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JURNAL
SOSAINS
JURNAL SOSIAL DAN SAINS
VOLUME 3 NOMOR 12 2023
P-ISSN 2774-7018, E-ISSN 2774-700X
THE RELATIONSHIP BETWEEN BIRTH DISTANCE AND
PERINEAL RUPTURE INCIDENT
Eka Marta Puspita Rini, Euvanggelia Dwilda Ferdinandus, Sofia Al
Farizi, Andriyanti
Airlangga University, Indonesia
Email: eka.marta.puspita-20[email protected], [email protected]nair.ac.id,
[email protected]nair.ac.id, [email protected].ac.id
Keywords:
Parity, birth
weight, fetal, birth
spacing, perineal
rupture
ABSTRACT
Background: Perineal rupture was a quite serious problem. Factors that influence the
incidence of perineal rupture were parity, birth spacing, fetal position, birth weight. Birth
spacing of less than 2 years was considered high risk because it can cause complications
during childbirth
Purpose: This research aimed to know the relationship between birth spacing and the
incidence of perineal rupture
Method: The design of this research was a quantitative analytic retrospective. The
population in this study was 268 medical records of mothers giving birth at Private
Midwife Practice Place Sudjiati Frans Surabaya and the sample size was 160. The
sampling technique used purposive sampling. The instrument used in this research was
medical records at Midwife Practice Place Sudjiati Frans Surabaya for the period
January – December 2022. Data were analyzed using Pearson correlation test.
Results: : Based on the results of pearson correlation with α = 0.05, the value of p =
0.001 (p < α) was obtained, which shows that there was a significant relationship
between birth spacing and the incidence of perineal rupture in mothers giving birth.
Conclusion: Birth interval had a significant relationship with the incidence of perineal
rupture at Private Midwife Practice Place Sudjiati Frans Surabaya.
INTRODUCTION
Childbirth is a natural process experienced by women by expelling the products of
conception either normally or artificially (Nurathohiroh & Kurniawati, 2023) Childbirth
often results in injury to the birth canal, injuries are usually minor but sometimes extensive
and dangerous injuries occur. After delivery, the vulva and perineum must always be
examined (Juliati, Riskina, & Riska, 2020). Perineal rupture is not uncommon as a
complication in childbirth, especially in vaginal delivery (Lenden, Wardana, & Karmaya,
2020).Perineal rupture is a tear that occurs in the perineal area when a baby is born, either
The Relationship Between Birth Distance and Perineal
Rupture Incident
2023
Eka Marta Puspita Rini, Euvanggelia Dwilda Ferdinandus, Sofia Al Farizi,
Andriyanti 30
spontaneously or using tools or procedures. Perineal tears generally occur in the midline
and can become extensive if the fetal head is born too early.
WHO data states that 2.7 million cases of perineal rupture occurred in mothers giving
birth. This figure is estimated to reach 6.3 million in 2050. In America, 26 million mothers
in labor experience 40% perineal rupture. 50% of perineal rupture incidents in the world
occur in Asia. The prevalence of pregnant women experiencing perineal rupture in
Indonesia with the incidence of suture wound infection being 5% and bleeding being 7%
and postpartum maternal mortality being 8%. Research conducted by Triyani et al., (2021)
showed that the incidence of perineal rupture at Serui Regional Hospital from October to
December 2019 reached 41.9%. In East Java, perineal rupture experienced by women
giving birth results in 7% bleeding, and stitch wound infections account for 5% (WHO,
2020).
Based on a preliminary study at Private Midwife Practice Place Sudjiati Frans
Surabaya in July 2023, data was obtained that the average number of mothers giving birth
each month in 2022 is 15 - 30 mothers. The number of vaginal births from January to June
2023 was 149 mothers, most of whom were multigravida with birth intervals between 3 -
9 years. A total of 104 mothers who gave birth (69.79%) experienced perineal rupture either
spontaneously or by episiotomy, while the number of mothers who did not experience
perineal rupture was 45 women who gave birth (39.91%).
The results of Maudy's research in 2023, the factors that influence the incidence of
perineal rupture are parity, birth spacing, fetal position, birth weight. Birth spacing of less
than 2 years is considered high risk because it can cause complications during childbirth.
A distance of 2-5 years is a safer distance for the mother and fetus. Likewise, the birth canal
may experience a third or fourth degree perineal tear in the previous birth, so the recovery
process is not complete and perineal tears can occur. In mothers who do not have birth
spacing, meaning that they are primipara, more perineal rupture occurs because it is
influenced by other accompanying factors such as feelings of fear of childbirth and
flexibility of the birth canal which is caused by a lack of preparation for birth during
pregnancy (Agustin, Hafshawaty, Zainul, & Probolinggo, 2023). With the correlation
between perineal rupture, one of the factors being birth interval, the researcher aims to find
a relationship between birth interval and the incidence of perineal rupture.
METHOD
The type of research used in this research is retrospective analytical quantitative to
determine the relationship between one variable and another using past medical records.
The approach used in this research is cross sectional. The sample for this study were
mothers giving birth during January 2022 - December 2022 using purposive sampling
technique. Sample for this research are 160 medical records of mothers giving birth at
TPMB Sudjiati Frans Surabaya. The way to measure variables in this research is to use a
dummy table which consists of the characteristics of the respondent, birth interval and
perineal rupture. The research was conducted from September until November 2023.
RESULT AND DISCUSSION
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Some of the following tables are the results of studies conducted by researchers on
the relationship with the incidence of perineal rupture at Private Midwife Practice Place
Sudjiati Frans Surabaya.
Maternal Characteristics
The characteristics of respondents can be seen in distribution table below:
Table 1. Frequency distribution of characteristic mothers giving birth at TPMB
Sudjiati Frans
Characteristics of responden
n
Age <20 years
20-35 Years
> 35 years
10
134
16
Distance to health facilities
Near
Far
53
107
Education
Low
Intermediate
Tall
2
17
16
Desired pregnancy
Yes
No
11
24
Number of parities
Primipara
Multipara
Grandemultipara
32
83
45
Newborn baby’s weight
<2500 gram
>2500 gram
2
158
Use of Contraception
Yes
No
113
47
Birth Interval
<2 years
2-5 years
>5years
28
52
14
Perineal Rupture Incident
Rupture
No Rupture
105
55
Episiotomy
Yes
No
41
119
Based on table 1, it is known that almost all respondents aged 20 - 35 years, most
respondents have a long distance from home to health facilities, most respondents had a
intermediate education level. The majority of respondents wanted a pregnancy, most of the
respondents were multiparous and almost all respondents had Newborn baby weight > 2500
grams. The majority of respondents used contraception and had a birth interval > 2 years
(multigravida). The majority of respondents experienced perineal rupture, respondents had
perineal rupture at grade 2 and did not have episiotomy.
The Relationship Between Birth Distance and Perineal
Rupture Incident
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Eka Marta Puspita Rini, Euvanggelia Dwilda Ferdinandus, Sofia Al Farizi,
Andriyanti 32
Relationship between Birth Distance and Perineal Rupture
The relationship between birth spacing and the incidence of perineal rupture needs
to be known as a connecting factor or variable related to the research objectives. Based on
the Pearson Correlation test, the results were obtained:
Table 2. Cross tabulation of birth interval with the incidence of perineal rupture
Birth interval
Incidence of perineal rupture
Total
p
Yes
No
N
%
N
%
N
%
<2 years
20
21,2
8
8,5
28
29,7
-0,001
2-5 years
22
23,4
30
32
52
55,4
>5 years
12
12,8
2
2,1
14
14,9
Total
54
57,4
40
42,6
94
100
Based on table above, it can be seen that 20 respondents with a birth interval of <2
years experienced perineal rupture (21.2%) and 22 respondents with a birth interval of 2-5
years experienced perineal rupture (23.4%). Meanwhile, 30 (32%) did not experience
perineal rupture at a birth interval of 2-5 years.
Based on the results of the Pearson correlation statistical test using SPSS with α =
0.05, the value of p = 0.001 (p < α) was obtained, which shows that there is a significant
relationship between birth spacing and the incidence of perineal rupture in mothers giving
birth at TPMB Sudjiati Frans.
In this study there was a negative correlation test between birth interval and the
incidence of perineal rupture. The closer birth spacing will increase the risk of perineal
rupture in mothers giving birth. Meanwhile, a greater distance between births will minimize
the risk of perineal rupture. The ideal birth interval to minimize the risk of perineal rupture
is 2 – 5 years. The closeness of the relationship in this study reached 0.989, so it can be
concluded that there is a very close relationship between birth interval and the incidence of
perineal rupture. This proves that birth spacing is one of the factors that can influence the
incidence of perineal rupture.
Maternal Characteristics
1. Age of Respondents
Based on the research results, data was obtained that almost all respondents were
aged 20 - 35 years, namely 134 respondents (83.7%), very few of the respondents were
< 20 years old, namely 10 respondents (6.3%). This is in line with research conducted
by (Nasrun, Binekada, & Kusnan, 2023) that the majority of mothers giving birth were
aged 20-35 years (68.7%). The characteristics of respondents based on age in this study
stated that the respondents were not included in the category of mothers at high risk.
age 20-35 years, where the mother is of healthy reproductive age, while the age above
35 years is the minimum age of the mother, which means that mothers who are pregnant
and giving birth are in the safe zone, where the age of 20-35 years is the age that is
considered physically and psychologically mature (Hukubun, Budiono, & Kurniawati,
2021) This theory is in accordance with the results of research from Candrayanti (2019)
which states that mothers aged < 20 years and > 35 years are more likely to experience
perineal rupture. The optimal productive age for healthy reproduction is between 20 -
35 years. The risk will increase at ages under 20 years and over 35 years (Sukma & Sari,
2020)
2. Distance to health facilities
The results of this study showed that the majority of respondents had a long
distance from home to a health facility, namely 107 respondents (66.9%) and a small
number of respondents had a short distance from home to a health facility, namely 53
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respondents (33 .1%). In line with research conducted by Irawan and Ainy (2018),
where JKN participants who have homes with long distances still use health services
because there are no other health service options. This is not in line with research
conducted by Zafasia (2022), the research results show that respondents will use health
services that are close to home. This is in accordance with the utility theory of health
services which explains that a person's desire to utilize health services can be influenced
by supporting factors, one of which is distance traveled.
3. Education
Based on the research results, it was found that the majority of respondents had a
secondary education level, namely 83 respondents (51.9%) and very few of the
respondents had a primary education level, 32 respondents (20%). This is in line with
research conducted by Suparti (2019), that the majority of respondents had a secondary
education level. A person's level of education will influence a person's level of
knowledge, where the higher a person's education, the higher their knowledge. So
respondents with secondary education have an influence on knowledge of nutritious
food for pregnant women. Pregnant women with adequate nutritional intake experience
normal weight gain during pregnancy. This increase in weight has an impact on the
weight of the baby being born (Nursaidah, 2017).
4. Desired pregnancy
The results of this study showed that the majority of respondents wanted a
pregnancy, namely 106 respondents (66.3%) and a small percentage of respondents did
not want a pregnancy, namely 54 respondents (33.7%). Desired pregnancy occurs in
couples who really want children and at the right time. Unwanted pregnancies (KTD)
consist of pregnancies that are not on time (mistimed pregnancies) and pregnancies that
are not wanted at all (unwanted pregnancies). An untimely pregnancy occurs when a
woman wants children in the future, but the pregnancy occurs sooner than planned. An
unwanted pregnancy is a pregnancy that occurs in women who already have children
and do not want them anymore (Febriana & Sari, 2021)
5. Number of parities
The results of this study stated that the majority of respondents were multipara,
namely 87 respondents (54.4%) and very few respondents were grandemultipara,
namely 4 respondents (2.5%). In line with research conducted by (Darmawati,
Kesehatan Ummi Khasanah, & Istimewa Yogyakarta, 2023), that of the 115
respondents, the highest percentage was in high parity (multigravida) as many as 81
respondents (70.4%) and in low parity (primigravida) as many as 34 respondents
(29.6%). Research results This is in accordance with previous literature which states
that primiparous mothers have a higher risk of rupture because they have never had
experience in the birth process. In this condition, the perineal tissue is still relatively
stiff so that damage to the perineum and pelvic floor in general becomes more severe
(Elisa Ulfiana, Siti Nur Endah, 2016). With each delivery, the soft tissue of the birth
canal and surrounding structures will be damaged during each delivery. Damage is
usually more pronounced in primiparous women because the tissue in primiparas is
denser and more resistant than in multiparous women.
6. Newborn baby’s weight
Based on the research results, it was found that almost all respondents had
newborn baby weights >2500 grams, namely 158 respondents (98.7%) and very few of
the respondents had newborn baby weights, namely 2 respondents (1.3%). This is in
line with research conducted by Rachmawati (2022) which explains that the majority of
mothers who gave birth experienced grade I lacerations with sufficient birth weight
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Eka Marta Puspita Rini, Euvanggelia Dwilda Ferdinandus, Sofia Al Farizi,
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(between 2500-4000 grams) as many as 40 people (48.8%), while at least 40 mothers 1
person (1.2%).
Fetal factors include birth weight, abnormal head position, difficult forceps
extraction, shoulder dystocia, and congenital abnormalities such as hydrocephalus. This
happens because the baby's large weight makes it difficult to pass through the pelvis
and causes perineal tears in the mother who gives birth. In babies with a large birth
weight, spontaneous perineal rupture can occur when the head and shoulders are born.
When passing through the birth canal, the baby's weight influences the amount of
pressure on the muscles around the perineum so that the perineum bulges and stretches
until the baby's head and all parts of the body are born. The greater the pressure on the
perineum, the greater the risk of perineal rupture (Wulandari, 2016).
7. Using Contraception
Based on the research results, it was found that the majority of respondents used
contraception, namely 113 respondents (70.6%), a small number of respondents did not
use contraception, namely 47 respondents (29.4%). This is in line with the results of
Akbar's (2018) research that respondents who used contraceptives had normal parity of
42 respondents and high parity of 31 respondents.
Most contraceptive methods are effective if used appropriately. Contraceptive
failure can be caused by various factors, namely incorrect use, missed or irregular use,
or because the method chosen is less effective (Widyawati, 2020).
In this study, the majority of respondents used contraception but still experienced
pregnancy. This is because the respondent stopped using (dropped out) an incident that
occurred when he stopped being an acceptor for a couple of childbearing age who had
previously been a family planning acceptor.
8. Birth Interval
The results of this study showed that the majority of respondents had a birth
interval of > 2 years (multigravida) as many as 94 respondents (58.7%) and a small
number of respondents had birth intervals of no distance (primigravida) as many as 66
respondents (41.3%). This research is not in line with Fatimah (2019) that the majority
of respondents had a birth interval < 2 years. From these results it can be seen that a
birth interval of ≤ 2 years is more at risk of perineal rupture than a birth interval of > 2
years. The higher incidence of perineal rupture occurs the closer the mother's birth
distance is, this is because the birth interval is ≤ 2 years, the perineal muscles and scar
tissue from the rupture have not recovered to their original state, thereby increasing the
risk of perineal rupture. Meanwhile, when the birth interval is > 2 years, the perineal
muscles and reproductive organs have returned to their original condition (Lenden et
al., 2020)
9. Perineal Rupture Incident
Based on the research results, data was obtained that the majority of respondents
experienced perineal rupture, namely 105 respondents (65.6%) and a small number of
respondents did not experience perineal rupture, namely 55 respondents (34.4%). This
is in line with research conducted by Riyanti (2023) that the majority of respondents
experienced perineal rupture, 138 respondents. Perineal rupture occurs in almost all first
deliveries and is not uncommon in subsequent deliveries. Perineal tears generally occur
in the midline and become extensive if the fetal head is born too early, the angle of the
pubic arch is smaller than normal, the fetal head passes through the lower pelvic inlet
with a size greater than the suboccipitobregmatic circumference or the child is born by
vaginal surgery.
10. Episiotomy
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Based on the research results, it was found that the majority of respondents did
not have an episiotomy, 119 respondents (74.4%) and a small number of respondents
had an episiotomy, 41 respondents (25.6%). This is in accordance with research
conducted by (Rahmaniah, 2018) which states that postpartum mothers experience more
spontaneous ruptures compared to ruptures due to episiotomy. One way to reduce
irregular and wide tears in the vagina and perineum is to perform an episiotomy. An
episiotomy can make the wound or tear parallel and regular, making the wound easier
to stitch up.
In line with this research is research conducted by (Radnia et al., 2022) which
states that there is no significant relationship between episiotomy and the incidence of
perineal rupture. Apart from that, in this study, measurements of the perineum were
carried out which can provide information on whether an episiotomy will be performed.
Women have anatomically different perineum sizes. Differences in perineal size in
primipara women may be related to episiotomy. This study also stated that episiotomy
significantly reduced the rate of grade 1 and 2 perineal tears.
11. Relationship between Birth Distance and Perineal Rupture
Based on the research results, 20 respondents with a birth interval of <2 years
experienced perineal rupture (21.2%) and 22 respondents with a birth interval of 2-5
years experienced perineal rupture (23.4%). Meanwhile, 30 (32%) did not experience
perineal rupture at a birth interval of 2-5 years.
Based on the results of the Pearson correlation statistical test using SPSS with α
= 0.05, the value of p = 0.001 (p < α) was obtained, which shows that there is a
significant relationship between birth spacing and the incidence of perineal rupture in
mothers giving birth at TPMB Sudjiati Frans.
In this study there was a negative correlation test between birth interval and the
incidence of perineal rupture. The closer birth spacing will increase the risk of perineal
rupture in mothers giving birth. Meanwhile, a greater distance between births will
minimize the risk of perineal rupture. The ideal birth interval to minimize the risk of
perineal rupture is 2 – 5 years. The closeness of the relationship in this study reached
0.989, so it can be concluded that there is a very close relationship between birth interval
and the incidence of perineal rupture. This proves that birth spacing is one of the factors
that can influence the incidence of perineal rupture.
The results of this study are in line with research conducted by (Nurhayati, 2023)
that 43 mothers who gave birth with a high risk birth interval (< 2 years) mostly
experienced perineal rupture, namely 26 people (60.5%), while the opposite was true
for 65 mothers who gave birth. with a low risk birth interval (> 2 years), the majority
did not experience perineal rupture, namely 46 people (70.8%). The results of the
statistical test above obtained p value = 0.002, which is smaller than the alpha value
(0.05). This means that there is a significant relationship between birth distance and the
incidence of perineal rupture in the working area of the Sobang District Health Center,
Lebak Regency in 2022.
Birth interval is the time span between the birth of the current child and the birth
of the previous child. A birth spacing of less than 2 years is classified as high risk
because it can cause complications during delivery. A birth spacing of 2-3 years is a
safer distance for the mother and fetus. The condition of the birth canal may be that
during the previous birth the perineum was torn, so that recovery was not complete and
perineal rupture could occur (Shinta, 2019).
Setting the ideal pregnancy spacing will also have an impact on the mother's
health. The mother's reproductive health will experience optimal recovery if the
pregnancies are not too close together. However, if the distance is too far or too long, it
The Relationship Between Birth Distance and Perineal
Rupture Incident
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Eka Marta Puspita Rini, Euvanggelia Dwilda Ferdinandus, Sofia Al Farizi,
Andriyanti 36
is not good for the mother's health. This can be seen from the research results that
mothers with children >5 years apart are more likely to experience perennial rupture.
This happens because the perenium is stiff and the muscles are not as elastic as in the
second or third pregnancy (Sigalingging & Sikumbang, 2018).
CONCLUSION
Birth interval has a significant relationship with the incidence of perineal rupture at
TPMB Sudjiati Frans Surabaya. Health workers can monitor risk factors for perineal
rupture as a preventive measure. So it can reduce the incidence of perineal rupture in
mothers giving birth and provide education and motivate mothers to regulate birth spacing.
It is hoped that future researchers can carry out research related to the history of previous
births and include other risk factors that have not been studied by current researchers.
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