Development of a Childbirth Psychophysiology Educational Model

on Husbands' Activeness in Supporting Childbirth

ABSTRACT
Background: Childbirth is a physical and psychological experience for the mother. This can cause the mother to be anxious during
labor. Husband's support in the birthing process can reduce maternal anxiety and have a positive impact on childbirth. This research
has never been conducted in Indonesia and South Sumatra in particular. This study aims to determine the effect of the
psychophysiological education model of childbirth on husbands' activeness in supporting childbirth in the independent practice of
midwives in the Ujanmas Baru village area. Method: The research design is quasi-experimental in the form of a pre-post test design.
Respondents in this study were 40 pregnant women in the control group and 40 pregnant women in the intervention group. The
research was conducted in April-July 2023. The independent variable was the psychophysiological health education model for
husbands. The dependent variables are the husband's knowledge and actions, the mother's anxiety, the duration of labor, and the
baby's fitness. The research was conducted during two interventions with 60 minutes for husbands. Data analysis used chi-square and
Mann-Whitney tests. Results: The results showed that the husband's knowledge and actions increased significantly (p-value 0.000).
Maternal anxiety was lower than in the control group, and the duration of the first and second stages of labor was considerably
shorter (p-value 0.000). Still, there was no significant difference in the 1 minute APGAR (0.768) and 5 minute APGAR (0.138).
Husband education using a psychophysiological model can be an alternative to the importance of the husband's presence in childbirth
preparation to improve good birth outcomes.

Keywords: Knowledge,Action, Husband's model Psychophysiology , labor

INTRODUCTION
The process of childbirth readiness has a vital role in directing birth planning toward a normal birth and anticipating
actions that need to be taken if complications occur. 1 The most common birth complication, according to the Indonesian Health
Demographic Survey, is cases of prolonged labor (41%).2 Factors influencing the birthing process are the birth canal, fetus,
strength, position, and psychology of the mother.3,4
One aspect of childbirth readiness is psychological factors involving the husband's support. Unfortunately, not all
health service facilities allow the presence of a husband's birth attendant. 5 When the husband is not present during the birthing
process, this often affects the smoothness of the birthing process. The impact can be fear, which can cause tension in facing the
birthing process, disrupting the process. This disorder can cause labor to take longer and hinder the labor process itself. 6
Currently, husbands' participation in reproductive health is still low. Globally, the role of men in reproductive health has yet to
be visible. Husbands play a critical and significant role both directly and indirectly in the health of mothers and children,
including in making decisions regarding interventions to be given to wives regarding physiological and pathological matters in
the birth process.7 Previous research shows that only 3% of women refuse to be accompanied during the birthing process. In
comparison, 97% of husbands did not accompany them during the birth process for various reasons given by their husbands,
including the husband did not know what to do (didn't know what to do), the husband was busy with work, the husband was
afraid, the husband thought birth was not very important 8,9.
Husbands provide husband's involvement or positive support referring to the husband's participation both physically
and mentally so that it is hoped that it can improve the survival and welfare of the mother and baby. 10–12 A husband's readiness
as a birthing companion is vital in shaping a person's (husband's) behavior. The high level of husband involvement stems from
knowledge and skills regarding the birthing process, giving rise to a positive perception of the birthing process. As a health
worker, you should participate in preparing your husband to be a good birth partner in providing birth assistance so that it meets
the goals expected by health workers. 13–15
Previous research has made efforts to educate husbands to improve birth outcomes, including finding that maternal
anxiety has decreased. Several educational interventions have been given to husbands in Indonesia, namely the education of
husbands in acupressure to reduce labor pain; the teaching of husbands is limited to knowledge in supporting childbirth 16,17.
The condition of maternal anxiety and its impact on birth outcomes has not yet been researched to explain it. A field survey
conducted in November 2021 at the Independent Midwife Practice in the Ujanmas village area found that more than 50% of
births were not accompanied by the husband, even though the husband was not traveling at the time of the delivery. The reason
given by husbands is that they think the person who should accompany the birthing process is more precisely the biological
mother, mother-in-law, or older sister; in other words, husbands believe that the birthing process is a woman's business. Apart
from these reasons, husbands also feel that they do not know what they should do when attending childbirth; some husbands are
even afraid of blood and are fearful of facing the birthing process. Apart from that, information obtained from the maternal and
child health (KIA) coordinating midwife at the Ujanmas community health center revealed that there has never been any special
health promotion in the form of education for husbands of pregnant women facing the birthing process. Based on the problems
above, researchers are interested in researching and developing a psychophysiological educational model of childbirth
regarding husbands' activeness in supporting the birth process.
METHOD
Quantitative research with a quasi-experimental design with a non-randomized control trial pre-posttest design. This
research was conducted in April – July 2023 at the Independent Practice of Midwives in the Ujanmas Baru Village Area, Muara
Enim, South Lampung. The subjects in this study were all married couples and third-trimester pregnant women who met the
inclusion criteria. The sampling technique used consecutive sampling. The inclusion criteria in this study were husbands with
third-trimester pregnant women in average condition at the Independent Midwife Practice in the Ujanmas Baru Village area and
willing to be respondents. Exclusion criteria were couples with unwanted pregnancies, Gemelli, and diagnosed mental health
problems. Dropout criteria were couples who did not complete the research and moved. The total population in this study was
120 pregnant women. Researchers calculated the sample using the two mean difference test formula with α 0.05 and power
90%. The minimum sample for each group was 36 people. The researchers added 20% for dropout reasons for 43 people per
group. There are 4 PMBs in the Ujanmas Baru Village Area, and they are divided into two groups to avoid information bias
between the two groups.
The independent variable of this research is husband training using psychophysiological methods of childbirth. The
study's dependent variables consisted of the husband's knowledge, actions, maternal anxiety, the duration of the first stage of
labor, the duration of the second stage of delivery, and the baby's fitness. The husband's knowledge and actions used
instruments from research by Imansari (2016)18, anxiety measured using the Hamilton Anxiety Rating Scale 19, counting the
duration of the first stage operating hours, measuring the duration of the first stage using minutes, baby's fitness using APGAR
Score.3 Data collection was carried out using primary and secondary data. Secondary data was obtained by looking at the
register of pregnant women and the KIA book. Preliminary data was obtained directly through psychophysiological model
development interventions. The husband's support for childbirth begins with a pretest of the husband's knowledge and actions.
Evaluation (posttest) was conducted to determine the research results regarding ability, husband's activities, anxiety about the
first stage of labor, duration of the second delivery stage, and the baby's fitness.
Data analysis used the SPSS version 24 program. The distribution of the numerical data in this study was not expected,
with a Shapiro-Wilk value < 0.05 20. The test for homogeneity of respondent characteristics used the chi-square test on gravida
and education data and Mann Whitney on age data. Measuring knowledge, husband's actions, anxiety, duration of labor, and
baby's fitness using the Mann Whitney test with alpha 0.05 and CI 95% 20. Researchers applied the Helsinki Code of Ethics,
which was approved by the ethics committee of the Palembang Health Polytechnic with number 0749/KEPK/Adm2/ VII/2023.

RESULT AND DISCUSSION

This research was completed within four months. The original subjects were 43 people in each group. There were 40 people in
the intervention group and 40 people in the control group who completed the study. Subjects who did not meet the study were 3 from
the intervention group and 1 from the control group. A total of 2 people moved from Ujan Mas Baru Village .
Table 1. Characteristics of research subjects
Characteristic Control n=40 Intervention P value
n=40
Age
Mean±SD 27,03±4,84 29,10±7,25 0,217
Median 25,0 29,0
Range 20-35 17-35

Gravida
1 19 (47,5%) 18 (45,0%) 0,841
2 15 (37,5%) 14 (35,0%)
3 6 (15,0%) 8 (20,05)

Education
Elementary 10 (25,0%) 8 (20,0%) 0,652
Intermediate 14 (35,0%) 18 (45,0%)
High 16 (40%) 14 (35,0%)
Based on Table 1, it was found that the characteristics of the two groups did not differ significantly according to age,
parity, and education (p-value> 0.05). In this study, the ages of both groups met the criteria, namely in the range of 20-35
years. Age is the mother's physiological and psychological readiness to give birth. 21 Both groups in this study were in the low-
risk age category. In this study, the second gravida group was most numerous in the first gravida, followed by the second
gravida. First, gravida is assumed to have a higher level of anxiety about childbirth. 22 Both groups have gravida, which is not
significant. This means that the duration of labor in both groups is the same for primigravida and mutigravida. 23 The education
of the control group is highest in higher education compared to the teaching of the intervention group, namely Middle
education. This could affect the control group's ability to obtain better information about health than the intervention group.
Table 2. The influence of education on the psychophysiological model of childbirth education on husbands' knowledge and
activeness in supporting childbirth
Variables Control n=40 Intervention P value
n=40
Knowledge pre
Mean±SD 33,25±15,75 24,50±17,23 0,003
Median 30,0 20,0
Range 10-70 10-80

Knowledge post
Mean±SD 45,50±13,95 76,75±7,97 0,000
Median 50,0 75,0
Range 20-90 70-100

Delta Knowledge
Mean±SD 16,25±14,26 52,25±19,93 0,000
Median 20,0 50,0
Range 0-40 0-80

Behavior pre
Mean±SD 33,75±21,08 30,75±16,07 0,825
Median 30,0 20,0
Range 10-70 20-80

Behavior post
Mean±SD 63,75±25,08 98,25±4,46 0,000
Median 65,0 100,0
Range 0-100 80-100

Delta Behavior
Mean±SD 30,0±33,1 67,50±17,35 0,000
Median 30,0 70,0
Range 0-60 20-80

Based on Table 2, both groups obtained data on husbands' knowledge and behavior in supporting childbirth before and after the
psychophysiological educational model research. Knowledge before the study showed that husbands' knowledge in the control
group was significantly higher than in the intervention group (p-value 0.003). Knowledge became substantially higher after the
psychophysiological educational model research in the intervention group (p-value 0.000). This can be seen from the difference
in knowledge increase in the intervention group being more significant than the control group (p-value 0.000). Based on the
husband's behavior before the research, it showed that there was no significant difference in support for childbirth (p-value
0.825). In contrast, after the study, the psychophysiological educational model showed that the behavior of the intervention
group was significantly higher than that of the control group (p-value 0.000). It can be seen that the increase in the husband's
behavior in the intervention group was higher compared to the control group (p-value 0.000).
In this study, the control group's knowledge was higher than the intervention group before the study. However, at the end of the
study, it showed that the knowledge of the intervention group was higher, with a more significant difference in increase
compared to the control group. The behavioral results in both groups before the study were not significant. After the research
showed that the intervention group was significantly higher, it can be seen from the increase in behavior in the intervention
group, which was higher than in the control group. This shows that the psychophysiological educational model is adequate for
husbands regarding their knowledge and active behavior in supporting childbirth.
Low quality in providing support to pregnant women can increase the level of anxiety in facing the birthing process. The best
support a pregnant woman can hope for is direct support from her partner. Increasing the husband's understanding and skills
through education that supports the birthing process can also improve the husband's knowledge and consent behavior. 24 The
husband's readiness as a birth companion is essential in shaping the individual's behavior. The husband's level of involvement
in the birthing process is influenced by his knowledge about the process, which can create a positive view of the birthing
process. As a health worker, it is essential to play an active role in preparing the husband so that he can be a practical birth
companion and achieve the goals expected by the health worker. 14,15. Husbands' opportunities to provide adequate support to
mothers during childbirth can be increased by delivering appropriate health education. 25
The effect of health education on understanding a husband's support during childbirth will vary among individuals who receive
such instruction. The possibility of husbands providing adequate support to mothers during childbirth can be increased through
 appropriate health education. The success of this support can also increase the mother's self-confidence in facing the birth
process.25
According to the researchers' assumptions, the husband's psychophysiological health education model has received training to
support his wife during the birthing process. They have been provided with understanding and skills involving motivation and
pain reduction techniques during labor. The presence and support of the husband during labor provide emotional comfort to the
mother and ensure that all her needs are met. The comfort women feel when their husbands offer support during the birthing
process is triggered by their desire to involve their husbands in women's health. The goal is to make the wife feel delighted
with the support provided by her husband, and it is hoped that this effort will help the delivery process run smoothly.
Table 3. Effect of educational model of birth psychophysiology on mothers and babies
Variabel Kontrol Intervensi P value
n=40 n=40
Kecemasan
Mean±SD 29,53±5,14 24,83±4,67 0,000
Median 29,0 24,5
Rentang 17-40 15-35

Lama kala I (jam)

Mean±SD 5,81±1,60 4,13±1,94 0,000
Median 6,0 4,0
Rentang 3,0-8,0 1,0-8,0

Lama Kala II (menit)

Mean±SD 41,0±11,44 30,88±16,20 0,000
Median 37,5 30,0
Rentang 20-55 15-60

APGAR 1 menit
7 14 (35,0%) 17 (42,5%) 0,768
8 22 (55,0%) 20 (50,0%)
9 4 (10,0%) 3 (7,5%)

APGAR 5 menit
9 15 (37,5%) 8 (20,0%) 0,138
10 25 (62,5%) 32 (80,0%)
Based on Table 3, it was found that the influence of education on the birth psychophysiology education model on mothers and
babies. Maternal anxiety when entering labor in the control group was higher than in the intervention group (29.53 ± 5.14; 24.83
± 4.67; 0.000). The duration of the first stage of labor for mothers in the control group was longer than the intervention group
(5.81 ± 1.60; 4.13 ± 1.94; 0.000). The duration of the second stage of labor for mothers in the control group was longer than in
the intervention group (41.0 ± 11.44; 30.88 ± 16.20; 0.000). The results of the baby's APGAR score at 1 minute and the first 5
minutes in both groups were not significant (p-value > 0.005)
In this study, maternal anxiety when entering labor in the control group was higher than in the intervention group. The length of
the first and second stages of labor for mothers in the control group was longer than the intervention group. However, the baby's
APGAR score was insignificant at 1 minute and the first 5 minutes in both groups.
The husband's presence is significant in supporting the mother during pregnancy, birth, and postpartum. Husbands can
provide support that includes encouragement, reducing physical stress, and providing the mother emotional security. Therefore,
providing comprehensive education to husbands to meet the mother's needs is essential, especially during pregnancy and the
birth process26,27.
The presence of the husband during labor in this study can reduce the anxiety of the mother giving birth. Husbands have
a great capacity to provide emotional support to mothers who are giving birth. The husband can say soothing words, massage
the mother, or hold her hand tightly. Research 1 explains that this kind of emotional support plays a vital role in helping
birthing mothers feel more peaceful and relaxed, which in turn can reduce their anxiety levels. The husband can also play a role
in helping the mother understand and deal with the birth process, explain the details of the procedures that occur during labor,
and provide practical assistance, such as assisting the mother in changing positions or giving warm compresses. All of these
efforts can increase mothers' self-confidence and prepare them mentally to face childbirth, thereby helping to reduce anxiety 5.
The tension felt by the mother during childbirth can affect the length of the labor process. Research has shown that
mothers who experience high levels of anxiety tend to experience longer labor. Fear can induce physiological changes in the
mother's body, including increased heart rate, blood pressure, and the production of stress hormones. 28 Previous research studies
show that stress can hinder the progress of the birth process. Apart from that, anxiety can also make mothers feel more tense
and difficult to relax. This can reduce the effectiveness of contractions and slow down the labor process. 29 The husband's
partner is essential in creating a comfortable atmosphere during labor. High comfort can help mothers feel more relaxed and
focused on the birthing process, speeding up the process.30
 The husband's presence before giving birth will calm the pregnant mother. Giving birth is a struggle that requires the
husband's support, and the husband can provide significant support long before the time of delivery arrives through childbirth
preparation. By attending childbirth preparation training, husbands can understand the steps to take when their wives undergo
the birth process. This can positively impact birth outcomes, including preventing prolonged labor and improving maternal and
infant well-being and survival.10,11,31.In previous research, husbands who received support training in childbirth could increase
the self-confidence of mothers giving birth so that birth outcomes could improve, such as anxiety and duration of labor. 32
In this study, providing health education on a psychophysiological model can increase the husband's support, anxiety,
and duration of labor. However, it is not significant for the baby's APGAR score. This is because the anxiety in both groups is
still moderate, and the duration of labor is within normal limits. Fetal welfare problems arise if the mother already has a
pathological condition before delivery. 33 Therefore, the APGAR score is not significant in this study.

Based on the premise of this research, the psychophysiology education provided in this research aims to encourage
husbands to be actively involved in supporting mothers during the birth process, including emotional and physical support. The
support provided by the husband can play a role in reducing the stress and anxiety levels of mothers who are giving birth. More
than that, the husband's support can increase the mother's self-confidence in facing childbirth, which can help the mother feel
more relaxed and focused on the birth process, thereby accelerating the process. The support provided by the husband can also
create high levels of comfort during labor, which contributes to the mother's relaxation and focuses attention on the labor
process, which ultimately can speed up the process.

The strength of this research is that we involved primi and multigravida parity types so that this research can be
generalized to the conditions of all parties. We assess that there is no significant relationship between equality and maternal
anxiety, so the husband's support is considered essential for mothers of all parities. This psychophysiological model can be
applied to various parities. The limitation of this research is that the researchers did not directly analyze the correlation between
the husband's support, anxiety, and duration of labor. It is hoped that future research can see the impact of the husband's support
model over a more extended time..

CONCLUSION
The results of this study saw that husbands' knowledge and actions increased after the psychophysiological model of
health education. Maternal birth outcomes also had a lower level of anxiety and a shorter duration of labor, although this did
not affect the baby's APGAR Score. Husband education using a psychophysiological model can be an alternative to the
importance of the husband's presence in childbirth preparation to improve good birth outcomes.

Acknowledgments (optional)
The author would like to thank the research team, the research subjects from whom the researchers took the data, and the
Palembang Health Polytechnic for funding this research activity.

Conflicts of Interest (optional)

Researchers declare there is no conflict of interest.

REFERENCES
1. Antoniou E, Stamoulou P, Tzanoulinou MD, Orovou E. Perinatal mental health; the role and the effect of the partner: A
systematic review. Healthc. 2021;9.
2. Kemenkes RI. Survey Demografi Kesehatan Indonesia. Jakarta; 2017.
3. King TL, Brucker MC, Osborne K, Jevitt C. Varney’s Midwifery. Burilington: World Headquarters Jones & Bartlett
Learning; 2019.
4. Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, et al. The effect of the first vaginal birth on
pelvic floor anatomy and dysfunction. Int Urogynecol J. 2019;30:1689–96.
5. Wilson CL, Simpson JA. Childbirth pain , attachment orientations , and romantic partner support during labor and
delivery. 2016;
6. Mok YK, Cheung KW, Wang W, Li RHW, Shek NWM, Yu Ng EH. The effects of not having continuous companion
support during labour on pregnancy and neonatal outcomes during the COVID-19 pandemic. Midwifery [Internet].
2022;108:103293. Available from: https://doi.org/10.1016/j.midw.2022.103293
7. Murdayah, Lilis DN, Lovita E. Faktor-Faktor Yang Berhubungan Dengan Kecemasan Pada Ibu Bersalin. Jambura J Heal
Sci Res. 2020;3:115–25.
8. Ahmed RE, Janet P, Shumona SS. What Do Women Want? An Analysis Of Preferences Of Women, Invovement Of
Men,And Decision – Making In Maternal And Newborn Health Care In Rural Bangladesh. BMC Pregnancy Childbirth.
2020;
9. Wonwosen T. Barierrs to husband’s involvement in maternal healthcare in sidama zone, southern ethiopia: a qualitative
study. BMC Pregnancy Childbirth. 2021;
10. Boltena MT, Sahlemichael A, El-Kitab Z. Male Patner’s Participation In Birth Preparedness And Complication
Readiness In Low And Middle Income Countries: A Systematic Review And Meta-Analisys. BMC Pregnancy
Childbirth. 2021;
11. Farida I, Kurniawati D, Perdani P. Hubungan Dukungan Suami Dengan Kesiapan Persalian Pada Ibu Hamil Di Usia
Remaja Di Sukowono Jember. J Pustaka Kesehat. 2019;7.
12. Mareta BB, Loriana M, Martina DF. Education on the Benefits of Husband’s Support for Mothers During Childbirth. J
Kreat Pengabdi Kpd Masy. 2021;4.
13. Dheska PA, Ratih JK. Optimalisasi Peran Suami Sebagai Persiapan Pendamping Persalinan Melalui Prenatal Couple
Yoga Di Wilayah Yogyakarta Tahun 2018. Avicenna J Heal Reaserch. 2019;2.
14. Zakaria M, Ziaur KR. Women Perception Of Male Involvement In Antenatal, Childbirth And Postnatal Care In Urban
Slum Area Bangladesh,Community Base Cross Sectional Study. Health Care (Don Mills). 2021;
15. Kassanesh TM. The Asociation Between Male Involvement In Instituional Delivery And Women’s Use Of Instituional
Delivery In Debre Tabor Town North Weast Ethiophia : Community Base Survey. Plos One J. 2021;
16. Bakoil MB, Manalor LL, Diaz MF, Tuhana VE. Education On The Benefits Of Husband’s Support To The Mother
During Childbirth. J Kreat Pengabdi Kpd Masy. 2021;4:787–94.
17. Karningsih, Yulfitria F, Fratidhina Y. Empowerment of Pregnant Women and Husbands Regarding the Use of Sp6
Acupressure in the East Jakarta Pmb Work Area. In: Prosiding Seminar Nasional Poltekkes Jakarta III 2022 [Internet].
2022. p. 349–57. Available from: https://www.poltekkesjakarta3.ac.id/ejurnalnew/index.php/ProsidingSEMNAS2022/
article/view/1175
18. Imansari F. Tingkat Knowledge, Sikap dan Tindakan Suami Dari Ibu Pramigravida dan Dari ibu Multigravida tentang
Pendampingan Suami dalam Proses Persalinan di Rumah Bersalin Mattiro Baji Tahun 2016. 2016;
19. Akbar YF. Perbandingan Derajat Kecemasan Kehamilan Aterm Primigravida Pada Remaja Dan Dewasa Muda Dengan
Menggunakan Hamilton Anxiety Rating Scale. Universitas Hasanuddin; 2020.
20. Sugiono. Statistika Untuk Penelitian. Bandung: Alfabeta; 2017.
21. Ulfah RF, Karimah A, Prasetyo B. Faktor Resiko Yang Berhubungan Dengan Tingkat Kecemasan Ibu Hamil Usia
Remaja Di Puskesmas Rongga. J Ris Kesehat [Internet]. 2022;14:393–401. Available from:
https://doi.org/10.34011/juriskesbdg.v14i2.1998
22. Hastanti H, Budiono B, Febriyana N. Primigravida Memiliki Kecemasan Yang Lebih Saat Kehamilan. Indones
Midwifery Heal Sci J. 2021;3:167–78.
23. Hidayah A, Sumini GT, Santutri Bedha Y. Perbedaan tingkat kecemasan ibu hamil primigravida dan multigravida
trimester III dalam menghadapi persalinan di RSU Al Islam H.M Mawardi Sidoarjo Tahun 2020. Hosp Majapahit.
2021;13:112–21.
24. Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, et al. Causes and outcomes in studies of fear of
childbirth: A systematic review. Women and Birth [Internet]. 2019;32:99–111. Available from:
https://doi.org/10.1016/j.wombi.2018.07.004
25. Wardhana A. Pengaruh Pendidikan Kesehatan Terhadap Knowledge Tentang Dukungan Suami Selama Proses Persalinan
Di Bendan Banyudono Boyolali. Univ muhammadiyah Sura. 2016;53:1689–99.
26. Mosunmola RN, Sokoya, Adekunbi RN. Women’s perception of husbands’ support during pregnancy, labour and
delivery. IOSR J Nurs Heal Sci. 2014;3:45–50.
27. Yeni HH, Siska I. Hubungan Dukungan Suami Dengan Nyeri Persalinan Di UPT Puskesmas Selatbaru Kecamatan
Bantan Tahun 2019. Ensiklopedia J. 2022;4:2003–5.
28. Stjernholm YV, Charvalho P da S, Bergdahl O, Vladic T, Petersson M. Continuous Support Promotes Obstetric Labor
Progress and Vaginal Delivery in Primiparous Women – A Randomized Controlled Study. Front Psychol. 2021;12:1–7.
29. Dimitraki M, Tsikouras P, Manav B, Gioka T, Koutlaki N, Zervoudis S, et al. Evaluation of the effect of natural and
emotional stress of labor on lactation and breast-feeding. Arch Gynecol Obstet. 2016;293:317–28.
30. Vischer LC, Heun X, Steetskamp J, Hasenburg A, Skala C. Birth experience from the perspective of the fathers. Arch
Gynecol Obstet [Internet]. 2020;302:1297–303. Available from: https://doi.org/10.1007/s00404-020-05714-z
31. Nasihah M, Hidayah NN. Pengaruh Peran Serta Suami Terhadap Tingkat Kecemasan Ibu Hamil Dalam Menghadapi
Proses Persalinan Di Desa Tejoasri Kecamatan Laren Kabupaten Lamongan 2015. Proc Natl Acad Sci [Internet].
2015;3:1–15. Available from: http://dx.doi.org/10.1016/j.bpj.2015.06.056%0Ahttps://academic.oup.com/
bioinformatics/article-abstract/34/13/2201/4852827%0Ainternal-pdf://semisupervised-3254828305/semisupervised.ppt
%0Ahttp://dx.doi.org/10.1016/j.str.2013.02.005%0Ahttp://dx.doi.org/10.10
32. Mareta BB, Loriana M, Martina DF. Edukasi Manfaat Dukungan Suami Kepada Ibu Selama Persalinan. J Kreat
Pengabdi Kpd Masy. 2021;4.
33. Baruddin, Suryawan B, Permatasari I. Faktor Faktor Penyebab Asfiksia Neonatorum Di Rumah Sakit Daerah Mayjend
H.M Ryacudu Kotabumi Lampung Utara Tahun 2015. J Kesehat. 2015;1:0–9.