Continuity Of Midwifery Care Research Articles

O18 - Women with perinatal mental health concerns have improved outcomes with Midwifery Continuity of Care but a change in practice is required to support the midwives

O18 - Women with perinatal mental health concerns have improved outcomes with Midwifery Continuity of Care but a change in practice is required to support the midwives

Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis.

The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran. This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software. Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation. The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Comprehensive Midwife Care For Mrs "T" With Normal Pregnancy In Ujung Loe Public Health Center, Ujung Loe District, Bulukumba Regency

Many factors influence and can be the cause of AKI and IMR, so it is necessary to make more effective efforts than before, namely by conducting continuous midwifery care so that complications starting during pregnancy can be detected as early as possible and given appropriate treatment. This comprehensive midwifery care was given to Mrs. "T" in her third trimester of pregnancy at the Ujung Loe Health Center with the aim of providing comprehensive midwifery care starting during pregnancy, childbirth, newborns, postpartum, neonates, and family planning. The results of comprehensive midwifery care for Mrs "T" carried out independent and collaborative care starting from the period of pregnancy with physiological complaints and progressing normally, in normal delivery with spontaneous delivery, normal newborns, four times respiratory visits, and three times neonates who proceed normally without any complications and the use of 3-month injectable contraception (DMPA). The conclusion of comprehensive midwifery care for Mrs. "T" starting from 36 weeks, three days of gestation, childbirth, newborns, postpartum, neonates, and family planning with 3-month injection KB (DMPA), proceeded normally without complications or complications carried out according to midwifery service standards using a comprehensive and documented SOAP midwifery care management approach. It is hoped that the results of this study can be used as reading material and references for further researchers, adding insight and learning in the implementation of comprehensive midwifery care, implementing comprehensive midwifery care according to standard operating procedure (SOP) in every health service, especially at the Ujung Loe Health Center, Ujung Loe District, Bulukumba Regency and providing awareness to the public. especially the mother regarding her concern for the health condition of her and her fetus so that it can minimize problems or complications that can occur.

PENERAPAN RELAKSASI OTOT PROGRESIF SEBAGAI UPAYA PEMENUHAN ISTIRAHAT DAN TIDUR PADA LANSIA DI PUSKESMAS TANJUNG BALAI KARIMUN

Symptoms of insomnia often occur in the elderly (elderly), even almost half of the elderly reported having difficulty starting sleep in maintaining their sleep, as many as 50-70% of all elderly aged > 65 years. Treatment of insomnia can be done with non-pharmacological and pharmacological therapies. Non-pharmacological therapies, especially behavioral therapies, are effective for chronic insomnia in the elderly, which consist of several methods, namely Progressive Muscle Relaxation, sleep restriction, stimulus control, sleep hygiene and cognitive behavioral therapy. The aim of the study is to provide comprehensive and continuous midwifery care for elderly mothers, with management of midwifery care in accordance with midwifery service standards. Midwifery care that is applied is progressive muscle relaxation to meet the sleep needs of the elderly. The research method used in the preparation of practice reports is descriptive research using the case study method. Recommendations that can be given to the elderly are general behavior, especially suggestions about healthy sleep practices

Asuhan Kebidanan Berkelanjutan/Continuity Of Care

MMR and IMR are indicators to see health status and assess the level of ability to provide health services, which is still a major problem in developing countries. The purpose of writing this article is to provide Continuity Of Care midwifery care for pregnant, maternity, postpartum, BBL, and family planning women using standard midwifery care, so that the writer/reader is able to apply continuous midwifery care. Type of coc research This type of research is qualitative research. In this study, the experimental group will receive treatment, which is given care using the CoC method. In COC data types, we use 3 types of data collection, namely, primary data, secondary data and tertiary data. Objectively and subjectively which includes health records of postpartum mothers, newborns and records of the results of pregnancy and postpartum services data collection techniques. Data collection was carried out through interviews, document review and participatory observation. Data analysis comes from subjective data and objective data taken from providing care to Continuity Of Care participants starting from pregnancy, postpartum, newborn and family planning which will then be analyzed in accordance with Varney Midwifery Management and SOAP Documentation

Intimate partner violence screening during pregnancy: midwives’ perspective

ABSTRACT Violence during pregnancy has serious health consequences. Several scientific societies recommend introducing domestic violence screening in clinical practice, but it is poorly employed. This study aimed to explore midwives’ perspective regarding how, where, and when to conduct intimate partner violence screening during pregnancy to increase its clinical application. We performed a qualitative study using a hermeneutic phenomenological approach. Eleven midwives were recruited, and semi-structured interviews were conducted. The interviews were audio recorded and transcribed verbatim. Content analysis was conducted. Six main themes emerged: “the healthcare providers involved,” “the best place to investigate,” “the best time to ask,” “how to investigate,” “what facilitates investigations and women’s disclosure,” and “what hinders investigations and women’s disclosure.” Most interviewees believed that midwives are the most suitable healthcare providers to investigate violent situations during pregnancy because the continuity of midwifery care can facilitate women’s disclosure. Midwives emphasized the importance of an environment where women’s privacy is respected. Midwives did not consider it appropriate to ask about domestic violence at the first antenatal appointment. Most believed that the best way to investigate domestic violence depends on the context and the woman’s personal history.

Advancing Practice Leadership Collective Equipping Midwifery Leaders

This article explores how midwives in leadership positions can be equipped to contribute to maternity care reform through improving the access that women and birthing families in Australia have to Midwifery Continuity of Care (MCoC). Drawing from findings of a recent Australian qualitative study into the topic, principles for increasing midwifery leadership skills, exploring personal commitment to improving maternity care and establishing relationships with key stakeholders are discussed. Current midwifery leaders as well as the leaders of the future have an important role to play in the expansion of MCoC and strengthening of the midwifery profession.

Midwifery Continuity of Care in Indonesia: Initiation of Mobile Health Development Integrating Midwives' Competency and Service Needs.

Midwives' competence in providing continuity of care using mobile health (mHealth) applications is limited in developing countries. This study identified and explored midwives' competency and service needs to develop mHealth in Midwifery Continuity of Care (MCOC) education and training. It used an explanatory sequential mixed method, and was conducted from August to December 2021. A cross-sectional approach was used to find the characteristics and competency scope of 373 midwives in West Java, and continued with a qualitative design through a Focus Group Discussion (FGD) of 13 midwives. Descriptive data analysis (frequency, mean, deviation standard) and qualitative data analysis (coding, sub-themes, and theme) were conducted. In terms of the midwives who participated in this study, more than half were aged ≤ 35 years (58.98%), with a working period > 10 years (56.30%), had diploma degrees (71.12%), and used smartphones on average 1-12 h/day (78.28%). Most midwives needed to develop competency in the MCOC scope, including its early detection of the risk factor of complications and treatment management. They were concerned about the purposes, benefits, and design of mHealth. In summary, midwives' competency indicators for early detection are more needed in MCOC using mHealth. Further research is required to evaluate midwives' competence in MCOC using mHealth.

Early Detection of Maternal and Infant Health with Sustainable Midwifery Services

Continuity of care is continuous midwifery care starting from the mother during pregnancy until the mother experiences premenopause. At this time a woman needs good health services to avoid reproductive diseases so that she can carry out her role as a woman optimally, so as to prevent maternal and infant morbidity and mortality. This research design uses the SCLR (Study Case Literature Review) method. After the author carried out midwifery care using a comprehensive approach and SOAP documentation on Mrs. F from pregnancy, childbirth, postpartum, and BBL starting from January 4, 2022 - February 5 2022. Then the author will compare whether there is a gap or not, the gap between the care provided already given and existing theory. In pregnancy F has had midwifery care and no discrepancy was found between theory and real cases, Mrs. F received an examination according to the theory of pregnancy. Maternity care for Mrs. F there is no gap between the theory and the real case. Postpartum care for Mrs. F there is no gap between the theory and the real case. Mrs. F received 3 visits, namely: 6 hours, 6 days and 28 days of postpartum visits. Mrs. F is having a good postpartum period.Postpartum care for Mrs. F there is no gap between the theory and the real case. Mrs. F received 3 visits, namely: 6 hours, 6 days and 28 days of postpartum visits. Mrs. F is having a good postpartum period. Newborn care for Mrs. F there is no gap between the theory and the real case. BBL with good general condition, with normal vital signs. Strong in breastfeeding, after 28 days can 1 hour BBL suckle breast milk. Family planning care for Mrs. F there is no gap between the theory and the real case. After counseling Mrs. F chooses a 3-month injection KB with the approval of her husband. Planning to become a family planning acceptor for 3 months for 5 years.

WHY WE HAVE TO REFORM MIDWIFERY EDUCATION?

Background: Learner, methods and contents are three important parts of the learning variables beside lecturer, academic environment and patients. Facts and new findings show that we need to reform these learning variables accordingly especially in Obstetrics and Midwifery domainGaps:maternal deaths is still high despite higher number of obstetricians, doctors and midwives; as well asthe government has encouraged an increase in the number of institutions providing midwifery study programs. On the other hand, new paradigm in education has been ordered by the Ministry of Education such as student-centred learning, Outcome-based education, and also other approaches suggested by expert in medical education such as holistic education, bedside teaching, feedback & reflection, and problem based learning. Thus modify educational content and method in obstetrics and midwivery inline with new facts and findings and appropriate methods is necessary.Recommendation: One alternative to modify educational content and methods in midwifery education that can be implemented in clinical learning is the continuity of care approach accompanied by continuous feedback. This approach is proven to be able to reduce maternal mortality and as an effort to synergize education in an effort to achieve government program targets. However, in reality, midwifery education institutions have not fully adopted this approach. So there is a need for leadership commitment to carry out learning reforms with a sustainable curriculum approach, continuous feedback, continuous assessment, continuous midwifery care and continuous supervision so that learning outcomes as outputs and reducing maternal mortality as an outcome can be as expected.

O87 - Experiences of Early Career Midwives (ECM) who aspire to work in Midwifery Continuity of Care (MCOC)

Early Career Midwives (ECM) can work successfully in Midwifery Continuity of Care (MCoC) models, however rarely have this opportunity. This research explores the facilitators and barriers to ECM’s securing positions, and working successfully, in MCOC models. This presentation is part of a larger body of work which aims to design a professional development pathway that can be used to prepare ECMs to work in MCOC and overcome the identified barriers. It is widely accepted that MCOC is the ‘top’ model of care. This work aims to provide help to midwives join MCOC models early in their career, and be ‘together at the top’. Semi structured interviews were conducted with ten ECMs – five of whom had succeeded in working in MCOC, and 5 of whom were still working in other models of care. These interviews were thematically analysed to look for common themes and ideas. Using Delphi technique, the findings will inform a co-designed survey to collect data from a larger sample of ECMs. Three themes were identified. “Back yourself” incorporating ideas around believing in yourself and intentionally building your career in the direction of MCOC. “Maybe I’ll be ready”, expressing positive and negative feelings at the end of their new graduate year towards working in MCOC - including enculturation, confidence, skills acquisition, and observing the treatment of MCOC midwives. And “Celebrated”, describing the feelings and experience of becoming a MCOC midwife as an ECM. This research is important because of the drive to provide the ‘top’ model of care to more women. Difficulty staffing these models hinders this. The experiences of these midwives highlight possible ways forward in addressing the barriers to using ECMs to staff MCOC.

O80 - Translating midwifery continuity of care models in regional NSW: Women and maternity staff experiences of implementing a new service

Midwifery Continuity of Care (MCC) models significantly improve outcomes for women and their babies. Despite this widespread implementation of MCC has not been achieved, particularly in regional areas. This project evaluated the implementation of MCC across two regional/rural communities. The aim of this research was to understand the impact of the implementation process over the first 12 months of a new MCC service, across two regional NSW sites. A Realist evaluation was used to assess MCC within the structure of existing maternity services, accounting for both women and healthcare staff experiences of this change, exploring; what works, what doesn’t and why. Qualitative data was collected using a Claims, Concerns and Issues Framework to guide focus group interviews, across the two regional sites. Thematic and comparative data analysis was used and informed a Knowledge to Action Cycle to effect model improvements. Common themes across both participant groups identified that a ‘Trusting Relationship’ was highly valued, a need to review ‘Operational Issues’ and scaling up of ‘model to include all risk’. Thirdly, participants provided feedback on ‘Communication’ between stakeholders and identified opportunity for improvements of the model and implications for future implementation of MCC models The findings draw attention to concerns that women and health workforce face when transitioning into MCC models. Participants provided feedback on a number of issues, particularly communication surrounding the implementation of MCC. These findings informed service modifications and will support future translation of MCC in regional areas. Implications Implementation of MCC needs to be evaluated and a robust feedback loop using realist approach can provide valuable information to improve the implementation and design of MCC models; ensuring they meet the needs of rural and regional workforce, women and their communities.

O82 - Mandarin Caseload Midwifery Program-Using Non-English Language Concordance and continuity of midwifery care

This presentation will focus on the experiences of bilingual midwives providing care to Chinese born women. It will also discuss the results of a retrospective cohort study that evaluates birth outcomes of the Mandarin Caseload Midwifery Program (MCMP). Cultural variances become more pronounced during the perinatal period, and language difficulties can be more impactful for women from non-English speaking backgrounds affected by the heterogeneity of health determinants, needs, and vulnerabilities. Discordant language communication, when a woman and care provider don't share proficiency in the same language, creates an added disadvantage. Chinese-born women are the third-largest group of women giving birth in Australia, and more than 20% of them require an interpreter when receiving maternity care. However, migrants are not just recipients of care but are also increasingly represented amongst clinicians providing care. At Westmead Hospital, we used an opportunity to utilise bilingual midwives to provide caseload midwifery services for women who share their ethnic background and first language. MCMP was established within an existing low-risk entry, no exit model of caseload midwifery care. It started in August 2019 with two full-time Mandarin-speaking midwives, each caring for 36 women a year. By September 2021 MCMP looked after 142 Chinese born women and their babies. The Midwives providing the care develop strong relationships with women. They feel more confident delivering education in their first language and understand and support the cultural differences encountered when accessing the Australian healthcare system . Routine audits evaluated the outcomes of care, and the data in this retrospective cohort review demonstrates high levels of vaginal birth (87%), lower reliance on epidural analgesia (30%), and shorter hospital stays. Westmead hospital MCMP demonstrates the benefits of language concordant care for midwives using bilingual skills and maternity care outcomes.

P43 - Providing health equity in midwifery continuity of care: Aboriginal Dads and Bubs

Western Sydney Local Health District (WSLHD) has a large urban Aboriginal population, with numerous health and social inequities, which lead to health disparities including significantly higher rates of avoidable perinatal death, pre-term birth and low birth weight babies (McInerney et al. 2019). Optimising the early life environment is key to reducing these inequities. Sandall, Soltani, Gates, Shennan, & Devane's (2016) systematic review reports that women who received midwife-led continuity models of care were more likely satisfied with their care, engagement in perinatal care increased, and the risk of chronic disease was altered. Additionally, collaborative practice with Aboriginal Health Practitioners improves culturally sensitive health interventions, like smoking reduction. In 2019 the WSLHD quality project ‘review of outcomes for families with the father, or the baby, identified as Aboriginal or Torres Strait Islander’ were comparable to the outcomes of women identified to already receive continuity of care due to Aboriginality. From 2020, WSLHD’s new caseload model of care, Dragonfly Midwifery, is servicing families of women and fathers (or babies) who identify as Aboriginal and/or Torres Strait Islander to meet this comparative need, to impact on interventions that can reduce health inequity. 50% of Aboriginal women versus 7% were recorded as smoking in pregnancy in WSLHD. (eMaternity, 2021). NSW rates had declined previously, but not in WSLHD. Quit smoking in the first half of pregnancy in 2021, following a targeted smoking cessation program and Aboriginal caseload, has shown a 7% reduction in low birth weight babies in WSLHD in the last 3 months. Midwifery caseload and a smoking cessation program can impact smoking rates, hence including all pregnancies with First Nations babies may be optimal practice to impact intergenerational health.

O85 - Do Women with an Existing Perinatal Mental Health Concern Benefit from Caseload Midwifery?

Women with a history or current perinatal mental health (PMH) disorders have an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload practice (MCP) improves outcomes for women, including a 24% reduction in preterm birth rates. The Australian Clinical Practice Guidelines for PMH recommend MCP for women with PMH, though this is rarely implemented. Our aim was to compare obstetric and perinatal outcomes for women with a history of PMH between MCP and standard models of maternity care. Retrospective cohort study using routinely collected data of women with PMH between 1st January 2018 – 31st January 2021. We compared characteristics and outcomes between groups; adjusted for maternal age, gestational age, ethnicity, smoking, socioeconomic status, BMI, pregnancy complications and severity of mental health disorder. 3028 women with PMH, 352 (12%) received MCP. The commonest diagnosis was anxiety and depression (n=723, 23.9%). Women receiving MCP were younger (mean 30.9 vs 31.3, p=0.03), Caucasian (37.8 vs 27.1, p<0.001), from a postcode of advantaged (31.0% vs 20.2, p<0.001); less likely to smoke (5.1 vs 11.9, p<0.001) and lower BMI (mean 24.3 vs 26.5, p<0.001). Women in MCP had lower odds of preterm birth (adjOR 0.46, 95% CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95% CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95% CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95% CI 0.57-1.09). Evidence from this study demonstrates women with PMH who have continuity of midwifery care have improved outcomes compared to women with PMH who receive standard care. This provides further evidence that women are better together through midwifery continuity of care. Future RCTs for this group of women is needed to establish causation.

S4 - What women want for the next birth: a content analysis on the wishes for future pregnancy in a national Australia survey (BESt)

Although women in Australia have access to a variety of models of care and birth locations there is not universal access to all choices due to location, State/Territory and cost. Recent data from AIHW found most women (40%) accessed public hospital maternity care that is fragmented in nature. Midwifery continuity of care has been found to reduce interventions in labour, reduce pre-term birth and increase women’s satisfaction however only 15% of women in Australia had care through midwifery group practice and 2% have private midwifery care. An essential aspect to evaluating the impact of maternity models of care is to consider the experiences and attitudes of women who access maternity care. In 2021 The Birth Experience Study (BESt) surveyed women who had birthed in Australia in the previous 5 years to explore a variety of factors contributing to pregnancy, birth and postnatal experiences, including what women would choose if they were to have another pregnancy. To understand the wants and wishes of women when planning a future pregnancy and birth experience in Australia. A qualitative content analysis was undertaken on 6,101 open text responses to the survey question “Would you do anything different if you were to have another baby”. The open-text quotes were analysed using an inductive content analysis where the categories developed from the dataset by a team of experienced and developing research members There were seven main categories, five that focused on what women wanted for their next birth, one where women didn’t want another pregnancy and one where women didn’t wish to make any changes. The largest category ‘I want to be a better advocate for myself’ described how women internalised their previous experience, feeling the need to better advocate for themselves in future to receive the care or experience they deserved.

Implementation of Continuity Of Care In Cases of Post Sectio Caesaria

Pregnancy, childbirth, newborns, postpartum, neonates and the initial visit of family planning acceptors are physiological but in the process there is a possibility that they can threaten the lives of mothers and babies and even death. The maternal mortality rate in Banjarmasin in 2020 did not get any cases of death, but the infant mortality rate in 2020 reached 9 cases. This research method is a case study. This study was to carry out continuous midwifery care for mothers starting from pregnancy and cesarean delivery for indications of placental calcification on continuty of care. Case studies conducted with obstetrics and obstetric care data obtained from the implementation of midwifery management and midwifery documentation. Midwifery care was carried out from a physiological pregnancy, delivery by cesarean section due to indications of placental calcification by ultrasound examination results, the baby was born in good health, the postpartum period did not occur bleeding, there was no infection, lochea expenditure and the uterine involution process were normal, and the mother decided using the mini-pill as a contraceptive method. Midwifery care is carried out for pregnant, maternity and postpartum women as an effort to detect pathological conditions that may occur.

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

BackgroundAround 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS).MethodsA prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8).ResultsOverall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited.ConclusionsWomen and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities.Trial registrationISRCTN17447733 first registration 13/02/2018.

Penerapan Asuhan Berpusat pada Perempuan dalam Asuhan Kebidanan Berkelanjutan Nyonya S di Puskesmas Sewon 1 Bantul

ABSTRACTMaternal and child health is a problem in Indonesia and even the world. It is proven in the Sustainable Development Goals (SDG's), one of the goals in the health sector is to improve the welfare of mothers and children. In addition, according to the Indonesian Ministry of Health in 2015, the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) each year reached 450 per hundred thousand live births. However, this can still be prevented by providing appropriate and intensive care to the client. One of the intensive care is comprehensive care. Comprehensive midwifery care if done properly can prevent or detect early complications that will occur in the mother. The client is Mrs. S, she has one risk, which is over 35 years old, so it is a risky pregnancy. Midwives in the case of midwifery students provide comprehensive midwifery care. Students are able to apply continuous midwifery care from pregnancy to the puerperium to Ny. S at Sewon 1 Health Center Bantul. The care provided during pregnancy is pregnancy massage because Mrs. S several times complained of fatigue. During childbirth the author provides care by teaching the mother breathing relaxation techniques and motivating the mother. During the postpartum period, the mother was worried because her breast milk had not yet come out, so she was given oxytocin massage and motivation for the mother. During the neonatal period, Mrs. S had experienced jaundice, the care provided was to breastfeed the baby to the mother and recommended breastfeeding at least every 2 hours even though the milk had not come out. Continuing midwifery care has been provided to Mrs. S by taking into account the various risk factors that Mrs. S and the baby. Keywords: Continuity of Care, Pregnancy Massage, Oxytocin Massage

Asuhan Kebidanan Komprehensif Pada Ibu Hamil Keputihan Dan Nyeri Perut Dengan Penerapan Asuhan Kebidanan Komplementer Terintegrasi

Continuity of Care (COC) midwifery care is continuous midwifery care from pregnancy to family planning as an effort to reduce Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). ANC has been carried out according to standards both in quantity and quality and the problem of vaginal discharge and abdominal pain is resolved with Continuity Of Care (COC) and complementary care. The implementation of the care given to Mrs. "F" was in accordance with the predetermined plan, ANC was carried out 9 times at PBM, during pregnancy in TM I the mother complained of nausea, in TM II she complained of vaginal discharge and abdominal pain and was given complementary midwifery care interventions with betel leaf boiled water for 14 weeks. days and vaginal discharge could be resolved on the second visit, while complaints of lower abdominal pain were given complementary therapy with warm water compresses. In labor, the mother gave birth with sectio Caesarea surgery so that the author could not provide the planned complementary care intervention, namely the provision of nabees dates and massage counter pressure. Babies born fit BB 3300 grams and PB 50 cm and IMD was not carried out, complementary therapies were given, namely baby massage and murrotal therapy. Postpartum care runs normally. Complementary care is provided, namely the provision of banana heart nutrition and oxytocin massage, but does not do pain management with the massese because the mother does not feel significant pain. Mother decided on the MAL method even though she had been directed and given MKJP counseling care. After the author conducted midwifery care for Mrs. “F” during pregnancy, there was no discrepancy between theory and case. In the delivery care, the mother gave birth by Sectio Caesarea and there were no complications, complementary care was not given, the neonatal period, the postpartum period were running normally and complementary care was given but counter pressure massage was not given. During the neonate, puerperium, and family planning, all were within normal limits. It is hoped that the owner of the practice land can perform Continuity Of Care (COC) midwifery care and provide complementary midwifery care as a solution to overcome maternal complaints such as vaginal discharge with water boiled betel leaf and lower abdominal pain with warm water compresses.