The Correlation Between Participation In Pregnancy Workouts And Perineum Ruptures Incidence In Woman With Normal Labor At The Sumengko Village Maternity Cottage, Lamongan District

Received: March, 16, 2020 Revised: April, 16, 2021 Available online: May 2021 Pregnancy workouts are exercise programs intended for pregnant women to tighten the body and prepare the necessary muscles to face labor. Labor often results in perineum tears. This study aims to determine the correlation between participation in pregnancy exercise and perineal rupture incidence. The research method used correlation analysis using a retrospective approach. The population in this study were postpartum mothers at the Sumengko village maternity cottage, Kedungpring District, Lamongan Regency. The sample was 24 respondents using the quota sampling technique and then analyzed using Chi-Square. Most respondents who participated in pregnancy workouts did not experience perineal rupture (54.2%). Meanwhile, respondents who did not participate in pregnancy workouts experienced perineal rupture (33.3%). The chi-square test result was p=0.000 (α<0.05). There was a correlation between participation in pregnancy workouts and perineal rupture incidence in women with normal delivery. Thus, pregnant women should participate in pregnancy workouts regularly to prevent perineal tears.


INTRODUCTION
A pregnancy workout is a useful exercise for helping pregnant women get the energy to smooth the labor process. It is recommended for mothers who are pregnant for the first time and mothers who have experienced difficulties in childbirth or have given birth to premature children (Widianti and Proverawati 2010). Labor often results in perineum tears or perineum rupture. When perineal rupture does not manage well, it can cause bleeding and infection, and for a long time, discomfort in sexual intercourse (Saifuddin, 2014)In Indonesia, 75% of women who experience normal delivery have perineal lacerations. In 2017, out of a total of 1951 spontaneous vaginal births, 57% of mothers received perineal sutures (28% due to episiotomy and 29% due to spontaneous tears) (Depkes, 2017).
The direct cause of maternal death was bleeding (28%), preeclampsia/eclampsia (24%), infection (11%), prolonged labor (5%), and abortion (5%). Besides, anemia and chronic energy deficiency (CED) in pregnant women are also the leading causes of maternal mortality, as much as 5% of the causes of maternal mortality in Indonesia (Kementrian Kesehatan, 2014 (Mochtar, 2012) One way to control the perineal rupture incidence is pregnancy workout. It is a useful exercise for helping pregnant women get the energy and smooth the labor process. It is recommended for mothers who are pregnant for the first time and mothers who have experienced difficulties in childbirth or have given birth to premature children (Widianti and Proverawati, 2010). In general, it is recommended for pregnant women so that the mother is ready when labor arrives. With breathing exercise carried out in pregnancy workouts, the mother has no longer trouble following the doctor's or midwife's orders during childbirth.
Many benefits can be obtained, especially for mothers whose pregnancy is more than 32 weeks. As a result, the mother is ready to give birth and expedite the delivery process (Fania, 2010 rupture. Of six women, four women did pregnancy exercise, and two women did not participate in pregnancy exercise. Four women who did not experience perineal rupture regularly did pregnancy exercises. This study analyzes the correlation between participation in pregnancy workouts and perineal rupture incidence at Sumengko Polindes, Kedungpring Sub-District, Lamongan District.

METHOD
Research methods used correlation analysis. The population was postpartum mothers with 24 respondents by quota sampling technique who met the inclusion criteriapostpartum mothers with normal delivery.

DISCUSSION
Most respondents who participated in pregnancy workouts did not experience a perineal rupture.
Pregnancy workouts are carried out from 28 weeks of gestation until birth. showed that most pregnant women who participated in pregnancy workouts did not experience perineal tears, and few of them only experienced the first degree of perineal tears (Anggraini dan Martini, 2015;Turlina, 2015). It is because they often do relaxation exercises that can make the perineum flexible. There are pelvic gymnastics in pregnancy workouts. Regular pregnancy workouts can help the pelvic floor muscles' elasticity and get effective results in the labor process. Mother can train calm in facing the labor process, strengthen and maintain elasticity when straining the pelvic floor muscles and inner thigh muscles to relax actively so that the pelvic floor muscles become elastic during labor (Hullian, 2012).
The results showed that most respondents who experienced perineal rupture did not participate in pregnancy workouts. It is in line with Turlina (2015) study regarding the correlation between pregnancy workout and perineal rupture incidence. The study reported that women with normal labor who did not participate in pregnancy exercise experienced perineal tears (62.5%), and 37.5% did not have perineal tears. Oxom & Forte (2010) states that perineal rupture generally occurs in primiparous, but not infrequently also in multiparous. The usual causes of perineal rupture at parity are precipitous labor, forceful straining, edema, and fragility of the perineum, flexibility of the birth canal, and labor with cesarean section. The causes of fetal factors are fetal birth weight, breech presentation, abnormal head position, forceps extraction, shoulder dystocia, and congenital anomalies.
There was a correlation between participating in pregnancy workouts and the perineal rupture incidence in a woman with normal delivery. In line with Riswati (2015) the results showed a significant correlation between pregnancy workout and perineal tears in primigravida at the Tegalrejo Public Health Center, can also affect the incidence of perineal rupture. Helping factors consist of the way to communicate with the mother. During childbirth, the examination to prevent perineal rupture is a pelvic examination with the suitability of the baby to be born (Oxom & Forte, 2010). Pushing too hard will cause perineal rupture because the baby will be born uncontrollably and too quickly. Health workers should establish cooperation with mothers, guide mothers to rest or breathe quickly and use the correct manual tactics to regulate the baby's birth and prevent lacerations (JPNK-KR, 2008). A straining mother before complete cervical opening can cause edema and cervical laceration (Kementerian Kesehatan Republik Indonesia, 2013).

CONCLUSION
Participation in pregnancy workouts correlates with perineal rupture incidence. Most respondents who participated in pregnancy workouts did not experience perineal rupture at the Sumengko Polindes, Kedungpring Sub-District, Lamongan District. Thus, pregnant women should participate in pregnancy exercise regularly to prevent perineal rupture