Layanan Painless Labor dan Jaminan Kesehatan Nasional di Indonesia
Abstract
Persalinan dikenal sebagai salah satu pengalaman paling menyakitkan bagi wanita, dengan derajat nyeri ringan hingga sangat berat. Nyeri persalinan disebabkan oleh faktor fisiologis (seperti kontraksi uterus, dilatasi dan penipisan serviks), serta faktor psikologis (seperti stress dan kecemasan), dan diketahui dapat menimbulkan dampak yang membahayakan baik bagi kesehatan ibu maupun bayi. Nyeri persalinan menyebabkan peningkatan stimulasi simpatis, hiperventilasi, hipoksemia, alkalosis respiratorik, penurunan perfusi uteroplasental, nyeri kronik, serta gangguan psikis jangka panjang. Painless labor (persalinan tanpa rasa sakit) dengan teknik analgesia neuraksial, seperti epidural labor analgesia, dianggap sebagai solusi efektif untuk mengurangi nyeri persalinan dan mencegah komplikasi. Beberapa kondisi klinis dan komorbiditas dalam kehamilan dapat diuntungkan dengan penggunaan painless labor, misalnya kondisi penyakit kardiovaskular, karena dinilai mampu menjaga stabilitas hemodinamik. Konsensus internasional pun menyepakati bahwa permintaan pasien saja sudah cukup menjadi indikasi dilakukannya tindakan painless labor. Namun, implementasi painless labor di Indonesia menghadapi tantangan besar, seperti keterbatasan cakupan pembiayaan kesehatan. Jaminan Kesehatan Nasional (JKN) dapat menanggung biaya prosedur ini hanya untuk kasus-kasus dengan komorbiditas tingkat sedang hingga berat. Kebijakan ini berbeda dengan asuransi swasta yang menawarkan cakupan lebih luas. Mengingat manfaat analgesia persalinan terhadap kesehatan ibu dan bayi, peningkatan akses dan penggunaan prosedur painless labor dapat menjadi tindakan yang efektif biaya di Indonesia.
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Jurnal Anestesi Obstetri Indonesia
