Pelayanan Kebidanan Komplementer

1. Safe Practice
Complementery in
Midwifery
Bd. Peny Ariani, SST, M.Keb

2. Midwifery  Complementary Care

4. Current Issues
Bagaimana pelayanan Kebidanan
Komplementer dalam Kehamilan
di beberapa Negara?
Berbasis Evidence based Practice
untuk menentukan apakah
Pelayanan Kebidanan
Komplementer dinilai aman?
Apakah Bidan memiliki Aspek
Legal dalam Penerapan
Pelayanan Kebidanan
Komplementer?
Dasar Pelayanan Kebidanan
Komplementer, Permenkes RI No.
37 2017 Terkait Intergrasi
Pelayanan Kesehatan Tradisional
ke dalam Pelayanan Kesehatan
dari berbagai Profesi 
Kebidanan

5. Complementery as Innovation
• Innovation and flexibility on the part of the
professional development..
• Trends towards institutional accreditation  institution
must have something specifically different.
• The implications of these changes for individual
professionals are considerable.
• Midwife as professional must fully understand the
changing nature of personal and professional
accountability.
• Midwives have to have an informed and principled
understanding of their role and responsibility

6. Complementary medicine
• Complementary medicine” or “alternative
medicine” refer to a broad set of health care
practices maybe become part of country’s
own tradition or conventional medicine and
are not fully integrated into the dominant
health-care system.
• They are used interchangeably with traditional
medicine.

7. Herbal medicines
• Herbal medicines include herbs,
• herbal materials,
• herbal preparations and
• finished herbal products,
that contain as active ingredients parts of plants,
or other plant materials, or combinations.

8. Complementary therapies
• Alexander technique
• Aromatherapy
• Bach and other flower extracts
• Body work therapies, including massage
• Conseling stress therapy
• Hypnotherapy
• Meditation
• Reflexology
• Shiatsu
• Healing
• Maharishi Ayurvedia medicine
• Nutritional medicine
• Yoga
• Qi-Gong, ect

9. Midwife & Complementary
Therapy
• Midwives and their clients are becoming
increasingly interested in the use of
complementary and alternative therapies.
• Midwife has to understand a variety of different
strategies for dealing with the effects of
pregnancy and childbirth.
• Complementary therapy education for midwives
need to be considered.
• Maybe establishment of a new clinical specialism
of complementary therapies in midwifery also
have to be considered.

10. Experinces of Complementer
Therapy
• Kepuasan Klien
• Promosi Konsep Normal dalam
Asuhan Kebidanan
• Mengurangi Intervensi Medis
• So more women want to know
and have an experience in
complementery therapy.

11. Warning to Safe Complementery
therapy
• Pain management in labour
• Nausea
• Backache
• Turning a breech baby
• Labor induction
• Anemia
• Massage in pregnancy
• Massage in Postpartum and Infant

12. Be a ware of contraindication
• Fetal Growth restriction (FGR)
• Cardiac or pulmonary disease
• Cervical insufficiency
• Vaginal bleeding (APH)
• Hypertention in pregnancy
• Risk for preterm labour
• High Risk in pregnancy

13. Complementary and Alternative Therapies in
Midwifery Practice
• Some midwives who formally incorporate
complementary therapies within their practice follow
the policy of the institution where they work.
• Midwives’ Association recognises that:
– Various forms of healing, such as therapeutic touch,
massage, relaxation, meditation, visualisation, and
environmental manipulation (e.g. the use of colour, music,
quiet, aroma, etc) are, and always have been, a part of
midwifery practice.
– Orthodox and complementary sometimes may enhance
the health and well being of individuals.
• This is should continue to be, recognised and valued.

14. INDONESIAN MIDWIVES ACT
LOW NO 4 2019 ON
MIDWIFERY

15. • Pasal 41
(1) Praktik Kebidanan dilakukan di: a. Tempat Praktik
Mandiri Bidan; dan b. Fasilitas Pelayanan Kesehatan
lainnya.
(2) Praktik Kebidanan sebagaimana dimaksud pada ayat
(1) harus dilakukan sesuai dengan kompetensi dan
kewenangan serta mematuhi kode etik, standar
profesi, standar pelayanan profesi, dan standar
prosedur operasional.
• Pasal 42
(1) Pengaturan, penetapan dan pembinaan Praktik
Kebidanan dilaksanakan oleh Konsil.
(2) Konsil sebagaimana dimaksud pada ayat (1)
merupakan bagian dari Konsil Tenaga Kesehatan
Indonesia yang diatur dengan Peraturan Presiden

16. The Midwives’ Association
adopts the policy that:
• The practice of complementary and
alternative therapies must be supported by
written policies and protocols endorsed by the
employing facility.
• The informed consent of the individual
receiving the complementary therapy is
essential.
• Any practice of complementary and
alternative therapies should be incorporated
into the total care of the individual.

17. REGULATION OF THE MINISTER OF
HEALTH OF THE REPUBLIC OF
INDONESIA NO. 37 2017 CONCERNING
INTEGRATED TRADITIONAL HEALTH
SERVICES

18. Pasal 1 ayat 2
• Pelayanan Kesehatan Konvensional adalah
suatu sistem pelayanan kesehatan yang
dilakukan oleh dokter dan/atau tenaga
kesehatan lainnya berupa mengobati gejala
dan penyakit dengan menggunakan obat,
pembedahan, dan/atau radiasi.

19. • Pasal 4
• (1) Tenaga kesehatan tradisional dan tenaga
kesehatan lain
• yang memberikan Pelayanan Kesehatan
Tradisional Integrasi sebagaimana dimaksud
dalam Pasal 3 ayat (1) wajib memiliki SIP sesuai
dengan ketentuan peraturan perundang-
undangan.
• (2) Pelayanan Kesehatan Tradisional Integrasi
sebagaimana dimaksud pada ayat (1) harus
dilaksanakan berdasarkan standar profesi,
standar pelayanan kesehatan, dan standar
prosedur operasional.

20. Midwives’ Rules to Practice
• Midwives who are practicing have to follow
the rules and guidelines of their employing
institution.
• The midwife practicing only when competent;
providing correct safety, storage and
administration instructions for clients;
• Record keeping; and proper evaluation of the
course of treatment and ongoing care.

21. • Pasal 5
• (1) Penyelenggaraan Pelayanan Kesehatan Tradisional
• Integrasi di Fasilitas Pelayanan Kesehatan sebagaimana
dimaksud dalam Pasal 3 ayat (2) harus:
– menggunakan pelayanan kesehatan tradisional
komplementer yang memenuhi kriteria tertentu;
– terintegrasi paling sedikit dengan satu Pelayanan
Kesehatan Konvensional yang ada di Fasilitas Pelayanan
Kesehatan;
– aman, bermanfaat, bermutu, dan sesuai dengan standar;
dan
– berfungsi sebagai pelengkap Pelayanan Kesehatan
Konvensional;

22. Complementery and Evidence
Based
• Midwives have to be prepared to work from a
basis of ethical, evidence-based practice,
ready and willing to articulate the rationale for
their actions and always looking for new and
more effective ways of delivering good quality
midwifery care.
• Individuals will also have to be fully aware of
the legal mandatory and custom to practice.

23. Complementer and EBP

24. • Kriteria tertentu sebagaimana dimaksud pada
ayat (1) huruf a meliputi:
– terbukti secara ilmiah;
– dilaksanakan sesuai dengan kebutuhan terbaik
– pasien; dan
– memiliki potensi promotif, preventif, kuratif,
rehabilitatif, dan meningkatkan kualitas hidup
pasien secara fisik, mental, dan sosial.

25. Lingkup Pelayanan Kebidanan Komplementer
dalam Siklus Asuhan Kebidanan
Kehamilan
Persalinan
Nifas
BBL, Bayi
dan Balita
Masa
Antara dan
Menopause

26. Kehamilan
Trimester
I
• Mual-Muntah
• Psikologi
Trimester
II
• Pembesaran
Rahim
• Perubahan
Metabolisme
Trimester
III
• Nyeri
Punggung
• His Palsu
• Nutrisi

27. Persalinan
Kala
I
• Nyeri
• Cemas
• Jalan
Lahir
Kala
II • Proses
Mengejan
• Rileksasi
Kala
III
• Rileksasi
• Plasenta
Kala
IV
• Stress
• Perdarah
an
• Robekan

28. Nifas
Menyusui/IMD
• Nyeri
Punggung
• ASI tidak
Lancar
Proses
Mobilisasi
• Berkemih
Spontan
• Defekasi
Proses
Recovery
• Luka Jahitan
• Otot Perineum

29. BBL, Bayi dan Balita
BBL
• IMD
• Kolik
• Growth Spurt Bayi
• Simulasi
Tumbang
Balita
• Simulasi
Tumbang

30. Masa Antara dan Menopause
KB
• Kecemasan
• Infertil
Masa
Antara
• Kesehatan
Reproduksi
Menopause
• Nyeri
Punggung
• Kecemasan
• Kesehatan
Reproduksi

32. Interprofessional Collaboration
• Principle of interprofessional equality and
compatibility: in standards and processes,
regulatory systems should recognise the
equality and interdependence of professions
offering essential services.
• Midwives have to develop and work
collaboratively on the public behalf,

33. Be prepared and eligible
• The use of a range of therapeutic approaches,
both orthodox and complementary, may enhance
the health and well being of individuals.
• Individuals have the right, wherever possible, to
the health care of their choice.
• Midwives must maintain a current knowledge
base and are responsible for ongoing education in
their chosen areas of practice, including those
who practise complementary and alternative
therapies  Certificate is needed

34. Be a Legal Practicioner
• In order to practice complementer legally
midwives have to set themselves as they are not
protected by medical doctor or other disciplines.
• There are few countries healthcare activities are
allowed without state authorisation such as
acupuncturists, herbalists, osteopaths.
• The increasing demand for alternative health care
across the developed world has, therefore,
sometimes been met by practitioners outside the
law and without recognisable training
qualifications, professional standards, or
insurance.

35. Registration/licence to practice
• Criteria for registration/licence to practise
• Criteria for maintaining registration/licence to
practise
• Criteria for losing registration/licence to
practice
• Code of conduct/ethics as a baseline for
practice
• Scope of practice defined
• Practice standards

36. Summary
• Practitioners of complementary and
alternative practice has to be certificate
before practicing it.
• Because of the wide variation in
complemenery therapies, complementery in
midwifery practice should initially set up its
own regulatory body (Professional
Organization), although it may be possible to
practice in collaboration with others health
profession.

37. Summary
• It is important to practitioners, policy makers,
governing bodies and researchers, providing
insight into the motivations for using
Complementary and Alternative Medicine in
midwifery.

38. A Midwife
A midwife must posses
•The hand of a Lady
•The eyes of Queen
•The heart of Angel

39. We may not have it all
together, but
together we have it all