The Effect Of Consuming Pineapple Juice (Ananas Comusus [L] Mer) TowardsThe Duration Of The Stage I Latent Phase

In Indonesia, prolonged delivery is one of the cause of Maternal Mortality. The prolonged deliverywhich occurs in the latent phase is also called prolonged latent phase, a labor which lasts overeight hours of labor in primigravida. This research was started by the society’s custom of consuming fruits that are beneficial to smooth a labor process, consuming pineapples. Pineapples contain high amountsof vitamin C, sugar, vitamin A, a number of minerals, and an enzyme called bromelain. Bromelain is an enzyme that stimulates the production of prostaglandin. The increased prostaglandin causescontractions in the uterine muscle so that labor occurs. This study aims to determine the effect of pineapple juice towards the duration of the first stage of the latent phase. Themethod of this research was quasi experimental. The 6 Susi Irianti, Siti Sugih Hartiningsih, Achmad Suardi2019. JNKI, Vol. 7, No. 1, Tahun 2019. 6-10 study was conducted in July to September 2018 at Ciruas Public Health Center, Serang, Banten. The sample in this study was 80 mothers in latent phase. Sampling was taken by using consecutive sampling technique. The analysis oftiming differences in umbilical cord detachment was tested by using the Mann Whitney statistical test. The result shows that the average length of time in the first stage of the latent phase in the intervention group was 91,53 minutes, which was 57,75 minutes faster compared to the control group’s length of time, 149,28 minutes. There wasa significant difference in the group given pineapple juice with those who were not given pineapple juice with p value 0,002 (á <0,05). Giving pineapple juice can accelerate the duration of the stage I latent phase in primigravida because pineapples contain an enzyme called bromelain and serotonin. The consumption of pineapple can be a solution fornutrients consumed when labor started at the first stageof latent phase and make the time period of the latent phase shorter and reduce the risk of intervention during labor.

study was conducted in July to September 2018 at Ciruas Public Health Center, Serang, Banten.The sample in this study was 80 mothers in latent phase.Sampling was taken by using consecutive sampling technique.The analysis oftiming differences in umbilical cord detachment was tested by using the Mann Whitney statistical test.The result shows that the average length of time in the first stage of the latent phase in the intervention group was 91,53 minutes, which was 57,75 minutes faster compared to the control group's length of time, 149,28 minutes.There wasa significant difference in the given pineapple juice with those were not given pineapple juice with p value 0,002 (á <0,05).Giving pineapple juice can accelerate the duration of the stage I latent phase in primigravida because pineapples contain an enzyme called bromelain and serotonin.The consumption of pineapple can be a solution fornutrients consumed when labor started at the first stageof latent phase and make the time period of the latent phase shorter and reduce the risk of intervention during labor.

INTRODUCTION
The government has the commitment to improve the development ofmaternal and neonatal health status (1).A prolonged laboris a direct factor to Maternal Mortality Rate in Indonesiaaround 1,8% (2).The most common indicator of a labor progress is the cervix opening and depletion and the uterus that keeps contracting.The sucesful labor can be achieved with a rhytmical uterus contraction from an adequate frequency, intensity, duration, and changes in the connective tissue which results in cervix dilation (3).Uterine contactions are direct consequences to the significant electrical activity which happens in myometrium cells.The force of the uterine contractions needs to be measured to estimate the labor duration quantitavely by uterine fundal palpation (1).Normally, the duration of labor in the first stage latent phase according toFriedman's curve is 8 hours (4,5).However, there is a new alternative which started by a tradition developed in the society to consume a fruite which is believed to make the labor progress smoother:like consuming pineapples (6 ).Pineapples contain an enzyme called bromelain (7).Bromelain can be obtained from pineapple plants from different stems, leaves, fruit and stem skin.The content of the enzyme is more in the flesh of the fruit, this is reflected in its higher activity compared to the avtivity on the stem (8).This enzyme stimulates the escalation of prostaglandin production.This escalation of prostaglandin generates contractions in the uterine muscle so that the labor happens (9).The World Health Organization (WHO) has recommended the use of an alternative therapy derived from medicinal plants, with an aim to open up opportunities for healthcare providers to develop complementary therapies which came from the efficacy of herbs.This study aims to find out the effect of pineapple (Ananas Comusus [L] Mer) towards the duration of the stage I latent phase.

MATERIALS AND METHODS
The design of this research is quasi experiment,posttest only with control group designwith 80 primigravida mothers who were divided into two groups.This research was conductedfromJuly to October 2018 in Ciruas Public Health Center.The sampling technique used nonprobabilitysampling, namelyconsecutive sampling.

The inclusion criteria were:
Mothers who do pregnant exercises during pregnant, Mothers who do not consume pineapple before the stud y, Able to communicate verbally and nonverbally, Servical Opening 1-3 cm, History of obstetric must be aterm, single, head presentation   Based on the normality test to the intervention group and control group showsthesig.value< 0,05 It can be concluded that the data is not normally distributed.The difference test used in this research is Mann Whitney test.

Discussion
Based on the results of the research, the average duration of the first stage latent phase in the intervention group is shorter than that in the control group91,53minutes.This was caused by the enzyme bromelain in pineapples that has the ability to increase prostaglandin and resulting in the increase of uterine contraction (9 ).Consumption before pregnancy can cause abortion or miscarriage, but consumption at the beginning and laborIt contain active principles which can enhance oxytocin induced uterin contractions, assist labor and help remove retained plasenta (10).The laboratory test done by Muzzamanin 2009 that tested the effect of pineapple extract shows a significant result on the experimental animal (a guinea pig).It can be concluded from the researchthat the more amount of pineapple extract given, the more the experimental animal's uterine muscle activity increases.So, there is a significant difference in the duration of the first stage latent phase between the intervention and the control group (11).Puspitasari in 2010 do research in pregnant woman over 36 weeks who consumed pineapple affect uterine contractions during childbirth (12) There has not been a research that experimentally tested the effect of pineapple juice towards the duration of the stage I latent phase yet, so the result of this research is that pineapple juice can be beneficial for midwives as one of the complementary therapies to prevent complications during the first stage latent phase.Besides, pineapples are easy to be found in any part of Indonesia, especially Serang, so it makes it easy for the mothers giving birth to find the fruit.There are also several descriptive researches that mention that pineapples are the fruits that can be used by women in full term pregnancy to stimulate labor contractions.It is because pineapples contain 125 ,0208 mg of enzyme bromelain,11.484,18U oftotal enzyme activity, 91,86 U/mg of bromelain's specific activity that are adequate to stimulate the release of prostaglandin.The increasing hormone prostaglandin in a mother's body causes uterine contractions (11,13).
There is also another research which stated that giving only 0,2 ml of pineapple extract to an experimental animal can kill the embryo when the gestational age is only 2 to 4 days due to the uterine contraction.Therefore, pineapples belong abortifacient herbs.In that research, it was suggested for mothers in the early term of pregnancy not to consume pineapples (14).This is in line with other researches which stated that consuming plentiful amount of pineapples causes preterm labor, because the enzyme bromelain can provoke early contractions (13).

CONCLUSION AND RECOMMENDATION
The conclusion to this research is giving pineapple juice to delivery can shorten the duration of the first stage latent phase.The average duration of latent phase in the intervention group is 91,53 menit.The average duration of latent phase in thecontrol group 149,28 menit.There is a significant effect of giving pineapple juice (Ananas Comusus [L] Mer) towards the duration of the stageI latent phase.
It is necessary to develop a research with more sample in order to be generalized for a greater population, and add another variable in order to see how big the effect is.

Table 4 The difference test of duration of the stage I latent phase between the intervention and
*lavene's test