Vulva Hygiene Analysis Using Betel Leaf Decoction in Puerperal Period with Healing of Perineal Wounds in BPS Ria Mulya P, Sst., M .Kes in Katerungan Village, Krian Sidoarjo

Vulva hygiene in the treatment of birth canal injuries consist of 2 types, there were using antiseptics and not using antiseptics, which is used traditional treatments that use betel leaves. Treatment of birth canal injuries using betel leaves by boiling and using the water for vulva hygiene or cleaning the wound of the birth canal. Based on the survey conducted in March 2018 on 10 post partum mothers who visited the BPS Ria Mulya P, SST., M.Kes. on Katerungan Krian Sidoarjo the researchers observed and filled out observation sheets on 10 respondents that 10 postpartum mothers who used stew betel leaves, 7 postpartum mothers (70%) Healing wounds quickly and 3 postpartum mothers (30%) Healing of his wounds slowly. This condition that the number of postpartum mothers who heal their wounds quickly using betel leaf decoction.                      The method of this study is used longitudional analytic. The population was 30 postpartum mothers who visited clinic. Samples were taken were 30 respondents (postpartum mothers with perineal suture wounds using betel leaf decoction) using the Proposive sample technique. Data collection using observation sheets then the data tabulated and analyzed by chi square test. Based on the results of the calculation of the chi square test, the result of the Pvalue <Î± is 0.007 <0.005. This shows that there is an effect of vulva hygiene using betel leaf decoction during childbirth with perineal wound healing.                    The conclusion of this study is the decoction of betel leaf able to accelerate the process of healing perineal wounds during childbirth. The results of this study are still not perfect, and the ability of research is limited, for the next researcher more numbers of respondents are prepared so that the generalization can be expanded.      Keywords: Vulva Hygiene, betel leaf decoction, Perineum Wound Healing.

In this study the method used is longitudinal analytic. The population was 30 postpartum mothers who visited the clinic. Samples were taken as many as 30 respondents (postpartum mothers with perineal suture wounds using betel leaf decoction) using Proposive sampling technique. Data collection using observation sheets then data tabulated and analyzed by chi square test. Based on the results of the calculation of the chi square test, the result of Pvalue<α is 0.007 <0.005. This shows that there is an effect of vulvar hygiene using decoction of siri leaves during labor with healing of pe rineal wounds.
The conclusion of this study is the decoction of betel leaves can accelerate the healing process of perineal wounds during labor. The results of this study are still not perfect, and the ability of the study is limited, for the next researcher more respondents are prepared so that generalizations can be expanded.

PRELIMINARY
The postpartum period is the period that begins after the placenta exits and ends when the uterine uterus returns to its original state (before pregnancy). The postpartum period lasts for around 6 weeks (Sulistyawati, 2009: p. 1). One infection in a suture wound caused by rupture and episiotomy, treatment of a ruptured wound and untreated episiotomy of the birth canal can be the entrance of germs and cause infection, the mother becomes hot, wet wounds and open sutures, some even produce a foul odor. from the birth canal (vagina). (http://kesehatan.kopasiana.com). Rupture of a wound in the perineum is caused by natural tissue damage due to pressure on the head or shoulder of the fetus during labor. The form of rupture is usually irregular so that tissue tear is difficult to stitch (Hamilton, 2002). Episiotomy is a deliberate action on the perineum and vagina that is stretched. This procedure is performed if the perineum is expected to be torn by the head of the fetus, perineal infiltration must be performed under local anesthesia, unless the patient has been given anesthesia anesthesia. Episiotomy incisions can be performed in the midline or mediolateral. Midline incisions have the advantage that not many large blood vessels are found here and this area is easier to repair (Jones Derek, 2002). To prevent infection of stitches caused by rupture or episiotomy, it is necessary to maintain the cleanliness of the vulva. Hygiene of the vulvar during labor must be done, because during the puerperium there is a lot of blood and dirt coming out of the vagina. (Ali Sungkar, 2007).
Vulva hygiene in the treatment of birth canal injuries is 2 types, namely by using antiseptics and not using antiseptics by using traditional drugs that use betel leaves (Damayanti, R, 2003). Treatment of birth canal using betel leaves by boiling and using water for cleaning the vulva or cleaning birth canal injuries, because betel leaves contain essential oils consisting of bethephenol, cavical, seskulterpen, hydroxyvaikal, cavibetol, estrogen, eugenol and karvakrool where biochemical substances at Bethel leaf (Piper betle) has the power to kill germs and fungi, is also an antioxidant that accelerates the process of wound healing (Damayanti, R, 2003).
According to WHO, in 2010 there were more than 585,000 maternal deaths during pregnancy or childbirth. As many as 11% of maternal deaths are caused by infections where 25-55% of cases of infection are caused by infection of the wound in the birth canal (Rustam, Mochtar, 2000). Perineal tear injury is also a significant problem in communities in the Asian region, 50% of the incidence of perineal tears in the world occurs in Asia. The prevalence of women who suffer from perineal tears in Indonesia in the age group 25-30 years is 24%, while for women of childbearing age 32-39 years is 62% (Campion, 2010).
Data from Surabaya General Hospital stated that in 2011, among 287 post partum mothers there were 136 post partum mothers (47.7%) who returned to control perineal sutures on day 7, there were 48 people (35.3%) with injuries the perineum hasn't gotten good.
According to research in the UK, every year there are 20,000 women who experience perineal tears as many as 15% of them experience slow wounds and 6% of them experience infection due to lack of cleanliness of vulvar hygiene during the healing process (Heimburger, 2009).
Based on the Study of Health Care Performance in December 2005, it was stated in rural areas in West Java that 70% of postpartum mothers used betel leaf medicinal plants to wash their genitals.
Based on a survey conducted on 10 post partum mothers who visited BPS in RiaMulya P, SST., M.KesKaterunganKrianSidoarjo village by observing and filling in the observation sheet obtained 10 respondents that 10 postpartum mothers who used betel leaf decoction, 7 postpartum mothers (70%) Heal wounds quickly and 3 postpartum mothers (30%) Cure their wounds slowly. This shows that the number of postpartum mothers who recovered their wounds quickly used betel leaf decoction.
According to Bruner and Sudaddarth, there are two factors that influence recovery from injury, namely internal and external factors. Internal factors include the wound healing phase and the body's resistance to managing the immune system. External factors include nutrition, how the treatment is carried out, vulvar hygiene is carried out considering episiotomy wounds are in the urinary tract, vagians and anus while respondents themselves in the postpartum and lochia period are still out.
Health workers provide information or counseling about the use of betel leaves which can accelerate healing of perinealwounds and these plants are often found in the yard or yard because it is easy to live.
This study was conducted aimed at preventing infection in the postpartum mother and accelerating the process of healing the perineum wound.

RESEARCH METHODS
The method used is longitudinal analytic. Samples were taken as many as 30 respondents (postpartum mothers with perineal suture wounds using betel leaf decoction) using Proposive sample techniques. In this study using 2 variables, Independent Variables (Vulva Hygiene Using Betel Leaves Leaves at Childbirth) and Dependent Variables (Perineum Healing Wounds). Independent and Dependent variables use a nominal scale. The process of collecting data by observation. Data processing techniques include Editing, Coding, Tabulatin. The collected data is processed and then analyzed using the chi square test.

Characteristics of respondents based
on the use of betel leaf decoction at puerperium. Based on Table 4.5 above, it can be seen that from 30 respondents more than half (56.7%) used betel leaf decoction (every day, 2-3 times a day) that is as many as 17 respondents.
2. Characteristics of respondents based on healing of perineal wounds.   Table 4.7 above, it shows that of 30 half respondents (50%) used betel leaf decoction and rapid perineal wound healing from 15 respondents.
Based on the results of the calculation of the chi square test results obtained P = 0.047 with α 0.05. This shows that P <0.05 then, H0 is rejected which means that there is an influence of vulvar hygiene using betel leaf decoction during puerperium with healing of perineal wounds. propagate to a height of 15 meters, even more. Betel leaf stems generally have a greenish brown color. The stem is round and has a segment, this part will grow the roots of betel leaves. Betel leaves have a heart-like shape (more pointed tip). Betel leaf branches are single or one-on-one, and they grow alternately.

Characteristics of respondents based
Each betel leaf has a stem connected to the stem. When the betel leaves are squeezed, it will give off a distinctive aroma. Treatment of birth canal injuries using betel leaves by boiling and using water for cleaning the vulva or cleaning birth canal injuries, because betel leaves contain essential oils which consist of bethephenol, kavikal, seskulterpen, hydroxyvaikal, cavibetol, estrogen, eugenol and karvakrool where the biochemical substances in Betel leaf (Piperbetle) has the power to kill germs and fungi, also an antioxidant that accelerates the process of wound healing (Damayanti, R, 2003).
Betel leaf contain blood-retaining drugs to resist bleeding and insecurity that make healing of wounds on the skin. This is indicated by 17 postpartum mothers who used the betel leaf decoction 2. Characteristics of respondents based on perineal wound healing at BPS RiaMulya P, SST.,M.KesKaterunganKrianSidoar jo Village in 2018.
Based on table 4.5 above, it can be seen that 30 respondents from half (51.51%) experienced rapid healing of 15 respondents.
Perineal wounds are said to heal quickly if the wound on the 3rd day begins to dry up and begins to close, and on the 7th day the wound has closed well with scarring. While the perineal wound is said to be slow to heal if the wound on the 3rd day is not dry and not closed but only the 7th day the wound begins to close. In the category of slow healing, this wound is in accordance with the theory that the wound healing process lasts for 6-7 days (Barbara, 1996) Reality in the field shows that the majority of postpartum mothers with perineal suture wounds are a fast healing process. If the healing process is slow there are several factors that influence external factors (Environment, Based on Table 4.7 above, it shows that of 30 half respondents (50%) used betel leaf decoction and rapid perineal wound healing from 15 respondents.
Based on the results of the calculation of the chi square test results obtained P = 0.047 and α 0.05. This shows that P <0.05 then, H0 is rejected which means that there is an influence of vulvar hygiene using decoction of betel leaves during puerperium with healing of perineal wounds.
Perineal wounds are said to heal quickly if the wound on the 3rd day begins to dry up and begins to close, and on the 7th day the wound has closed well with scarring. While the perineal wound is said to be slow to heal if the wound on the 3rd day is not dry and not closed but only the 7th day the wound begins to close. In the category of slow healing, this wound is in accordance with the theory that the wound healing process lasts for 6-7 days (Barbara, 1996). Treatment of birth canal injuries using betel leaves by boiling and using water for cleaning the vulva or cleaning birth canal injuries, because betel leaves contain essential oils which consist of bethephenol, kavikal, seskulterpen, hydroxyvaikal, cavibetol, estrogen, eugenol and karvakrool where the biochemical substances in Betel leaf (Piperbetle) has the power to kill germs and fungi, also an antioxidant that accelerates the process of wound healing (Damayanti, R, 2003).
From the results of the study, 30 postpartum women (15 postpartum mothers were cured quickly and 2 postpartum mothers were slow wound healing) who used betel leaf decoction (every day, 2-3 times a day) and 13 postpartum mothers (3 postpartum mothers with rapid wound healing and 10 mothers gave birth to slow wound healing) did not use betel leaf decoction (not every day <2-3 times a day). From the description above, the use of siri leaf decoction affects the healing of perineal wounds.
To overcome this problem, can provide information or information about the use of betel leaves to accelerate healing of perineal wounds. In this case the role of health workers including midwives is very necessary to provide education.
In this study there are limits both from research and matters relating to research. These limitations include limited research abilities and experience because they are still in the learning stage, limited time and research staff so that the expected results may not be satisfactory.

From the results of the study
showed that of 30 respondents more than half (56.7%) used decoction of siria leaves as many as 17 respondents.
2. From the results of the study showed that 30 respondents more than half (50%) experienced rapid healing as many as 15 respondents.
3. Based on the results of the calculation of the chi square test obtained P = 0.047 with α 0.05. This shows that P <0.05 then, H0 is rejected which means that there is an influence of vulvar hygiene using decoction of betel leaves during puerperium with healing of perineal wounds.