Effectiveness of MCH handbook development with the addition of fps variables as an early detection for pregnancy and childbirth complications

Background: The development of an early detection guidebook for risk factors in pregnant women's complications packaged in MCH books was considered effective for health workers and mothers as guidelines for the prevention of complications. However, the use of Effectiveness of MCH handbook development with the addition of fps variables as an early detection for pregnancy and childbirth results showed the development of MCh handbooks with the addition of FPS variabels effectively used as one of the efforts in early detection of pregnancy and childbirth with percentage results: physiological (56.2%) psychological (62.5%) and sociological (68.7%). Based on the results, the response of pregnant women to trials in the development of MCH handbooks obtained an average percentage (87%), the addition of FPS variabels to MCH handbooks was effectively used as an effort to early detection of pregnancy and childbirth complications. The fulfillment of these three aspects can increase the achievement of the MCH program in the early screening of complications. Conclusions: This study concludes that the addition of NEW FPS variabels in MCH handbooks is feasible and effectively used as one of the media to conduct early detection of the occurrence of pregnancy and childbirth.

MCH Handbooks has been used in more than 30 countries, including Indonesia, Utah, Kenya, assessment of physical disorders without judging from psychological and sociological. Objectives: The purpose of this study was to produce an MCH handbook model with addition NEW FPS (Physiological, Psychological and Sociological) factors to maximize the understanding of pregnant women and the enforcement of high potential risk diagnoses carefully and accurately.

Methods: This was Research and Development (R&D) study using Borg and Gall models.
The data in the study was obtained using interviews, NEW FPS questionnaires, pregnant women's response trial questionnaires. The population in this study consisted of 16 people and taken a sample of 16  In addition, MCH handbook still focuses on the physical health condition of the mother, it should be noted that not only physical changes, pregnant women also experience adjustments to psychological changes. This happens because there is a change in the role and also the mother's coping mechanism in overcoming physical changes (10). The psychological condition of the mother can affect the health of fetus starting from conception. About 10% of pregnant women and 30% of postpartum mothers experience mental disorders, especially depression and anxiety disorder. Health workers should pay more attention to the psychological condition of the mother. In fact, many of them are only focused on giving this-and-that advice to a disease, but forget that many disorders of the disease are not related to pathological conditions but associated by emotional instability in the mother (11). Sociological conditions also need to be considered, humans as social creatures, tend to seek support from others. Sociological conditions can affect the physiological and psychological conditions of the mother. The inattention of these two things can lead the mother to depression that indirectly affects the mother's health (13).
The results of the study were obtained from pregnant women with stress, caused by various problems from sociological aspects that they experienced socio-economic problems, family problems, limited access to health facilities which experienced not only by pregnant women, but also postpartum mothers in the era of pandemics (14).
The existence of regulations that require the use of MCH books and the incidence above The development of measuring instruments based on FPS factors was developed by refining the content components of MCH handbooks on pages 8, 9, 12, 17, and 19 to get valid and reliable data recording and measurement tools. So that, the data obtained will be in good quality and it can be used as a basis to establish a diagnosis about the potential high risk of maternal pregnancy. From the examination, it was found:

Addition of Physiological Variables
Based on Table 1, found all respondents (100%) made a complete ANC visit, some respondents (43.8%) had a risk of pregnancy and found no risk of complications in most respondents (62.5%).
After that, the midwife filled out a questionnaire about effectiveness of physiological variables addition and obtained the results of the assessment.
Based on the decisions of researchers, results are said to be effective if the percentage value is more or equal to 50% and said to be ineffective if the value is less than 50%. Based on Table 2, which is the result of SPSS calculations, it was known that the effective percentage value was 56.3%. So in conclusion, the addition of physiological variables can be said to be effective.

Addition of Psychological Variables
In the addition of psychological variables added assessment of several conditions that were expected to be the "start" of the emergence of psychological disorders in the mother including a history of previous obstetrics, a history of complications in childbirth, the existence of referrals. From the examination, it was found: According to Table 3, all respondents

Addition of Sociological Variable
In addition to sociological variables added an assessment of several circumstances that can pose risk conditions in pregnancy, namely     Coaching health workers is one of the efforts to foster motivation for health workers to be able to do programs more optimal (15).  Rochjati Score Card (KSPR). Filling KSPR is usually done at ANC examination by a midwife or obstetrician, filling KSPR completely will be very helpful to describe the condition of pregnant women, whether the pregnancy has a high risk of danger signs, has pregnancy complications, or is in good condition. According to KSPR, mothers get score of 2 with a green code for low-risk pregnancy, get score of 6 to 10 with a yellow code for high-risk pregnancy, and score of 12 with a red code for very-high-risk pregnancy (19).  The phase of pregnancy with stressful conditions will have an impact on the psyche of pregnant women and is at high risk for the mother and fetus. In pregnant women in the 3rd trimester more experienced positive psychic changes of 54.3%. In early pregnancy, the mother will usually pay attention to the changes experienced by both physical changes and psychological changes.

Variables
While in the 3rd trimester the mother will begin to accept the physical changes experienced and begin to prepare to welcome labor (22). During pregnancy, the physical and psychological changes experienced by the mother will cause discomfort such as more frequent urinate intensity, dyspnea, back pain, constipation and increased anxiety (23).
In Table 4

CONCLUSION AND RECOMMENDATION
In the trial of pregnant women's responses to the use of FPS variables in the MCH handbook that had been processed, it is known that the addition of FPS variables is "effectively" used as early detection for pregnancy and childbirth complications.