ANALISIS FAKTOR MEDIS, NON-MEDIS, DAN SISTEM PELAYANAN TERHADAP KEJADIAN SEKSIO SESARIA
DOI:
https://doi.org/10.51878/healthy.v5i4.15776Keywords:
Clinical Pathway, Faktor Medis, Faktor Non-Medis, Seksio Sesaria, Sistem PelayananAbstract
Abstract
The high proportion of cesarean sections in Bali, particularly in private hospitals, needs to be understood through the interplay of obstetric conditions, maternal characteristics, and healthcare delivery processes. This study analyzed the relationship between medical, non-medical, and healthcare service factors and the occurrence of cesarean section, while also mapping delivery patterns based on the Robson classification at Private Hospital X Bali. A quantitative study with a cross-sectional design involved 94 women who gave birth between January and December 2025, selected through consecutive sampling. Data were obtained from medical records, questionnaires, and clinical pathway observation sheets, and were analyzed using the chi-square test and multiple logistic regression. Cesarean sections accounted for 66.0% of deliveries, while 67.7% of the procedures were performed within the appropriate time frame. Factors associated with cesarean section included high-risk maternal age and parity, previous cesarean section, pregnancy complications, abnormal fetal conditions, education, socioeconomic status, insurance ownership, maternal preference, service time, and health insurance financing. Previous cesarean section was the dominant factor in the multivariate model (AOR=17.24; p<0.001), while Robson Group 5 contributed the largest proportion of cesarean deliveries. These findings support improvements in obstetric care through prevention of unnecessary primary cesarean sections, strengthened counseling and VBAC, Robson audits, and optimization of the clinical pathway.
Abstrak
Tingginya proporsi seksio sesaria di Bali, terutama pada rumah sakit swasta, perlu dipahami melalui keterkaitan antara kondisi obstetri, karakteristik ibu, dan proses pelayanan. Penelitian ini menganalisis keterkaitan faktor medis, nonmedis, dan sistem pelayanan dengan kejadian seksio sesaria serta memetakan pola persalinan berdasarkan klasifikasi Robson di Rumah Sakit Swasta X Bali. Penelitian kuantitatif dengan rancangan cross-sectional melibatkan 94 ibu bersalin selama Januari–Desember 2025 yang dipilih melalui consecutive sampling. Data diperoleh dari rekam medis, kuesioner, dan lembar observasi clinical pathway, kemudian dianalisis menggunakan uji chi-square dan regresi logistik ganda. Sebanyak 66,0% persalinan dilakukan melalui seksio sesaria dan 67,7% tindakan berlangsung tepat waktu. Faktor yang berkaitan dengan kejadian seksio sesaria mencakup usia dan paritas berisiko, riwayat seksio sesaria, komplikasi kehamilan, kondisi janin abnormal, pendidikan, status ekonomi, kepemilikan asuransi, preferensi ibu, waktu pelayanan, dan pembiayaan jaminan kesehatan. Riwayat seksio sesaria menjadi faktor dominan dalam model multivariat dengan AOR=17,24 dan p<0,001, sementara Robson Group 5 menjadi kelompok dengan kontribusi terbesar. Temuan ini mengarahkan peningkatan mutu obstetri pada pencegahan seksio sesaria primer yang tidak diperlukan, penguatan konseling dan VBAC, audit Robson, serta optimalisasi clinical pathway.
References
Abidi, S. M. A., Hussain, S. N. F., Abbas, S., Abidi, S. T. F., & Haresh, S. (2025). Application of the Robson classification in assessing cesarean section rates: An audit of a tertiary care hospital’s gynecology department in Karachi, Pakistan. Therapeutic Advances in Reproductive Health, 19, 26334941251339710. https://journals.sagepub.com/doi/full/10.1177/26334941251339710
Abo, M. T. E. P., Sirait, R. W., & Sinaga, M. (2025). Faktor yang memengaruhi pemanfaatan pelayanan kesehatan di wilayah kerja Puskesmas Lengkosambi tahun 2024. SEHATMAS: Jurnal Ilmiah Kesehatan Masyarakat, 4(2), 430–442. https://journal.literasisains.id/index.php/sehatmas/article/view/4870
Anggriani, Y., Pasau, R. P. M., & Carolis, F. (2025). Analisis faktor yang berhubungan dengan peningkatan insiden persalinan sectio caesarea. Jurnal Praba: Jurnal Rumpun Kesehatan Umum, 3(4), 18–27.
https://journal.stikescolumbiasiamdn.ac.id/index.php/Praba/article/view/598
Ashiko, A., Tilahun, C., Geta, T., Abraham, A., & Kassaye, G. (2025). Factors associated with primary cesarean section delivery among women who gave birth at Wolaita Sodo University comprehensive specialized hospital, Southern Ethiopia. Scientific Reports, 15(1), 37314. https://www.nature.com/articles/s41598-025-21158-4
Awali, D. S., Ridlayanti, A., & Pratiwi, D. E. (2026). Analisis faktor yang memengaruhi kejadian persalinan sectio caesarea di salah satu fasilitas pelayanan kesehatan di Kota Bandung tahun 2024. Jurnal Asuhan Ibu dan Anak, 11(1), 9–18. https://doi.org/10.33867/JAIA.659
Betran, A. P., Ye, J., Moller, A. B., Souza, J. P., & Zhang, J. (2021). Trends and projections of caesarean section rates: Global and regional estimates. BMJ Global Health, 6(6), e005671. https://doi.org/10.1136/bmjgh-2021-005671
Card, D., Fenizia, A., & Silver, D. (2023). The health impacts of hospital delivery practices. American Economic Journal: Economic Policy, 15(2), 42–81. https://www.aeaweb.org/articles?id=10.1257/pol.20210034
Dwipayanti, N. M. R., Wirata, I. N., Erawati, N. L. P. S., Ariyani, N. W., & Senjaya, A. A. (2025). Gambaran indikasi ibu bersalin dengan tindakan seksio sesarea di UPTD RSUD Gema Santi Nusa Penida tahun 2024. Jurnal Berita Kesehatan, 18(1), 299–309. https://www.ojs.stikes.gunungsari.id/index.php/JBK/article/view/279
Firawati, F., Ernawati, E., & La Isa, W. M. (2025). Faktor yang mempengaruhi keputusan ibu hamil dalam pemilihan jenis persalinan di Puskesmas Pampang. JIMPK: Jurnal Ilmiah Mahasiswa & Penelitian Keperawatan, 5(1), 13–18. https://ojs.institutnh.ac.id/index.php/jimpk/id/article/view/1717
Kumar, P., Srivastava, S., Chaudhary, P., & Muhammad, T. (2023). Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey. PLoS ONE, 18(9), e0291485. https://doi.org/10.1371/journal.pone.0291485
Minarni, M., Nency, A., & br Ginting, A. S. (2023). Hubungan dukungan suami, riwayat seksio sesarea, status ekonomi, dan asupan makan dengan kejadian anemia pada ibu hamil di Puskesmas Toboali tahun 2022. Sentri: Jurnal Riset Ilmiah, 2(4), 1201–1213. https://ejournal.nusantaraglobal.ac.id/index.php/sentri/article/view/723
Nurhidayah, R., & Dewi, A. K. (2023). Gambaran pasien bersalin dengan ketuban pecah dini di RS Sumber Waras berdasarkan kriteria Robson. Tarumanagara Medical Journal, 5(1), 139–145. https://journal.untar.ac.id/index.php/tmj/article/view/24400
Nursasih, N., Angin, W. M. P., & Sitepu, P. (2026). Faktor determinan persalinan sectio caesarea di Rumah Sakit Syafira Kota Pekanbaru tahun 2018. Jurnal Kesehatan Indonesia Peduli, 2(3), 351–366.
https://ojs.gelcipnus.org/index.php/jkip/article/view/268
Ode, W. O. N. B. W., Basri, N., Saimin, J., & Lieswan, L. L. (2025). Analisis faktor yang berhubungan dengan kejadian seksio sesarea berulang di Rumah Sakit Umum Daerah Kota Kendari periode 2023–2024. Lombok Medical Journal, 4(3), 104–108. https://jurnal.unram.ac.id/index.php/LMJ/id/article/view/7920
Partamayani, P. D. G., Apsari, P. I. B., & Budayasa, A. A. G. R. (2026). Perbandingan karakteristik ibu, indikasi, dan klasifikasi Robson pada persalinan seksio sesarea tahun 2013 dan 2018. Jurnal Kesehatan Reproduksi, 13(1), 11–17. https://journal.ugm.ac.id/jkr/article/view/92707
Psenkova, P., Tedla, M., Minarcinova, L., & Zahumensky, J. (2024). Application of a specific clinical pathway can affect the choice of trial of labor in patients with a history of cesarean delivery. BMC Pregnancy and Childbirth, 24(1), 292. https://link.springer.com/article/10.1186/s12884-024-06429-8
Pujiwati, W., Novita, A., & Rini, A. S. (2023). Pengaruh metode ERACS terhadap mobilisasi pasien post sectio caesaria di Rumah Sakit Umum Kartini Jakarta tahun 2022. SENTRI: Jurnal Riset Ilmiah, 2(5), 1684–1694. https://ejournal.nusantaraglobal.ac.id/index.php/sentri/article/view/875
Putri, C. I. M. P., & Sudiarta, G. (2026). Profil persalinan seksio sesarea di Rumah Sakit Umum Daerah Klungkung periode Januari 2024–Maret 2026. Intisari Sains Medis, 17(2), 598–608. https://www.isainsmedis.ejournals.ca/index.php/ism/article/view/2748
Ramadhana, A. S., Damayanti, T. Y. F., Cholila, N., & Hurin'in, N. M. (2024). Hubungan persepsi ibu hamil riwayat sectio caesarea (SC) dengan keinginan memilih vaginal birth after caesarean (VBAC) di RSUD Dr. R. Koesma Tuban. Merapi: Medical Research and Public Health Information Journal, 1(3), 66–76. https://journal.myrepublikcorp.com/index.php/MERAPI/article/view/122
Syarkawi, S., Dharina, D., Hermansyah, H., Zahara, M., & Nahrisah, P. (2026). Studi komparasi faktor risiko nonmedis pada persalinan normal dan caesar di RSUD Cut Meutia Aceh Utara. Jurnal Ragam Pengabdian, 3(1), 187–196. https://teewanjournal.com/index.php/juragan/article/view/2990
Wardani, I. N., Kurniawan, B., & Pramesona, B. A. (2024). Evaluasi penerapan clinical pathway sectio caesarea pada rumah sakit swasta di Bandar Lampung, Indonesia. Jurnal Manajemen Kesehatan Yayasan RS. Dr. Soetomo, 10(2), 337–345. https://jurnal.stikes-yrsds.ac.id/JMK/article/view/1941
Yunitawati, D., Sari, K., Paramita, A., & Sudikno. (2024). A higher maternal education level could be a critical factor in the exceeded cesarean section delivery in Indonesia. Iranian Journal of Public Health, 53(4), 876–884. https://doi.org/10.18502/ijph.v53i4.15561
