The Correlation of the Level of Anxiety of Nulliparous Women to the Length of the First Stage of Spontaneous Labor at Private Maternity Clinics in the Working Area of Delitua Puskesmas, Deli Serdang District in 2013

Abnormal length of the first stage of labor in nulliparous women (first pregnancy) can be related to severe anxiety during labor. Based on the preliminary survey in several private maternity clinics at the working area of Delta Puskesmas, Deli Serdang District, it was found that there was a prolonged first stage of labor (27.65%) in nulliparous women. The purpose of this study was to analyze the influence of anxiety level to the length of the first stage of labor. The type of this study was an analytic survey with explanatory research type. The samples comprised 40 childbearing women in private maternity clinics of Kasih Ibu, Kurnia, Tanjung, Wanda, and Mayana which were located in the working area of Delitua Puskesmas, Deli Serdang District, using accidental sampling technique. The data were gathered by using questionnaires and analyzed in the univariate analysis by using frequency distribution form, and bivariate analysis using Chi-Square test. The result of this study showed that the level of anxiety (p = 0.001) significantly related the length of the first stage of labor in which mothers who had severe anxiety. It is recommended that health providers should provide standardized services to childbearing women, especially to nulliparous women, so that their level of anxiety can be decreased facing the first stage of the labor process. It is also recommended that the husbands should support their wifes by positive behaviors so they will not think about negative things on their babies and on themselves.

Labor is an important occurrence for parents and family. It's well known, easiness in labor is highly dependent on mother's condition but very important to know that there is almost no human behavior and biological progress unaffected by the psychological condition. Fetal growth will make a mother more easily exhausted, hard to sleep and breathless. Even the strongest woman felt the same thing. Fear and too much worry would make concentration disturbance on preparing to face labor. If this condition happened unexpectant mother would not have an optimal preparation to labor her first baby (Utami, 2009).] Every unexpectant mother who never gives birth before would felt fear and worry more than an expectant mother who had given birth (Ambarwati, 2001dan Utami, 2009). The anxiety factor on mothers could make labor progress become longer and it will impact on morbidity and mortality rate because of painful feeling (Nayak, 2014). Prolonged labor usually happened in the first stage of labor. This stage is a progress of cervical dilatation until complete (American Pregnancy Association, 2015).

Namora Lumongga Lubis, Megawati Sinambela
Preliminary survey taken on Juli-September 2012 from several private maternity clinics in Delicia Public Health Center working area showed: There are 94 nulliparous mothers and 42,55% from them experiencing normal length of the first stage of labor (4-8 hour), 27,65% experiencing prolonged first stage of labor (>8-12 hour), 10,63% experiencing 20-24 hour first stage of labor, 19,15% referred to hospital because experiencing more than 24 hours. On the other side, there are 112 mothers who had given birth, 79,46% experiencing a normal first stage of labor, 12,25% experiencing a prolonged first stage of labor, 5,36 experiencing 12-16 hour first stage of labor and 2,68% experiencing 16-hour first stage of labor and referred to hospital.
Based on this background, the study showed the correlation between the level of anxiety of nulliparous women to the length of the first stage of spontaneous labor at Private Maternity Clinics in the Working Area of Delitua Puskesmas, Deli Serdang district in 2013.

Research Method
This is a quantitative study with explanatory method approach. This study is located in private maternity clinic in Delitua Public Health Center working area, Deli Serdang District. The population constitutes first pregnant mother (nulliparous) who will give birth in private maternity clinic in Delitua Public Health Center working area. The number of samples is 40 people taken by Accidental Sampling. Data were analyzed using Chi-Square test.

Correlation of Level of Anxiety with Length of First Stage Labor at Private Maternity Clinics in the Working Area of Delitua Puskesmas, Deli Serdang District in 2013
Chi-Square test result showed there is a correlation between anxiety level with the length of the first stage spontaneous labor primigravidae with p=0,001.  Table 3 showed a significant correlation between level of anxiety with length of first stage spontaneous labor, mother's anxiety from nulliparous women had given contribution to length of first stage labor it usually happened because of many pressure, high anxiety, instability feeling and own fear felling if babies born in abnormal condition, birth defects or died. Sometimes, young mothers felt too worried about how to caring a baby. Moreover, women who did not get attention and moral support from family especially from husbands are easily getting anxiety in labor.

Namora Lumongga Lubis, Megawati Sinambela
These result is corresponding with Jatmika Research in 1999 who found a high correlation between anxiety with the length of the first stage of labor and vice versa (Jatmika, 1999).] Anxiety will higher by the time give birth. This situation will make mothers become not cooperative. Stress in labor and reflex can cause increased level of chatekolamin. Psychological stress and hypoxia-related to pain and anxiety would increase adrenaline secretion. Adrenaline secretion increasing would make a vast kontriksi as a result uterus blood stream would decrease and finally, hypoxia happened, labor complication occurs and results in fetal death (Chapman, 2006).