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Diabetic nephropathy is a chronic complication resulting from hyperglycemia, which triggers oxidative stress and inflammation, leading to progressive structural and functional kidney damage. Orange peel and Aloe vera contain bioactive compounds with antioxidant and antifibrotic properties that may protect the kidneys from diabetes induced injury. Nanoemulsion delivery systems can enhance the bioavailability of these extracts in the body. This experimental study aimed to analyze the nephroprotective effects of orange peel and Aloe vera nanoemulsion in a diabetic nephropathy rat model, including glomerular morphology and kidney function. A post-test only control group design was used on Wistar rats divided into five groups: positive control, negative control, and three treatment groups receiving varying nanoemulsion doses. Glomerular structure was evaluated by assessing the number of glomeruli exhibiting synechiae and analyzed using the Kruskal–Wallis test due to non-normal data distribution, yielding p=0.2387 (p>0.05), indicating no significant differences among groups. Urea levels were elevated above normal, whereas creatinine levels remained within normal limits. Although not statistically significant, the treatment groups demonstrated nephroprotective tendencies, shown by improvements in glomerular synechiae in the diabetic nephropathy model.

Sectio caesarean (SC) is a major surgical procedure performed to save the mother and baby when normal delivery is not possible. However, this procedure may cause postoperative complications such as impaired physical mobility due to pain, muscle weakness, and anesthesia effects. These limitations can delay the healing process, increase the risk of infection, and reduce the mother's self-care ability. One effective non-pharmacological intervention to accelerate recovery is early mobilization through Range of Motion (ROM) exercises. This case study aims to analyze the effectiveness of early mobilization (ROM) intervention on improving mobility and reducing pain in post-sectio caesarean mothers. The study was conducted in June 2025 at RSUD Kajen with three respondents who underwent SC for different obstetric indications (postterm, CPD, and severe preeclampsia). The research design used a descriptive case study with pre–post intervention approach. The results showed that after performing ROM exercises gradually from six hours post SC, pain intensity decreased from a scale of 7–8 to 1–3 within three days. Mobility ability improved from only being able to turn sideways to sitting and walking with assistance. Respondents also showed increased motivation and independence in self-care activities. In conclusion, early mobilization (ROM) intervention is effective in accelerating recovery for post-sectio caesarean mothers. This intervention helps reduce pain, improve circulation, strengthen muscles, and enhance psychological adaptation. Early mobilization should be applied as part of routine nursing interventions in the postpartum ward.

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) can be a measure of a country's welfare in determining the optimal degree of health. The maternal mortality rate in the world is 303 thousand people (WHO 2023). MMR in Indonesia was 4,129 people in 2023. Meanwhile, the Infant Mortality Rate (IMR) in the world is 29,945 people (WHO, 2023). In Indonesia, there were 16.85 infant mortality rates in 2023. SEZ is a nutritional deficiency in pregnant women that lasts for several months or years. SEZ conditions can indirectly cause MMR and IMR. SEZ in pregnant women can cause complications such as IUGR, Abortion, LBW, Circulation, Anemia, Bleeding, and Childbirth complications. Research Objective: Providing Comprehensive Midwifery Care in accordance with midwifery care standards starting from pregnancy, childbirth, postpartum, newborn, and family planning in Mrs. A 22 years old with Chronic Energy Deficiency (SEZ) and Chepalo Pelvic Disproportion (CPD) with a midwifery management approach according to Varney and SOAP. Research Methods: Descriptive Qualitative with Case Study approach Results: Comprehensive Midwifery Care on Mrs. A aged 22 years with SEZ can be overcome by an increase in LILA, there is a CPD so that SC delivery is performed and appropriate case management is carried out so that labor, newborn, postpartum period, and family planning goes well. Conclusion: The results of the comprehensive care given to Mrs. A 22 years old with Chronic Energy Deficiency (SEZ) can be resolved marked by an increase in LILA, SC delivery on indications of CPD, normal LBW, normal postpartum, and mini pill birth control.

Labor is the process of expelling the products of conception, namely the fetus and placenta, after reaching full term and being viable in the womb. There are two types of delivery: normal delivery and caesarean section (SC). Caesarean section (SC) is a surgical procedure performed through an incision in the uterine wall to deliver the fetus. Caesarean delivery is indicate in cases of cephalopelvic disproportion, breech or transverse fetal position, fetal weight exceeding 4,000 grams, or maternal health conditions that may endanger the mother and fetus. One of the common complications following caesarean delivery is pain. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. An intervention that can be applied to reduce post SC pain is Guided Imagery Therapy. Guided imagery therapy is a non-pharmacological intervention aimed at reducing and controlling pain by creating pleasant and relacing thoughts, focusing on breathing, and visualizing positive scenarios. This study employed a descriptive case study design using the nursing process from assessment to evaluation. The study was conducted on two patients with moderate pain (pain scale 4-6) after SC at TK II Putri Hijau Hosiptal Medan. The results showed that after the application of guided imagery therapy for three days with a duration of 40 minutes per session, pain levels decreased to mild (pain scale 1-3). In ptient I, pain decreased from a score of 5 to 3, an in patient 2, from a score of 6 to 3. In conclusion, guided imagery therapy was successfully applied in reducing post -SC pain levels and can serve as a reference for further research on pain reduction following caesarean section.

This study aims to provide an overview of comprehensive midwifery care in reducing maternal morbidity and mortality at the Paguyangan Health Center, Brebes Regency. According to WHO data in 2023, the maternal mortality rate was recorded at 4,129 per 100,000 live births, with the same rate in Indonesia and 335 per 100,000 in Central Java. In Brebes Regency, there were 54 cases of maternal death caused by various factors. This study used a case study method with a descriptive approach to analyze midwifery care during pregnancy, childbirth, postpartum, newborn care, and family planning programs. The results show that Mrs. Ny. N, aged 35 and with a history of multiparity, had a pregnancy with high-risk factors. Despite this, her delivery proceeded naturally with a spontaneous birth of a female baby, who cried loudly, weighing 3110 grams, and measuring 50 cm in length. During the postpartum period, no complications were found, uterine reflexes were normal, and lochia was physiologically appropriate. The baby was healthy and received hepatitis B immunization and vitamin K1. In the family planning program, the mother chose to use a 3-month injection contraception. The conclusion of this study is that despite the high-risk factors faced by the mother, comprehensive midwifery care can help minimize risks and improve the quality of care during pregnancy and childbirth.

Background: Perineal rupture is a common complication in vaginal delivery that can increase the risk of postpartum hemorrhage, infection, and maternal death. One of the factors that contribute to the occurrence of perineal rupture is the baby's birth weight. Babies with a birth weight ≥4000 grams can cause greater pressure on the mother's birth canal, increasing the possibility of perineal tissue tears. In Indonesia, 75% of mothers who give birth vaginally experience perineal lacerations, and postpartum hemorrhage is still the main cause of 40% of maternal deaths. Purpose: This study aims to determine the relationship between birth weight and the incidence of perineal rupture in normal deliveries at the Independent Midwife Practice of Lusi Marbun, Simalungun Regency in 2022. Method: This study used an observational analytical design with a case-control approach. A sample of 30 mothers giving birth was selected using the total sampling method. Data were analyzed using the Chi-square test to determine the relationship between birth weight and perineal rupture. Results: The study showed that the majority of infants had a birth weight <4000 grams (63.3%), and the majority of mothers experienced second-degree perineal rupture (70%). Bivariate analysis showed a significant relationship between birth weight and the incidence of perineal rupture (p-value = 0.000). Conclusion: There is a significant relationship between birth weight and the incidence of perineal rupture. The greater the infant's birth weight, the higher the risk of perineal rupture in the mother during labor. It is important for health workers to detect fetal weight early, provide nutritional education during pregnancy, and optimally prepare for labor to minimize the risk of complications.

On May 20, 2025, researchers conducted a preliminary study in the delivery room and it was found that there were 30 mothers giving birth. From the interview results, it was found that there were three mothers who were not accompanied by their husbands, but by their parents, because their husbands were working and therefore could not be present. Mothers who were not accompanied by their husbands admitted to feeling anxious and worried about bad possibilities during the delivery process. In contrast, three mothers who were accompanied by their husbands expressed feeling more enthusiastic and calm because of the direct support from their partners. This study aims to determine the relationship between husband's assistance and the level of anxiety of mothers giving birth normally in the Siti Hajar Room of RSI Sultan Hadlirin Jepara. The type of research is quantitative with a correlational design. The study population included all mothers giving birth normally in the Siti Hajar Room in July 2025 with a total of 30 respondents. The sampling technique used was total sampling, while the research instrument was a HARS (Hamilton Anxiety Rating Scale) questionnaire that had been tested for validity and reliability. Data analysis used the Chi-Square test. The results showed that the majority of mothers gave birth accompanied by their husbands (70%), and most experienced mild anxiety (46.7%). The statistical test yielded an Asymp Sig value of 0.007 <0.05. Thus, it was concluded that there was a significant relationship between husband's support and maternal anxiety levels during childbirth..   Keywords: anxiety, childbirth, husband's suppor   Abstrak. Pada tanggal 20 Mei 2025, peneliti melakukan studi pendahuluan di ruang bersalin dan diketahui terdapat 30 ibu bersalin. Dari hasil wawancara diperoleh bahwa terdapat tiga ibu yang tidak didampingi oleh suami, melainkan oleh orang tua, karena suami bekerja sehingga belum bisa hadir. Ibu yang tidak didampingi suami mengaku merasa cemas dan khawatir akan kemungkinan buruk saat proses persalinan. Sebaliknya, tiga ibu yang didampingi suami menyampaikan perasaan lebih semangat dan tenang karena adanya dukungan langsung dari pasangan.Penelitian ini bertujuan untuk mengetahui hubungan pendampingan suami dengan tingkat kecemasan ibu bersalin normal di Ruang Siti Hajar RSI Sultan Hadlirin Jepara. Jenis penelitian adalah kuantitatif dengan desain correlational. Populasi penelitian meliputi seluruh ibu bersalin normal di Ruang Siti Hajar pada bulan Juli 2025 dengan jumlah 30 responden. Teknik sampling yang digunakan adalah total sampling, sedangkan instrumen penelitian berupa kuesioner HARS (Hamilton Anxiety Rating Scale) yang telah diuji validitas dan reliabilitas. Analisis data menggunakan uji Chi Square.Hasil penelitian menunjukkan mayoritas ibu bersalin didampingi suami (70%), dan sebagian besar mengalami kecemasan ringan (46,7%). Uji statistik menghasilkan nilai Asymp Sig = 0,007 < 0,05. Dengan demikian, disimpulkan terdapat hubungan signifikan antara pendampingan suami dengan tingkat kecemasan ibu dalam menghadapi persalinan. Kata kunci:kecemasan,persalinan,pendampingan suami

Maternal mortality remains a challenge in Indonesia, and one contributing factor is chronic malnutrition (CED), which impacts pregnancy, childbirth, the postpartum period, and the newborn. The 2022 registration report shows that of the 3,249,203 pregnant women whose MUAC was measured, 283,833 had a MUAC of less than 23.5 cm (at risk of CED), meaning 8.7% of these pregnant women were at risk of CED. In the Brebes area, the 2022 report recorded 3,475 pregnant women with CED. At the Bantarkawung Community Health Center in 2023, there were 36 cases of preeclampsia, 22 cases of transverse lie, 107 cases of CED, and anemia. Objective: Provide comprehensive midwifery care in accordance with standards of care for pregnant women, women giving birth, newborns, postpartum women, and family planning. Research method: Qualitative descriptive method, the type of research approach used in this study is a comprehensive case study approach. Results: Comprehensive care was provided to Mrs. R who suffered from chronic energy deficiency, and was successfully overcome. Delivery was carried out by caesarean section, the baby was born normally, and the postpartum period went smoothly, and the mother chose a contraceptive method, namely a three-monthly birth control injection. Conclusion: Comprehensive obstetric care has been proven effective in overcoming chronic energy deficiency, ensuring a safe delivery, a normal baby born, a normal postpartum period, and compliance with contraceptive methods.

          During the second and third trimesters of pregnancy, as fetal development progresses, pregnant women often experience lower back pain. This condition not only causes discomfort but also affects daily activities and overall quality of life. One of the non-pharmacological approaches believed to reduce lower back pain is prenatal exercise. This study aims to evaluate the effect of pregnancy exercise on reducing lower back pain among pregnant women in the second and third trimesters. This research employed a quasi-experimental design with a pre-post test approach without a control group. The sample consisted of 28 pregnant women in their second and third trimesters who met the inclusion criteria and reported experiencing lower back pain. Pain levels were assessed before and after the intervention using a valid and reliable pain scale. Data were analyzed using appropriate statistical tests, particularly the paired sample t-test. The findings revealed that the mean pain score before the intervention was 3.32 with a standard deviation of 0.772. After the intervention, the mean pain score decreased to 2.25 with a standard deviation of 1.005. Results of the paired t-test indicated a p-value of 0.000 (p < 0.05), demonstrating a significant difference in pain levels before and after pregnancy exercise. These results indicate that pregnancy exercise is effective in reducing lower back pain in women during the second and third trimesters of pregnancy. Therefore, prenatal exercise can be recommended as a safe, simple, and beneficial non-pharmacological intervention in midwifery care. It is expected that this study provides scientific evidence supporting the role of pregnancy exercise in improving maternal comfort and quality of life throughout pregnancy.

Breech presentation is a condition in which the fetus is in an elongated position with the head at the uterine fundus and the buttocks in the lower part of the uterine cavity. This condition can increase the risk of labor complications, especially if accompanied by serotinus (post-term pregnancy). Based on data from the Indonesian Ministry of Health (2021), the maternal mortality rate caused by breech presentation and serotinus in Indonesia was recorded at 1,309 cases. In Central Java, the incidence of breech presentation reached 11.5% (Central Java Health Office, 2021). This study aims to determine the implementation of comprehensive midwifery care for Mrs. D, aged 24 years, with breech presentation and serotinus at Mrs. S's PMB in the Kaliwadas Community Health Center area in 2023. The research method used a qualitative descriptive design with a case study approach. Data collection was carried out through interviews, observations, physical examinations, documentation studies, and medical record searches. The results of midwifery care showed that during pregnancy, Mrs. D had a good quality of life. Mrs. D underwent three antenatal care (ANC) visits, during which signs of pregnancy complications suggestive of serotinus were detected. Delivery was performed via cesarean section due to serotinus and breech presentation. During the neonatal period, three visits were conducted, with the baby's examination results within normal limits. During the postpartum period, four visits were conducted, during which the mother's condition was generally good, but at the third postpartum visit, problems with breastfeeding were discovered. Mrs. D was also known not to be using postpartum contraception. The results of this study emphasize the importance of early detection and appropriate management of breech presentation and serotinus pregnancies to prevent complications that endanger the mother and baby. Comprehensive midwifery care covering pregnancy, labor, postpartum, and newborn care is an integral effort to ensure the safety of mothers and babies.  

Background: A Caesarean section (CS) is a birthing procedure performed by making an incision in the mother's abdominal wall and uterus to deliver the baby, usually performed when normal vaginal delivery is not possible due to medical indications for the mother or fetus, such as placenta previa, abnormal presentation or position of the fetus, and other conditions that pose a risk of medical complications that endanger the mother and fetus. At Arjawinangun Regional Hospital, 1,491 CS births were recorded in 2021. One of the problems that often occurs in post-Cesarean section patients is impaired physical mobility, which causes limitations in the ability to move independently. This disorder needs to be addressed immediately so as not to hinder the recovery process. To overcome this problem, early mobilization intervention is very important. Early mobilization is a way to help patients increase their physical activity after undergoing surgery. Objective: This study aims to determine the description of the implementation of early mobilization in Mrs. M with impaired physical mobility after Caesarean section in the Dewi Sartika room, Arjawinangun Regional Hospital, Cirebon Regency, and to assess its effectiveness in overcoming these impaired physical mobility. Implementation method: This study used a case study method with research subjects in the form of patients who experienced impaired physical mobility after Sectio Caesarea at RSUD Arjawinangun Cirebon Regency. The implementation process involved providing early mobilization instructions which included light movement exercises tailored to the patient's condition. Results: The results of the study showed that after the implementation of early mobilization, impaired physical mobility in patients after Sectio Caesarea could be resolved significantly. Patients showed increased ability to move, reduced pain, and accelerated the post-operative recovery process.

Sectio caesarea is one of the surgical delivery methods performed when normal delivery is not possible. Although this procedure is considered safe, prospective patients often experience high stress due to fear of surgery, interventions such as religious music therapy that have spiritual value can calm emotions. This study aims to determine the effect of religious music therapy on stress levels in pre-section caesarean patients at RSUD dr. Tjitrowardojo Purworejo. This study used a quasi-experimental design with a non-randomized control group pretest-posttest design approach. The study sample was 30 patients who were divided into two groups, namely 15 people as the intervention group and 15 people as the control group. The research instruments were music therapy and stress level questionnaires. To analyze the data, the Wilcoxon Signed Rank Test and the Mann-Whitney Test were used.. The results showed a significant decrease in patient stress levels after listening to religious music. The average stress score before the intervention was higher than after the intervention, and the statistical test showed a p value <0.05, which means that religious music therapy has a significant effect on reducing stress. Religious music therapy can reduce stress levels in pre-cesarean section patients. This intervention can be used as part of anesthesia maintenance to improve patient comfort and mental readiness before surgery.

Anxiety is a common psychological response experienced by mothers during labor, which can impact both maternal and neonatal outcomes. Husband's support, as a form of social support, is believed to reduce maternal anxiety levels during delivery. However, empirical evidence in Indonesia, particularly at Obi General Hospital, is still limited. This study aimed to analyze the effect of husband's support on maternal anxiety levels during normal delivery at Obi Hospital in 2025. A quasi-experimental design with a non-equivalent control group approach was used. The study population consisted of mothers who underwent normal delivery at Obi General Hospital in 2025. A purposive sampling technique selected 30 respondents, divided into two groups: 15 respondents with husband support and 15 without. The research instrument was a validated anxiety level questionnaire, and data were analyzed using the Chi-Square test with α = 0.05. The majority of respondents were aged 25-34 years (60%), multigravida (53.3%), had a high school education (50%), were unemployed (60%), and had normal deliveries without complications (83.3%). In the group with husband's assistance, 80% experienced mild stress, 20% moderate stress, and none severe stress. In contrast, in the group without husband support, 26.7% experienced mild stress, 46.7% moderate stress, and 26.7% severe stress. The Chi-Square test yielded a p-value of 0.008 (p < 0.05), indicating a significant relationship between husband's support and maternal anxiety levels. In conclusion, husband’s support significantly reduces maternal anxiety during normal labor. Health facilities should implement policies that encourage active husband involvement in labor to improve maternal outcomes and the birth experience.

Background: Normal delivery is a significant moment in a mother's life, marked by the expulsion of the fetus after a full-term pregnancy, typically between 37 to 40 weeks, accompanied by intense uterine contractions. During the active phase of labor, mothers often experience peak pain due to increased frequency and strength of these contractions. One effective method to alleviate this pain is through counter pressure massage. This study aims to explore the differences in pain intensity among mothers in the active phase of labor before and after the application of counter pressure massage at RSU Permata Hati Klungkung. Method: This study used a pre-experimental design and purposive sampling technique. The population in this study were all mothers who underwent normal delivery in September to November 2024 with a total of 80 people, until a sample of 39 participants was determined. Data were collected through observations using a rating scale based on the Numerical Rating Score. Result: Data analysis was performed using the Wilcoxon test, revealing that the average pain score before the massage was 6.92, which decreased to 3.20 afterward. The Wilcoxon test yielded a p-value of 0.001, indicating a significant difference in labor pain intensity. Conclusion: This study shows that there is a difference in pain intensity before and after counter pressure massage is performed on mothers giving birth in the first active phase at Permata Hati Hospital, Klungkung with a p-value of 0.001.

Background: The second stage of labor is a critical phase associated with risks of maternal and neonatal complications if it lasts too long. Nonpharmacological interventions such as the gymball method have the potential to accelerate labor progress by optimizing the position and mobilization of the mother in labor, but contextual evidence in primary health care facilities in Indonesia is still limited. Objective: This study aims to analyze the effect of the gymball method on accelerating the second stage of labor in laboring mothers at the Mananggu Community Health Center. Methods: This study used a quasi-experimental design with a posttest-only control group approach. The sample consisted of 30 laboring women divided into an intervention group (gymball) and a control group (standard care). The dependent variable was the duration of the second stage of labor. Data were collected using observation sheets and partographs, then analyzed using an independent t-test. Results: The average duration of the second stage of labor in the gymball group was significantly shorter than that in the control group (p < 0.05). Conclusion: The gymball method was proven to be effective in accelerating the second stage of labor. This intervention is safe, low-cost, and feasible to be implemented as part of midwifery care at community health centers to improve the quality of normal delivery services.

Sectio caesarea is one of the surgical delivery methods performed when normal delivery is not possible. Although this procedure is considered safe, prospective patients often experience high stress due to fear of surgery, interventions such as religious music therapy that have spiritual value can calm emotions. This study aims to determine the effect of religious music therapy on stress levels in pre-section caesarean patients at RSUD dr. Tjitrowardojo Purworejo. This study used a quasi-experimental design with a non-randomized control group pretest-posttest design approach. The study sample was 30 patients who were divided into two groups, namely 15 people as the intervention group and 15 people as the control group. The research instruments were music therapy and stress level questionnaires. To analyze the data, the Wilcoxon Signed Rank Test and the Mann-Whitney Test were used.. The results showed a significant decrease in patient stress levels after listening to religious music. The average stress score before the intervention was higher than after the intervention, and the statistical test showed a p value <0.05, which means that religious music therapy has a significant effect on reducing stress. Religious music therapy can reduce stress levels in pre-cesarean section patients. This intervention can be used as part of anesthesia maintenance to improve patient comfort and mental readiness before surgery.

Continuity of care in midwifery is a series of continuous and comprehensive service activities ranging from pregnancy, childbirth, postpartum, newborn services and family planning services that connect women's health needs, especially and the personal circumstances of each individual. Comprehensive care is an examination that is carried out in complete with simple laboratory examinations and counseling. Comprehensive midwifery care includes places for continuous examination activities, including pregnancy midwifery care, childbirth midwifery care, postpartum midwifery care and newborn midwifery care and birth control acceptors. Pregnancy care prioritizes continuity of care is very important for women to get services from the same professional or from a small team of professionals, because that way the development of their condition will be monitored at all times and they will also become trusting and open because they feel that they already know the caregiver. The type of research used is descriptive, with a case study (Case Study), the sample used is Mrs. AS. After taking care of her, she has provided comprehensive obstetric care starting from pregnant women, childbirth, postpartum, babies and the results are normal pregnancy, normal childbirth, normal babies, and up to family planning. There is no gap between theory and case in the Comprehensive Midwifery Care for Mrs. AS and By.Mrs. AS in Kandangan Village.

Rupture of the perineum is one of the common complications in vaginal delivery that can increase the risk of postpartum hemorrhage, infection, and maternal death. One of the factors that contribute to the occurrence of perineal rupture is the baby's birth weight. Babies with a birth weight of ≥4000 grams can cause greater pressure on the mother's birth canal, increasing the likelihood of tearing of perineal tissue. In Indonesia, 75% of mothers who give birth vaginally experience perineal lacerations, and postpartum bleeding is still the leading cause of 40% of maternal deaths. This study aims to determine the relationship between infant birth weight and the incidence of perineal rupture in normal childbirth at the Lusi Marbun Independent Midwife Practice, Simalungun Regency in 2022.This study uses an observational analytical design with a case control approach. A sample of 30 maternity mothers was selected using the total sampling method. The data were analyzed using the Chi-square test to determine the relationship between birth weight and perineal rupture. The results showed that the majority of babies had a birth weight of <4000 grams (63.3%) and the majority of mothers experienced a second degree perineal rupture (70%). The results of bivariate analysis showed that there was a significant relationship between birth weight and the incidence of perineal rupture (p-value = 0.000). There is a significant relationship between birth weight and the incidence of perineal rupture. The greater the baby's weight, the higher the risk of perineal rupture in the mother during childbirth. It is important for health workers to carry out early detection of fetal weight, provide nutrition education during pregnancy, and prepare for the delivery process optimally to minimize the risk of complications.

The results of the Population Census data carried out in 2020 showed that the maternal mortality rate reached 189 per 100 thousand live births. And based on these figures, Indonesia is ranked second highest in ASEAN, which is further than other countries such as Thailand, Malaysia, Vietnam and Brunei, which have achievements below 100 per 100 thousand live births. The maternal mortality rate is one of the important programs for the Ministry of Health (Kemenkes) to pay attention to. Therefore, through this, the Ministry of Health carries out a care program from before pregnancy, pregnancy, childbirth, babies. And a number of cases of pregnant women giving birth include anemia 48.9%, hypertension 12.7%, KEK 17.3% and complications as much as 28%. The impact of childbirth on maternal mortality is also something that cannot be separated from the occurrence of maternal death. As a health worker with high integrity, it is very necessary to implement Mother and Baby Care. Indicators of quality service are in the process of pregnancy care, postpartum delivery carried out by health workers to the mother. One of them is carried out in the delivery process by explaining to the mother the technique of pushing when the opening is complete or 10cm. Do not do forced pushing (Valsalva) or tell the mother to push forcibly before it is certain that the opening is complete. This is one of the strict prohibitions conveyed by Bergastrom in his book. The process of delivering a baby can generally cause tears in the vagina and perineum. So when leading pushing in a mother in labor, it is necessary to do so as not to cause irregular tears in the birth canal. However, the process of delivering a baby through the birth canal or through normal delivery requires deliberate tearing to widen the birth canal. However, for further action, it is necessary to do hecting or stitches on the episiotomy wound which aims to restore the original shape of the perineal incision scar and stop bleeding as well as healing.

Cancer is one of the leading causes of death in the world, with the incidence rate continuing to increase every year. Conventional treatments such as chemotherapy and radiotherapy often have limitations, especially related to selectivity towards cancer cells and toxic side effects caused to normal cells. Therefore, an alternative approach that is more effective and safe is needed. One promising approach is the utilization of bioactive compounds from natural materials that are optimized through a medicinal chemistry approach. This study aims to examine the potential of natural compounds such as epigallocatechin gallate (EGCG) from green tea, berberine from Berberis vulgaris, curcumin from turmeric (Curcuma longa), and cardiotonic steroids (CTS) from Digitalis purpurea and Nerium oleander as anticancer agents, as well as their optimization strategies through structural modification, increased stability, and modern delivery technology. The method used is a systematic literature review of scientific articles from 2020 to 2025 obtained through the PubMed, ScienceDirect, and Google Scholar databases. The results of the study indicate that these compounds have various anticancer mechanisms of action, such as apoptosis induction, cell cycle inhibition, and activation of specific signaling pathways such as PI3K/Akt, MAPK, and ferroptosis. However, challenges such as low bioavailability, poor stability, and toxicity are still obstacles in their application. Through a medicinal chemistry approach, these compounds can be structurally modified or reformulated to improve their clinical effectiveness. In conclusion, the combination of natural wealth with medicinal chemistry innovation opens up great opportunities in the development of more selective, effective, and safe anticancer therapies in the future.