EFEKTIVITAS SENAM HAMIL TERHADAP PROSES PERSALINAN

SENAM HAMIL Definisi:

 Exercise is defined as any movement that is planned and done with
the purpose of maintaining or improving physical fitness. Exercise
is positively correlated with overall fitness and can range from
light, moderate, to vigorous. Examples of exercise include walking,
running, yoga, cycling, and resistance training. Many of the vast
physiological and psychological benefits of exercise and physical
activity are reported. According to ACOG (2015), an exercise
program that leads to an eventual goal of moderateintensity
exercise for at least 20–30 min per day on most or all days of the
week should be developed with the patient and adjusted as
medically indicated. Aerobic exercise was found to significantly
reduce anxiety and depression following pregnancy and chronic
fatigue syndrome. (Yang & Chen, 2018)
 Despite consistent reports that only approximately 40% of pregnant
women exercise, 95% of pregnant women believe that exercise is
helpful. According to these authors, women’s beliefs about the
benefits of prenatal exercise were correlated with whether they, in
fact, chose to exercise, although the numbers do not seem to match.
Approximately 92% of the women in the study were encouraged by
their physicians to exercise, although more than 69% of the women
were advised by their physicians to limit their exercise. Not
surprisingly, a relationship was noted between body mass index
and whether or not the women exercised. And prenatal exercise
was thought to improve mood. The women who exercised more
during pregnancy, had also exercised more during pre-pregnancy,
and the husband/partner was the most influential about pregnancy
exercise. (Field, 2012)
Tujuan Senam Hamil:
 Tujuan utama senam hamil adalah untuk mempromosikan praktik
yang sehat, meminimalkan berlebihan kecemasan dan mencegah
atau meminimalkan ketidaknyamanan dari kehamilan dan
persalinan. (Miquelutti, Cecatti, & Makuch, 2013)
 Praktek latihan fisik selama kehamilan dengan tujuan menjaga
kesehatan wanita selama kehamilan dianjurkan oleh American
College dari Obstetricians and Gynecologists (ACOG), dan
dimasukkan dalam program antenatal. Apalagi latihan harian
dapat mencegah diabetes gestasional dan kenaikan berat badan
gestasional yang berlebihan. Kemudian ada bukti bahwa latihan
fisik selama kehamilan tidak meningkat risiko cedera otot atau
perubahan tekanan darah arteri dan tidak meningkatkan risiko
persalinan prematur atau berat janin rendah. (Yoo, Wong-gyu,
2017)
Manfaat Senam Hamil:
 Aktifitas senam mengurangi resiko penyakit jantung dan
memperbaiki fungsi paru-paru. Pada ibu hamil dianjurkan senam
untuk menjaga kesehatan, dan juga untuk perbaikan kapasitas
fungsional dalam banyak penyakit kronis, seperti hipertensi,
diabetes, dan sindrom metabolik. (Jürgensen, Bastos, & Correia,
2017)
 In the treatment of stress urinary incontinence, pelvicfloor muscles
(PFM) strength training is considered the gold standard therapeutic
approach, since urinary incontinence (UI) may be caused by PFM
weakness and decreased awareness. It is now known that women of
almost all age groups lack awareness of the pelvic floor muscles,
which results in weakness of these muscles, regardless of age.
(Jürgensen et al., 2017)
 Just as maternal physiology is affected by exercise, so is fetal
physiology. The fetal heart rate has been shown to increase as a
 result of maternal exercise, both during and soon after the exercise
occurs. A research study evaluated exercise treadmill tests in
pregnant women of varying fitness levels, with exercise intensities
that were appropriate to the prepregnancy activity levels of the
participants, based on HHS guidelines. Assessments of fetal well-
being were made before and after the treadmill exercise sessions.
The results indicated that maternal treadmill exercise was well-
tolerated by the fetuses in this study. These results confirm that
light-to-moderate-intensity exercise during pregnancy is well-
tolerated by the fetus. (Gregg, Ii, & Ii, 2017)
 Exercise is a simple and inexpensive intervention that can play a
significant role in maximizing health and wellness during the
postpartum period. It is reported that exercise can improve
postpartum women’s physical and psychological health, including
reduced bodyweight, increased lactation, less severe levels of
depression, and enhanced mothering abilities and capacity to
implement regular physical activity regimens for herself and her
child. (Yang & Chen, 2018)
 Water aerobics has been effective with pregnant women in terms of
reducing physical discomfort, increasing mobility, improving body
image and increasing health-promoting behaviors. (Field, 2012)
Efektivitas Senam Hamil:
 It is believed that there may be a relationship between functional
capacity and UI, considering that performing exercise programs
improves muscle strength, especially of stabilizers and postural
muscles, greatly employed during whole body exercise. Moreover,
the PFM, responsible for the voluntary urinary continence
mechanism, are also considered stabilizers and postural muscles,
and can be reflexively activated during physical exercise. The PFM
are extremely important for the continence mechanism and, in
addition, act as a powerful pelvis stabilizer. Sapsford and Hodges
 showed that voluntary abdominal muscles contraction during
exercise, especially of the transversus abdominis, results in
increased PFM activity in healthy subjects with no history of lower
back pain. (Jürgensen et al., 2017)
 Some authors observed that functional decline and the reduction of
physical capacity can be associated to the development of UI and
that muscular strength reduction is influenced by age [15). In
addition, it is known that muscle weakness can increase the risk of
falls and that a relationship exists between UI and the risk of falls,
due to the urgency to get to the bathroom in time. However, in a
study by Tak et al. Institutionalized elderly women participated in a
program including weekly sessions over a period of 22 weeks of
physical exercises to improve PFM function and simple exercises
to improve upper limb mobility, hand function, standing up and
sitting down. Results showed no significant reduction in the
number of UI cases. (Jürgensen et al., 2017)
 Exercise also offers improved fitness and weight loss, and
opportunities for social interaction at a time when women
experience
decreased exercise and weight retention. (Pritchett, Daley, & Jolly,
2017)
KEHAMILAN  Kehamilan dan persalinan melibatkan fisiologis, emosional
dan perubahan sosial, dan penting selama periode ini
menerapkan perubahan gaya hidup yang akan bermanfaat baik bagi
ibu dan kesehatan janin. Dalam konteks perawatan kesehatan untuk
wanita hamil, program persiapan kelahiran terstruktur
menggunakan pendekatan multidisiplin memainkan peran penting;
Program semacam itu direkomendasikan untuk wanita hamil dan
pasangannya. (Jose, Cecatti, Yolanda, & Ii, n.d, 2015)
 Topik yang berkaitan dengan kehamilan, persalinan,
puerperium, perawatan bayi baru lahir, fisik dan
 Perubahan emosional dialami saat hamil, ketakutan dan
fantasi tentang persalinan dan nifas, dan
Ketidakamanan berhubungan dengan menjadi orang tua seharusnya
dibahas selama kehamilan dalam upaya untuk meminimalkan
kecemasan. Intervensi ini juga harus mencakup satu set dari
kegiatan yang memungkinkan wanita berkesempatan untuk
mengalami persalinan dan persalinan sebagai proses fisiologis dan
perasaan bahwa mereka mengendalikan situasi efektivitas mereka,
atau keteraturan yang dibutuhkan untuk memastikannya efektivitas.
(Jose, Cecatti, Yolanda, & Ii, n.d, 2015)
 Pregnant women are recommended to be physically active 30
minutes a day [17] and observational studies suggest that physical
exercise before and during pregnancy is associated with a lower
risk of low back pain [18,19], but pregnant women tend to reduce
their level or change type of physical exercise during pregnancy
and some discontinue physical exercises. This underlines the
importance of the choice of activity type when planning exercise
interventions for pregnant women. Activities such as swimming
and exercises in water increase among pregnant women and are
considered comfortable and safe to do. In 2011 The Danish
Rheumatism Association developed an exercise program, called
AquaMama, for healthy pregnant women to use in public
swimming pools nationwide. It aims to strengthen the larger muscle
groups (legs, abdominal, back, hips, buttocks, arms and shoulders).
No attempts have previously been made to investigate the effect of
this exercise program. A feasibility study with 30 pregnant
participants tested the AquaMama program and showed positive
results in regard to recruitment, compliance with the program and
the pregnant women Âs experience of an unsupervised water
exercise program. (Backhausen et al., 2017)
  In addition to the pedometer data suggesting fewer steps per day
across pregnancy, the decrease in activity has been measured in
other ways and confirms those data. In a review on both
retrospective and prospective data, leisure and workrelated physical
activity decreased across pregnancy (Poudevigne & O’Connor,
2006). Both the intensity and duration of activity decreased during
pregnancy compared to pre-pregnancy and in the third trimester
compared to the first trimester. This review also suggested that up
to 60% of women were inactive during pregnancy. Paradoxically,
some of the barriers to physical activity during pregnancy were
depression, anxiety and fatigue, despite significant data on non-
pregnant samples showing that these problems can be reduced by
regular exercise. (Field, 2012)
PROSES Nyeri Persalinan:
PERSALINAN
 Labour pain was measured with the McGill Pain Questionnaire in
87 primiparas and 54 multiparas. The average intensity of labour
pain ranked among the most intense pains recorded with the
questionnaire. However, the pain scores had a wide range and were
influenced by several medical and social variables. They were
significantly higher for the primiparas than for the multiparas.
Moreover, high pain levels were associated with a history of
menstrual difficulties and lower socioeconomic status. The
primiparas who had received prepared childbirth training had lower
pain scores than those who had received no such training.
Nevertheless, the effects of prepared childbirth training were
relatively small, and most patients (81 %) who received it requested
epidural anesthesia. Because many women who received training
suffered severe pain during labour, prepared childbirth training and
epidural anesthesia should be regarded as compatible,
complementary procedures. (Kinch, 1981)
 Lumbopelvic pain, defined as pain in the low back (lumbar region)
 and/or pelvic girdle (symphysis pubis, sacroiliac joint and gluteal
region) is the most common musculoskeletal complaint in
pregnancy. More than half of pregnant women experience low back
pain), and 10–65% pelvic girdle pain. Moreover, the pain is
frequently rated as moderate to severe. The prevalenceof
lumbopelvic pain in the postpartum period is only about half that
during pregnancy. (Shiri & Coggon, 2017)
 To date, little is known about the primary prevention of low back
and pelvic girdle pain in pregnancy. Light to moderate exercise
during pregnancy is safe for the mother and foetus and has
beneficial effects. It prevents excessive maternal and foetal weight
gain, prevents and controls gestational diabetes and improves
cardiorespiratory fitness. Exercise may also be effective in the
secondary prevention of low back pain in pregnancy, reducing its
intensity, and associated disability and sick leave. A recent
systematic review and meta-analysis combined trials on the
primary prevention of low back or pelvic girdle pain with those on
its secondary prevention. It is unclear, however, whether benefits
extend to primary prevention, and to pelvic girdle as well as low
back pain. The aim of the current systematic review and meta-
analysis of randomized controlled trials was to determine the effect
of exercise on primary prevention of low back and pelvic girdle
pain in pregnancy. (Shiri & Coggon, 2017)
Prevalensi Nyeri Persalinan:
 LBP is more prevalent in pregnant women (25%) than in the
general population (6.3%). Persistent LBP postpartum (16%) is
usually studied as a single entity. However, only one subgroup of
LBP, pelvic girdle pain (PGP), is associated with pregnancy.
Several studies have suggested an association between muscular
dysfunction and pregnancy-related LBP, however, muscle
dysfunction has not been evaluated as potential predictor of
 persistent LBP postpartum. Possible subgroup differences in the
course and predictors of persistent LBP are unknown. (Birgitta,
Gutke, & O, 2008)
 Women are at greater risk for persistent low back pain (LBP) than
men.1 The point prevalence of LBP is increased in pregnant
women (25%) compared with nonpregnant women of the same age
(6.3%).2,3 Sixteen percent of women with pregnancy-related LBP
report persistent pain 6 years later.4 Thus pregnancy represents a
specific risk for persistent LBP. (Birgitta et al., 2008)

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