the
mother as an individual, the perception of a
change in role, status and responsibility both
to the spouse and to their children. Role
conflict can be the initial onset of

psychological disorders in postpartum
mothers.
The results of this study explain that there is
no effect between the history of childbirth on
the possibility of the occurrence of postpartum
blues (p-value 0.089). The results of this study
are in accordance with the study conducted by
O'Hara, which explained that there was no
association between labor history and the
incidence of postpartum blues. Cury, et al
(2008) also mentioned that abnormalities or
complications experienced by mothers during
the intranatal period were not associated with
the occurrence of postpartum blues /
postpartum depression (p-value = 0.37).
Childbirth will stimulate increased support
from partners and other social group
members so that it can compensate for
additional stress from labor complications.
This is an analysis for researchers, that
mothers who experience labor with
Caesarean section do not get more optimal
support, both support from their husbands,
family, friends and health workers. So that
the results of this study indicate that there is
no effect between delivery of Caesarean
section with complications on the possibility
of postpartum blues.
This is different from what Henshaw said,
2013 that complicating labor is associated
with the occurrence of postpartum blues or
mood disorders in the early postpartum
period. Mothers who have Sectio Caesarea
will experience prolonged pain and anxiety.
The more anxious the mother increases the
pain (adds pain perception and pain nature).
Anxiety, fear, loneliness, stress or excessive
anger can cause an increase in the number of
stress-related hormones, such as β-
endorphins, adrenocorticotropics, cortisol
and epinephrine. These hormones work on
the uterine smooth muscle. Increased levels
of these hormones reduce uterine
117
contractility, which further prolongs labor
(Lowdermilk, Perry & Bobak, 2000).
Fear, anxiety and anxiety can be caused
because the mother is unable to get an
explanation about the delivery process that
will be faced especially in primiparous
mothers. Childbirth in an unplanned
pregnancy is reported to cause more severe
labor pain. Mothers who are accompanied
by their husbands during childbirth can
affect the intensity of the pain score. Other
emotional factors such as strong motivation
and cultural influences can influence the
modulation of sensory transmission and
affect the affective and behavioral
dimensions of dealing with pain. Cognitive
interventions such as explaining to the
mother about labor and how to manage labor
pain can reduce doubt, divert and keep
attention temporarily reducing pain.
Old labor will make the mother have a less
satisfying labor experience, so the mother
shows a negative self-image and can continue
to anger which can complicate the process of
mother's adaptation to her new roles and
functions. The labor process that takes place
under stress will make it more difficult for the
mother to control herself so that it makes the
mother more irritable and can reduce the
mother's effective coping abilities (Murray &
McKinney, 2001; Pillitteri, 2003).
This can be explained that intervention in
childbirth, such as delivery of Caesarean
section can cause long-term effects on the
mother, which can reduce maternal
confidence in carrying out its role, disrupt
the attachment process (bonding) which is
natural and can increase the incidence of
postpartum depression (Henderson & Jones,
2010).
The job of a maternity nurse is to provide care
and support during important times in the
labor process. The responsibility of the
maternity nurse is to monitor the condition of

the mother and fetus and recognize the
presence of abnormalities that allow proper
treatment and action from the doctor. The aim
of nursing care is to help the birth of a healthy
baby and satisfy the mother. Support and
encouragement to the mother helps reduce
maternal pain and anxiety. Support can be a
continuous presence during the active period
Reference
Aprillia, Yessi. (2014). Depresi Post Partum
dan Operasi Sectio Caesarea. Bidan
Kita. Daylicare.
Arikunto, (2006). Prosedur Penelitian
Pendekatan Praktek . Jakarta. Rineka Cipta.
Anonim, .(2008). Depresi setelah
melahirkan, bagaimana cara
mencegah dan mengatasinya.
Atmajaya Medical Education on
Reproductive and Addictive.
Retrieved from
http://www.tanyadokteranda.com/arti
kel/2008/07/depresi-setelah-
melahirkan-bagaimana-cara-
mencegah-dan-mengatasinya.
Beck., Cheryl., Tatano. (2006). Postpartum
Depression, it isn’t just the blues.
AJN, vol 106, No.5, 40-50.
Bobak I.M., Lowdermilk, D.L., & Jensen,
M.D., Perry, S.E. (2005). Buku Ajar
Keperawatan Maternitas. Edisi 4.
Alih bahasa: Maria & Peter. Jakarta:
EGC
Bobak. I.M., Lowdermilk. D.L., & Jensen,
M.D. (2000) Maternity Nursing. 4th
ed. St.Louis: Mosby
Carter., Frances., & Frampton., Chris.,M.A.
(2006). Cesarean Section and
Postpartum Depression; A Review of
the Evidence Examining the link.
Psychosomatic Medicine, vol 68,
321-330
Cunningham. (2012) Osbtetri William. Edisi
21. Jakarta: EGC
118
of labor, giving touches and compliments
that make it comfortable and provide
reinforcement. The results showed that the
support provided by nurses could reduce the
need to use medication to relieve pain and
operative birth and the APGAR value of the
fetus was more than 7 in 5 minutes
(Henderson & Jones, 2006)
Creswell JW. (2013). Research Design:
Pendekatan Kualitatif,
Kuantitatif dan Mixed. Pustaka
Belajar: Yogyakarta.
Curry ., Alexandre., Faisal., Menezes.,
Paulo., Rossi & Tedecco., Jose.,
Julio. (2008). Maternity “Blues” :
Prevalence and Risk Factors. The
Spanish Journal of Psychology, vol
11, No.2, 593-599. Diunduh dari
http://www.ucm.es/info/psi/docs/jour
nal/VII_n2_2008/art593/pdf
Elvira., Sylvia D. (2006). Depresi pasca
Persalinan. Jakarta : Balai Penerbit
Fakultas Kedokteran Universitas
Indonesia
Freudenthal., Crost., M., & Kaminski., M.
(1999). Severe post-delivery blues:
associated factors. Arch Womens
Ment Health, No2, 37-44
Henderson & Jones. (2006). Buku Ajar
Konsep Kebidanan (Essential
Midwifery). Alih bahasa Ria
Anjarwati. Jakarta: EGC
Henshaw., C. (2010). Mood disturbance in
the early puerperium: a review.
Archives of Women’s Mental Health,
vol 6, No.2, 33-42
Leigh.,Bronwyn., & Milgrom., Jeannette.
(2008). Risk factors for antenatal
depression, postnatal depression and
parenting stress. BMC Psychiatry
Lynn.,Christine.,E., & Pierre., Cathy., M.
(2007). The Taboo of Motherhood:
Postpartum Depression. International
 119

Journal for Human Caring, vol 11, Saryono. (2010). Kumpulan Instrumen
No.2, 22-31 Penelitian Kesehatan. Jakarta: Mulia
Lowdermilk, D.L. Perry , SE & Medika
Cashion,K.(2013). Keperawatan Sastroasmoro. S (2008). Dasar-dasar
Maternitas. Edisi 8. Jakarta: EGC Metodologi Penelitian Klinis. Edisi 3.
May., K.A & Mahlmeister. (2000). Jakarta: Sagung Seto
Comprehensive Maternity Nursing : Wong DL, Hockenberry-Eaton M, Wilson
Nursing Process and Child-bearing D, Winkelstein ML, Schwartz P.
Family 2nd edition. J.B. Lippincott : (2009). Buku Ajar Keperawatan
Philadelphia Pediatrik. Edisi 6. Volume 1. Hal 2-
Mayberry, L.J., & Affonso, D.D (1993). 14. Jakarta: EGC.
Infant temperament and ppd: a
review. Health care for women
international, 14(19), 201-211
Machmudah.(2010). Pengaruh persalinan
komplikasi terhadap terjadinya post
partum blues di kota Semarang.
Tesis. Universitas Indonesia.
NANDA International. (2015). Diagnosis
Keperawatan. 2015-2017. Edisi ke
10. Jakarta:EGC
Notoatmodjo. (2012). Metodologi Penelitian
Kesehatan. Edisi Revisi. Jakarta:
Rineka Cipta
Nursalam. (2011). Konsep dan Penerapan
Metodologi Penelitian Ilmu
Keperawatan. Salemba Medika:
Jakarta.
Pilliteri. (2010). Maternal and child Health
Nursing. Care of Childbearing and
Childrearing Family. 6td edition.
Lippincott
Prawirohardjo. (2010). Ilmu Kebidanan.
Jakarta: Bina Pustaka
Putra.Lutfti (2018) . Bernyanyilah saat
depresi pasca melahirkan melanda.
Kompas.Com
Riyanto A. (2011). Aplikasi Metodelogi
Penelitian Kesehatan. Nuha Medika:
Bandung
Reeder, Martin & Koniak-Griffin. (2011).
Keperawatan Maternitas : Kesehatan
wanita, Bayi, dan Keluarga. Jakarta:
EGC