The Effect Of Participation In Pregnant Women's Classes On Primigravida Anxiety Levels In Facing Childbirth At Pajarakan Health Center

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INTRODUCTION as old primigravida. Young primigravida are classified as high risk pregnancies (KRT) because the psychological and health of the mother and fetus can be high risk. Pregnancy is one of the conditions that can cause anxiety, although this condition is also something to be proud of because it will produce offspring as a complement and perfection as a woman. Pregnancy is a worrying thing because there is a feeling of fear and anxiety that something bad will happen to her during pregnancy and childbirth (Pane et al., 2021). The first pregnancy for a mother-to-be is a new experience marked by physical changes that cause various psychological problems. Physical changes in pregnant women cause psychological and emotional disturbances, causing ongoing worries until delivery (Mardjan, 2016). Worries and anxiety in pregnant women if not taken seriously can cause adverse effects on the pregnancy and the fetus (Rofi'ah et al., 2019). WHO data shows that about 5% of non-pregnant women experience anxiety, 8-10% during pregnancy, and this increases to 13% when they are about to give birth. From several researchers concluded that most women who have never given birth expressed anxiety about childbirth (WHO, 2020).
The effect of high anxiety causes insomnia, increases maternal blood pressure, increases the risk of preterm labor, miscarriage and decreases maternal immune response (Wungouw, H., & Lolong, J, 2017). Several factors that influence the anxiety of pregnant women, namely; lack of information about pregnancy, husband and family support, environment, health factors of pregnant women, attitudes of pregnant women towards pregnancy, the process of adjusting to pregnancy both physically and psychosocially, as well as information about the frightening experience of childbirth (Novitasari, 2013). Mother's knowledge obtained from positive education and information has an important role in reducing anxiety levels so that a learning method for pregnant women classes is developed that can provide information and exchange experiences in groups of pregnant women called pregnant women classes.
Research and prospective studies by Dewi and Pramono (2015) observing the anxiety of pregnant women in the transition to parenthood. The study was conducted using a STAI (State-Trait Anxiety Inventory) measuring instrument with 100 pregnant women in Australia as respondents. The results obtained are that 21% of pregnant women experience temporary anxiety disorders, 24% of respondents have basic anxiety, and 7% have depression. Research conducted by in West Java stated that attending classes for pregnant women and husband's support have an important role for pregnant women, especially when pregnant women experience complications during pregnancy and childbirth (Tuti, 2019).
The Pajarakan Health Center has a work area that includes 12 villages with a target number of pregnant women in 2020 as many as 708 people, a target number of pregnant women with high risk of 142, the number of obstetric complications being handled by 83 people of which 54 people occur in primigravida. The results of direct interviews in the MCH room of the Pajarakan Health Center from 10 primigravida mothers with the third trimester of pregnancy showed that 8 mothers expressed anxiety in facing their delivery. The purpose of this study, among others, to analyze the effect of participation in the class of pregnant women on the anxiety level of primigravida in dealing with childbirth at the Pajarakan Health Center.

MATERIAL AND METHODS
The type of research used is pre-experimental research. According to Sugiyono (2016), Pre-Experimental is research that has not been a real experiment, because there are still external variables that also influence the formation of the dependent variable. This research approach is a pre experimental approach, called Pre Experimental Design. This research uses One-Group Pre-Post-test Design. The technical design is that before the researcher gave a pre-test to the group. Then the researchers did the treatment or treatment.
According to Sugiyono (2017) with the One-Group Pre-Posttest Design, namely the results of the treatment can be known more accurately because it can compare with the situation before being given treatment. This research was conducted at Pajarakan Public Health Center located in Probolinggo Regency. The time of collecting research data was in March 2022. The population in this study was Primigravida in the Pajarakan Health Center area. This study contains the criteria used in Primigravida pregnant women who attend classes for pregnant women at Pajarakan Health Center only so that it can be determined that the number of samples in this study is 30 Primigravida mothers. The independent variable (independent) is participation in the class of pregnant women. While the dependent variable (dependent) is anxiety. The moderating variables are age, education level, socio-economist, attitude and knowledge. The data analysis technique used univariate and bivariate with linear regression statistical test.

RESULTS AND DISCUSSION
The research was conducted in March 2022 at the Pajarakan Health Center, Probolinggo Regency. The data of this study were collected from questionnaires that had been filled out by 30 respondents. Measurement of anxiety levels before and after classes for pregnant women can be measured using the bivariate test. In this study, the Wilcoxon signed paired test was used to test between two paired variables. The results of the characteristics of 30 respondents based on age, education level, and family income are listed in this description. The Wilcoxon test on the pre and post tests are:  Table 1 describes the frequency distribution of respondents showing that the majority of respondents' ages are in the age range of 20 to 35. The education level of the majority of respondents is undergraduate education. The majority of respondents' family income is between 2.5-3.5 million rupiah. This means that the majority have a good socio-economic level, seen from their income according to and even more than the Regional Minimum Wage (UMR) of Probolinggo Regency.
The Wilcoxon test on pre and post tests was based on the mother's knowledge regarding pregnancy and childbirth, measuring primigravida attitudes and measuring anxiety levels as follows. The results of the Wilcoxon test obtained a positive rank of 28, which means a number of 28 informants, especially knowledge from pretest to posttest increased, the average increase was 0.5 and the value of ties 2 which means that there are 2 respondents with the same pretest and posttest values, a significant value of 0.000 which makes it clear if participation in the class of pregnant women affects the level of knowledge of pregnant women on primigravida mothers during childbirth at the Pajarakan Health Center. Factors that play a vital role related to changes in the attitudes of informants in this study are responses to the class of pregnant women, in addition to the participation of feelings and emotions. The test results are based on Table 3. The Wilcoxon test results obtained positive ranks of 30, meaning that 30 informants' attitudes from pretest to posttest increased by an average of 15.5 or an average increase of 15.5. The ties value is 0 which means there is no similarity in the values before and after the class of pregnant women and the significant value is 0.00 because 0.00 <0.05. The results make it clear that the participation of pregnant women affects the attitude of the primigravida during childbirth.
The results of the Wilcoxon test got negative ranks of 30 or 30 respondents experienced a reduction in anxiety levels from before and after being involved in the pregnant women class, the mean ranks of 15.5 which means the average reduction is 15.5. The significance value in this study is 0.000, if there is a difference in the level of anxiety between before and after attending classes for pregnant women. These results can give a conclusion if there is an effect of class participation of pregnant women on the level of anxiety of primigravida mothers during the childbirth process at the Pajarakan Health Center.
After the frequency distribution of respondents, the Wilcoxon test on the pre and post tests are:  Table 4 explains that before taking the class for pregnant women, the majority of respondents experienced severe anxiety as many as 23 people or 76.6%, while the lowest was mild anxiety because no one experienced it (0%). After experiencing the class of pregnant women, the highest number of respondents experienced mild anxiety by 24 people or 80%, while the lowest was that no pregnant women experienced anxiety.
Wilcoxon test results obtained negative ranks of 30, which means 30 respondents experienced a reduction in anxiety levels from before and after taking the class for pregnant women, the mean ranks of 15.5 which means the average reduction is 15.5. The significance value in this study is 0.000, which means that there is a difference in the level of anxiety between before and after attending the class for pregnant women, so it can be concluded that there is an effect of participating in the class for pregnant women on the anxiety level of Primigravida mothers in facing childbirth at the Pajarakan Health Center.
Changes in anxiety levels are in accordance with the objectives of the pregnant women class, namely increasing knowledge, changing attitudes and behavior of mothers to understand about pregnancy, body changes and complaints during pregnancy, pregnancy care, childbirth, postpartum care, postnatal family planning, newborn care, myths Local beliefs/customs, infectious diseases and birth certificates and the expected outcomes in the class for pregnant women, namely the interaction and sharing of experiences between participants (pregnant women and pregnant women) and pregnant women with midwives/health workers about pregnancy and childbirth. The learning method used in the class for pregnant women, for example, sharing experiences and solving problems together greatly supports the increase in knowledge and attitudes so that the anxiety level of pregnant women will decrease and there will be no anxiety.

Differences in Primigravida Knowledge on Levels of Anxiety in Facing Childbirth before and after Taking Pregnant Women's Classes
The level of knowledge of pregnant women after taking the class for pregnant women has changed, namely the addition of the score, the results of the Wilcoxon test obtained a Positive Ranks value of 28, which means that after the class for pregnant women, it was found that there was an increase in post test scores for 28 respondents. The addition of the level of knowledge is evidenced by the addition of an average of 12.5 points, the significance value in this study obtained a significance result of 0.000 this means that the participation of pregnant women classes affects the knowledge level of Primigravida mothers or there is a difference in the level of knowledge of primigravida before and after attending the class pregnant mother. This difference occurs in the level of knowledge of respondents before attending classes for pregnant women, most of them are classified as moderate level of knowledge, After attending the class for pregnant women, most of the respondents belonged to a good level of knowledge. The results of this study are in accordance with the opinion of the Ministry of Health (2014) that the increase in the ability of mothers to adapt occurs because of the addition of information to the mother through class activities for pregnant women, so that the class for pregnant women is one form of effort that can be done by pregnant women to reduce or manage anxiety what he experienced.
Attitudes are not brought from birth but are formed and learned throughout the person's development in relation to the object. Attitude is simply a tendency to act on an object in a way. So, attitude is a person's closed response to a certain stimulus or object, which already involves the relevant opinion and emotion factors (happy-not happy, agree-disagree, good-bad, and so on) ( Notoatmodjo, 2010). The class activities for pregnant women have a positive influence on the anxiety level of primigravida mothers when facing childbirth, so that the anxiety level of primigravida mothers who take classes for pregnant women is lower/mild compared to primigravida mothers who do not take classes for pregnant women (Nilsson et al., 2018).
The knowledge obtained by primigravida in the class of pregnant women is influenced by understanding of the material obtained, according to Mulyasa's opinion quoted in Hartono's book, he concludes that understanding in the learning process can be developed by giving trust, free communication and self-direction, with this learning method so that someone will understand the lesson if self-confidence is developed, so that it will be easier to understand the material provided, provide opportunities for participants, communicate freely and purposefully, involve participants actively and creatively in the overall learning process so that participants' understanding of learning can be achieved.

Primigravida's Attitude to Anxiety Levels in Facing Childbirth Before and After Taking Pregnant Women's Classes
The results of the study prove that there is a difference in attitude values between before and after attending class. The value of Positive Ranks in this study is 30, which means that after the class for pregnant women, an additional attitude value was found. the addition of these attitudes with an average addition of 15.5 points. The significance value in this study obtained a significance value of 0.000. This means that the class of pregnant women affects the attitudes of Primigravida mothers at the Pajarakan Health Center or there are differences in attitude values before and after attending classes for pregnant women. The ties value in the Wilcoxon test is 0, which means that there is no similarity in values between the post-test and pre-test or before and after attending classes for pregnant women. Before the pregnant women class, the respondents already had a positive attitude. The results of the study are in accordance with the statement of the Ministry of Health (2019) which states that classes for pregnant women are facilitated by midwives/health workers with the aim of increasing knowledge, changing attitudes and behavior of mothers in order to understand pregnancy, childbirth and to prevent physical and mental illness. The opinion of Wawan and Dewi (2009) that a person's knowledge about an object contains two aspects, namely positive aspects and negative aspects. These two aspects will determine a person's attitude, the more positive aspects and objects that are known, the more positive attitudes will be towards certain objects. change the attitude and behavior of mothers in order to understand about pregnancy, childbirth and can prevent physical and mental illness. A person's knowledge about an object contains two aspects, namely positive aspects and negative aspects. These two aspects will determine a person's attitude, the more positive aspects and objects that are known, the more positive attitudes will be towards certain objects (Wungouw, H., & Lolong, J, 2017). change the attitude and behavior of mothers in order to understand about pregnancy, childbirth and can prevent physical and mental illness.

Primigravida Anxiety Levels in Facing Childbirth before and after Taking Pregnant Women Classes
The anxiety level of primigravida before and after attending classes for pregnant women has changed. The results showed that before taking the class for pregnant women, most of the respondents were classified as severe anxiety, after attending the class, most of the pregnant women were classified as mild anxiety, the results of the bivariate test obtained a negative rank of 30 which means that after attending the class for pregnant women there was a reduction in the level of anxiety with an average reduction. as much as 15.5 points. The significant value is 0, it can be interpreted that the participation of pregnant women has an effect on the anxiety level of primigravida mothers in facing childbirth. This change occurred because of the provision of information or learning in the class of pregnant women so that the mother's knowledge increased in the end being able to overcome her anxiety. The implementation of the mother's class is useful in terms of preparing both physically and psychologically for the mother in facing childbirth. In terms of psychology, the mother's activities can increase self-confidence enough in facing childbirth. This was mainly due to the fact that during the pregnancy class participants were given counseling about childbirth, postpartum care and newborn care. So that through class activities pregnant women participants can be better prepared and anxiety can be reduced in facing childbirth (Mulyani et al., 2009). In line with Adrestia, et al from research on the behavior of pregnant women's class participation with anxiety levels in dealing with childbirth in third trimester primigravida pregnant women in Kalisapu Village that there is a significant correlation between class participation of pregnant women and primigravida anxiety (Pratiwi, K., & Sukmayanti, L. M., 2020).
According to researchers, the participation of pregnant women in pregnancy classes will affect the mother's mental readiness in facing childbirth. From the results of the study, most pregnant women before taking pregnancy classes, more respondents experienced severe levels of anxiety than pregnant women after attending pregnancy classes would feel calmer in the face of childbirth. the existence of a class of pregnant women will have an influence on pregnant women in the process of preparing for childbirth. This results in the mental readiness factor of pregnant women in facing childbirth. Based on the assumption of the researcher, 30 primigravida respondents actively participated in the class for pregnant women. In this study, the mother's class was proven to have a positive impact on the psychology of the mother in dealing with childbirth. The provision of learning about all aspects related to maternal and infant health by health workers in the pregnant class can increase the mother's confidence in dealing with childbirth and be able to recognize the problems that occur in the mother and baby. The provision of learning about all aspects related to maternal and infant health by health workers in the pregnant class can increase the mother's confidence in dealing with childbirth and be able to recognize the problems that occur in the mother and baby.

CONCLUSION AND SUGGESTION
Based on the results of the analysis and hypothesis testing, it can be concluded that 1) The knowledge level of Primigravida mothers at the Pajarakan Health Center before the pregnant women class was included in a good level of knowledge while the attitude of Primigravida pregnant women at Pajarakan Health Center before the mother class pregnant is included in a positive attitude; 2) There is an increase in the level of knowledge of pregnant women at the Pajarakan Health Center after attending a class for pregnant women; 3) there is a reduction in the level of anxiety in primigravida women at the Pajarakan Health Center after attending classes for pregnant women.
Based on the results of the study, suggestions were obtained, including 1) Develop research through further research by developing research variables, increasing research into experimental research methods. It is hoped that the results of this study can contribute to improving the health of pregnant women and preventing the occurrence of obstetric complications caused by the anxiety of pregnant women in facing childbirth; and 2) It is expected to improve the implementation of classes for pregnant women with both quality and quantity and can involve all pregnant women in the Pajarakan Health Center Work Area to participate with the aim that all pregnant women have good knowledge and positive attitudes so as to prevent maternal anxiety in facing childbirth and obstetric complications.