"TAPEL for Postpartum Pain Reduction "

Tapel is a traditional medicine in the form of solid, pasta or like porridge used by smearing on the mother's abdomen after delivery. Tapel causes touch to the skin that is, a sense of cold, warm and also a refreshing smell. So it is possible that the element can reduce the pain Afterpain due to uterine contractions that are sometimes very disturbing mainly 2-3 days Postpartum. The effectiveness of Tapel use in postpartum mothers was analyzed using descriptively by correlating tapel administration to afterpain. From the result of data analysis using Wilcoxon test got that value of a-Symp. Sig (2 tailed)) of 0,000 due to asymp.sig (2-tailed) <Î± 0.05. The puerperal mother given Tapel gets distraction from the tapel. This is due to the cold sensation and the warm feeling that the patient feels when Tapel is smeared into the front of the stomach as well as the refreshing tapel smell (the smell of traditional medicine) makes a distraction in the mother who experiences Afterpain.   Keywords: Tapel, Afterpain, Post Partum


INTRODUCTION
The puerperium period begins after the placenta is born and ended when the uterine devices such as the condition before pregnancy. The puerperium lasts for about six weeks (Prawirohardjo, 2006). In the puerperium period two important events, namely uterine involution and lactation process. Involution is the process of returning the uterus to a state before pregnancy after childbirth. This process begins as soon as the placenta comes out due to contraction of the uterine smooth muscles (Bobak, Lowdermilk, & Jensen, 2005).
In the revolutionary period, a contraction is required. Contraction of the uterine muscle occurs due to stimulation of the hormone oxytocin released by the hypothalamus. The neural pulp is formed from stimulation of the mammary papilla is the primary stimulus for oxytocin release, whereas the distension of the vagina and the uterus is the second stimulus. Estrogen will stimulate oxytocin production, whereas progesterone will, in turn, inhibit oxytocin production. After the e-ISSN : 2597-9345 p-ISSN : 2597-761X mother undergoes labor, then the mother will feel the pain. In pharmacological action are inhaled analgesics, opioid drugs, general anesthesia, epidural analgesia. And in nonpharmacological measures is relaxation, hypnotherapy, massage, hydrotherapy, TENS (Transcutaneous nerve stimulation), acupuncture, mobilization and positioning, treatment therapy. However, women's perception of the severity of afterpain has been studied primarily in two drug trials. Both protocols assessed pain on a scale of 0-10 each representing no pain to severe pain on an individual basis, 159 women rated their pain ranging from 0.09 to 2.53. In Norway, 64 women completed ten visual analog scales ranging from 'no pain' to 'severe pain,' resulting in an average score below 10. This research found that afterpain was felt by more women and heavier on the first day, with the second and fourth days. Fewer primigravida women feel this pain and are felt heavier by multiparous women. The maximum incidence and severity are when afterpain is felt as moderate/severe pain by 56% of multiparous women on day one, and fourth day not only primigravida women who experience Afterpain as moderate/severe pain, but 5% multiparous women still feel it (Rosemary, 2004).
Although contraction is desperately needed, it is often disturbing because the contractions cause pain called 'lateral pain' (Afterpain), especially in multipara. Menurut (Prawirohardjo, 2006) Afterpain due to uterine contractions sometimes very disturbing the main 1-2 days postpartum. Afterpain this will be exacerbated by the condition of the mother who is in the lactation period.
From the preliminary study conducted in Mojokerto regency, from 10 postpartum mothers found five postpartum mothers experienced pain after giving birth. And five postpartum mothers experience no pain. The impact of afterpain can affect lactation failure, especially in mothers who have not had experience after giving birth to first child. Thus the baby is not the maximum get milk on 2-3 days. At that time the milk that comes out is colostrum where the content of the most important colostrum is immunoglobin G (IgG) that can not be found in other milk (PASI). With the immunoglobin G then increase the immune system of infants against infection. We as health workers (midwives) have a role as educators, it must provide knowledge to postpartum mothers, so they can understand ways to reduce postpartum abdominal pain, especially on days 1-5 postpartum.
The feeling of pain can be minimized by pharmacological methods or conventional methods. One of the efforts of conventional methods is to use tapel. According to the Minister of Health of the Republic of Indonesia (1990), tapel is a traditional medicine in the form of solid, pasta or like porridge used by smearing on the mother's abdomen after giving birth. Tapel sold in the market is tapel shrink belly that contains bangle, key, kedawung, kencur, fennel, pulosari useful to shrink the stomach postpartum, refresh the body after childbirth, relieve pain or heartburn, abdominal bloating, and many more benefits. These elements cause a touch of skin that is cold, warm and also refreshing smells. So it is possible that these elements can reduce pain. The purpose of this research is to know the influence of Tapel to Afterpain on Postpartum Mother.

MATERIALS AND METHODS
The research design was to use the Preeksperimental Pretest-Posttest Design (Hidayat, 2010). Population in this study were all postpartum mothers in ANANDA Clinic Mojokerto regency. A total of 20 people. The instrument used in tapel giving variable is Standart Operational Procedure (SOP) in tapel. While the afterpain variable is the Mc Gill scale observation sheet, the study was conducted in June -July 2017. According to (Prawirohardjo, 2006), afterpain after labor due to uterine contractions are sometimes very disturbing for 2-3 days postpartum. After pain can be described as an unpleasant sensation that occurs when we suffer injury or damage to our body. After the pain is experiencing sensory and emotional discomfort resulting from actual or potential tissue damage (S.  According to the Minister of Health (1990), Tapel contains traditional ingredients that have different benefits in each ingredient. Tapel sold in the market is a belly shrink staple containing bangle, cloves, fennel, pulosari, cinnamon, lime, eucalyptus oil, useful to shrink the stomach postpartum, refresh the body after childbirth, relieve pain. 1. The bangle rhizome contains saponins, flavonoids, and essential oils used to treat: abdominal pain, shrink the stomach after childbirth or due to obesity (Jamaluddin, Stuckey, Ariff, & Faizal Wong, 2017) 2. Cloves are used for the pharmaceutical industry and contain acrylic oil and chemical compounds called eugenol, oleanolic acid, glutamic acid, phenolic, profilin, resin, and gom. This plant is useful for: blackening eyebrows, increase heart rate, measles, fever (Jamaluddin et al., 2017). 3. Fennel fruits are containing acrylic oil, saponins, flavonoids, and polyphenols, are used for irregular menstruation. The skin of pulsars contains coumarin, tannins, bitter substances, and alkaloids. The pharmacological effects of pulsars include antidiarrheal, anti-fever, as a curious for almost all Javanese, antiasthma, febrifuge, antibacterial, and astringent, pore-reducing agents (Hariana, 2013). 4. Cinnamon bark has a spicy and sweet taste, smells fragrant, and is warm. Some of the chemicals contained in cinnamon include eugenol asiri oil, safrole, cinnamaldehyde, tannin, calcium oxalate, resin, and tanners. The pharmacological effects that cinnamon possesses include farting liver, antirheumatic, appetite enhancer, and pain relievers (Hariana, 2013).

RESULTS
Tapel does not contain chemicals that affect the body. Tapel postpartum given Tapel get distracted from tape. This is due to the cold sensation and the warm feeling that the patient feels when Tapel is smeared into the front of the stomach as well as the refreshing tape smell (the smell of traditional medicine) makes a distraction in the mother who experiences Afterpain.
This is the Gate Control Theory which states that the mechanism of pain reduction is the interaction between the pain stimulus and other sensations (warm sensations caused by cold tapels and warm feelings in the body) and the stimulation of fibers that send painless sensations block or decrease the transmission of pain impulses through the circuit gate resistor. Inhibitor cells in the dorsal horn of the spinal cord contain enkephalin, which inhibits pain transmission.
This theory explains how certain activities decrease the perception of pain. From tapel stimulates painless (non-nociceptive) fibers in the same receptor site as painkillers (nociceptors) are activated. Stimulation of a large number of non-nociceptive fibers, which are synchronized to the inhibitor fibers in the dorsal horn, inhibit (up to a level) the transmission of pain sensation in the ascending fluid (S. C. .
Tapel causes a cold sensation, warm feelings, and a refreshing smell typical of traditional medicine, so it becomes distracted for mothers who experience Afterpain. The pain can not be lost because if the pain is gone, then the mother's uterus does not contract so it will cause Subinvolusi. Just feelings of pain can be reduced or lowered by giving Tapel. The more days the amplitude of the contractions will decrease, so the mother will not feel pain anymore. But it depends on the individual it self because the pain after childbirth is an unpleasant sensation due to sensory nerve stimulation. Pain is personal; everyone perceives a different pain to the same stimulus depending on the threshold of pain it has. Because the pain in the time of Afterpain is very subjective, not only depends on the intensity of his but also depends on the mental state of the person. If he knows what happens to him, there is no fear, and he can accept everything that happens and will happen. This calm makes the pain feel little or nothing. The feeling of pain in his is probably due to ischemia in the uterine corpus where there are many nerve fibers. This event continues the feeling of pain through the sensory nerves in the hipograstikus plexus to the central nervous system.

CONCLUSIONS
There is a Chapel effect on Afterpain on Postpartum Mothers with asymp.sig (2tailed) values of 0,000 due to asymp.sig (2tailed) <α 0.05. After pain can be minimized by pharmacological methods or conventional methods. One of the efforts of conventional methods is to use tape. The puerperal mother given Tapel gets distraction from the tapel. This is due to the cold sensation and the warm feeling that the patient feels when Tapel is smeared into the front of the stomach as well as the refreshing tapel smell (the smell of traditional medicine) makes a distraction in the mother who experiences Afterpain.