JNK

JURNAL NERS DAN KEBIDANAN

(JOURNAL OF NERS AND MIDWIFERY)

http://jnk.phb.ac.id/index.php/jnk

Herbal Rujak Soup Accelerates Uterine Involution On Postpartum Mothers

Mariati1, Afrina Mizawati2, Ferly Yorenza3
1,2,3Midwifery Department, Poltekkes Kemenkes Bengkulu, Indonesia

Article Information Abstract

According to the World Health Organization (WHO) in 2021, the highest mothers’

mortality rate cases occurred in Africa with 525 deaths per 100,000 live births and

the lowest was in Europe with 13 deaths per 100,000 live births. The most common

cause of mothers mortality rate in Indonesia in 2019 was caused by several cases

such as bleeding (30.32%). Uterine atony occurs due to failure of uterine

contractions to control bleeding after delivery, causing uterine subinvolution. This

process is known as uterine involution. The herbal composition of rujak soup is

useful for preventing blood clots due to a compound called gingerol in ginger. The

type of research used in this study was a quasi-experiment with a two-group post-

test design. The population in this study was postpartum mothers from the first day

to the tenth day of postpartum at PMB F Bengkulu City as many as 117 people with

a sample of 30 respondents. The statistical test used was the Independent T-test. The

results of this study indicate that the average acceleration of uterine involution on

the seventh day is known that in the herbal soup rujak group is 4.73 and the uterine

involution acceleration in the palm juice group is 5.40 with a mean difference

between the herbal kuah rujak group and the date palm juice group. 0.67. There was

an effect between the group of herbal ingredients of rujak sauce and the palm juice

group on the TFU on day 7 with a p value = 0.038 and a mean difference of 0.67.

This proves that the herbal rujak soup accelerates uterine involution more. It is

hoped that the PMB of the Telaga Dewa Working Area will continue to promote

complementary medicine with herbal ingredients to reduce the use of chemical

drugs and help deal with problems during the postpartum period.

History Article:

Received, 16/04/2022

Accepted, 04/04/2023

Published, 30/04/2023

Keywords:

herbal rujak soup,

uterus involution

Correspondence Address:

Poltekkes Kemenkes Bengkulu - Bengkulu, Indonesia P-ISSN : 2355-052X

Email : afrinamizawati@poltekkesbengkulu.ac.id E-ISSN : 2548-3811

DOI: https://doi.org/10.26699/jnk.v10i1.ART.p025-031

This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/)

http://jnk.phb.ac.id/index.php/jnk
mailto:afrinamizawati@poltekkesbengkulu.ac.id
https://doi.org/10.26699/jnk.v10i1.ART.p018-024

26 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 25-31

INTRODUCTION

According to the World Health Organization

(WHO) in 2021, the highest mothers’ mortality rate

cases occurred in the African region at 525 deaths

per 100,000 live births and the lowest was in the

European region at 13 deaths per 100,000 live

births (WHO, 2021). The most common causes of

mothers’ mortality rate in Indonesia in 2019 were

caused by several cases, such as bleeding (30.32%),

hypertension in pregnancy (25.25%), infection

(4.90%), circulatory system disorders such as

anemia, hypertension (4 74%), metabolic disorders

such as constipation, excessive nausea and

vomiting (3.72%) and others (31.06). Postpartum

postpartum (PPS) is caused by 70% uterine atony,

20% trauma, and 10% abnormal placenta (POGI,

2016).

Uterine atony refers to the corpus uteri

myometrial cells inadequate contraction in response

to endogenous oxytocin that is released in the

course of delivery. It leads to postpartum

hemorrhage as delivery of the placenta leaves

disrupted spiral arteries which are uniquely void of

musculature and dependent on contractions to

mechanically squeeze them into a hemostatic state.

Uterine atony is a principal cause of postpartum

hemorrhage, an obstetric emergency. Globally, this

is one of the top 5 causes of maternal mortality.

(Gill P, et al 2023). The process of involution is the

return of the uterus to its pre-pregnancy state after

childbirth. The normal involution process is

characterized by the height of the uterine fundus

being half the center of the symphysis in the first

week. The process of uterine involution includes

the effects of oxytocin, autolysis, and tissue

atrophy. (Deussen AR, et al 2020).

Prevention of involution starts from the third

stage of labor, namely after the baby is born,

palpate the fundus to ensure a single fetus, inject

oxytocin and make sure the placenta is complete,

and continue with the fourth stage. Involution can

be medical (injections, massage, mobilization and

drugs) and non-medical (traditional) with herbal

drinks (jamu) and date palm juice. Dates juice

contains a hormone similar to the hormone

oxytocin, which is a hormone produced by

neurohypophysis (Zubova TV, et al 2021). Herbal

drinks (jamu) were popularized by the people of

Ternate as rojak sauce. The herbal soup rujak

comes from processed lemongrass, ginger,

galangal, turmeric, jaewa acid, palm sugar,

coriander and pepper plants (Nurkila and Rosida

2013). Composition The herb rujak rujak is useful

for preventing blood clots due to the presence of a

compound called gingerol in ginger.

Gingerol is a compound that can prevent

blood clots and turn into anticoagulants. Selenium

in palm sugar can relieve cramps and pain during

menstruation. In addition, brown sugar prevents the

occurrence of blood clots, so as to prevent infection

and sub-involution on days 1-10 of the puerperium,

in line with the research of Nurkila and Rosida

(2015) there is an effect of Herbal Rujak soup on

the process of postpartum stinging which is felt by

other postpartum mothers. discharge of puerperal

blood or lochia such as blood more smoothly out,

odorless puerperal blood, no abdominal pain and

other benefits to the body. Dates are a fruit that is

rich in benefits. Dates with various contents that are

useful in the body's metabolic processes are very

beneficial for health if consumed properly. Saryono

et al. (2016) stated that dates can prevent anemia,

help the involution process and improve milk

quality.

The herb used during the postpartum period is

known for generations as rujak spice which consists

of 8 medicinal plants namely ginger, turmeric, betel

leaf, bay leaf, tamarind, lemongrass, pepper and

brown sugar/palm (Muti'ah, 2014). This herb is

believed by the community to reduce post-partum

pain and almost all women use rujak spices during

the puerperium (Ani and Kusumawati, 2018).

The most important benefits felt by mothers

regarding the effect of the Herbal Rujak soup on the

postpartum period were the discharge of

postpartum blood or lochia more smoothly,

odorless puerperal blood, no abdominal pain and

other benefits to the body. Then the research of

Nurkila and Rosida (2013) explained that the

benefits of rujak herbs that were felt by postpartum

mothers, one of which was that there was no

abdominal pain. During the puerperium there will

be physiological changes, one of which will

involute the uterus so that postpartum mothers often

complain of abdominal pain (Laili, 2019). Ginger

and turmeric are plants used in ruja seasoning.

Postpartum mothers start consuming rujak herbs for

7-14 days during the puerperium and are consumed

2 times a day. The herbal content of the rujak

seasoning used in the rujak spice concoction

contains active compounds that can produce an

analgesic effect. For example, the plants used in the

rujak seasoning, namely ginger, lemongrass,

turmeric, betel leaf, bay leaf, pepper and tamarind,

contain anthocyanins that can act as analgesics.

Yorenza, Mariati, Mizawati, Irawandi, Herbal Rujak Soup Accelerates Uterine Involution on Postpartum … 27

In a study conducted by Anita (2020),

postpartum mothers who consumed traditional

rujak spices experienced a 31.70% decrease in

uterine diameter compared to postpartum mothers

who did not consume these herbal medicines.

Based on the results of an initial survey conducted

at the PMB in the Telaga Dewa Community Health

Center, Bengkulu City, data on the number of

postpartum mothers from January-December 2020

was obtained at PMB F as many as 117 people,

PMB O 96 people and at PMB M 19 people.

Preliminary study conducted at PMB F, postpartum

mothers only mobilize and exercise postpartum to

accelerate the involution process, there is no

complementary therapy applied to all postpartum

women regarding the benefits of giving rujak herbs

to accelerate the process of involution in

postpartum mothers with a high average involution.

occurred for 10 days.

Based on the data above, the authors

conducted a case study because there were still

many mothers who did not know that the involution

process could be accelerated by using rujak herbs,

so the authors were interested in conducting a case

study entitled "The Effectiveness of Rujak Rujak

Herbals on the Acceleration of Uterine Involution

in Postpartum Mothers in the Independent Practice

of Midwives in Bengkulu City in 2022”.

METHODS

The type of the research was quantitative

research. The design used in this study was a quasi-

experimental design, namely by looking at the

acceleration of uterine involution in postpartum

mothers from the first to the 10th day. using the

observation sheet. The design used in this study

was a two-group post test design. The population in

this study were all postpartum mothers from the

first day to the tenth day of postpartum at PMB F

Bengkulu City as many as 117 people. The sample

in this study were postpartum mothers in the

Bengkulu City Midwife Independent Practice. The

sample was divided into two groups, namely 15

samples in the intervention group and 15 samples in

the control group, with a total sample of 30 samples

This study used bivariate analysis which is

processed using computerization. Bivariate analysis

was used to see the effect of the independent

variable on the independent variable. The analysis

in this study to see the difference in the acceleration

of uterine involution between postpartum mothers

who were given Herbal Rujak soup and the group

of postpartum mothers who were given Sari Kurma

was performed with the Independent T Test if the

data distribution was normal or the Man Whitney

Test if the distribution was not normal.

RESULT

Table 1: Frequency Distribution of Age, Parity, IMD History of Post Partum Mothers in the Independent

Practice of the Telaga Dewa Midwife, Bengkulu City.

Variabel Herbal Rujak soup Sari Kurma

N % N %

Usia

< 20 tahun dan > 35 tahun

20 – 35 tahun

6,7

93.3

Paritas

Grandemultipara

Primipara/ Multipara

26,7

73.3

33.3

66.7

Riwayat IMD

Tidak

33,3

66,7

46,7

53,3

Source: Primer

Table 1 shows that, the age category of respondents 20-35 years was 14 people (93.3%), and in the date

palm juice group, respondents aged 20-35 years were 12 people (80%). From the table, it shows that in the

herbal soup group, there are 11 people (73.3%) who have primipara/multipara parity and in the palm juice group

there are 10 people (66.7%) who have primipara/multipara parity. Based on the table above, it is also known that

in the herbal rujak soup group there were 5 people (33.5%) who did not do IMD and in the palm juice group

there were 7 people (46.7%) who did not do IMD.

28 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 25-31

Table 2: Average acceleration of uterine involution in post partum mothers in the Independent Practice of

the Telaga Dewa Midwife in Bengkulu City.

Kelompok Intervensi N Max Min Mean Beda Mean Standar Deviasi

Herbal Rujak soup H3 15 11 9 9.67

0,73

0.724

Sari Kurma H3 15 11 9 10.40 0,632

Herbal Rujak soup H7 15 6 4 4.73

0,67

0,828

Sari Kurma H7 15 7 4 5.40 0,799

Source: Primer

From table 2 it is known that the average value of uterine involution acceleration on the third day in the

herbal soup rujak group is 9.67 and the acceleration of uterine involution in the palm juice group is 10.40 with a

mean difference between the herbal soup and dates group of 0.73. The average acceleration of uterine involution

on the seventh day is known to be 4.73 in the herbal soup rujak group and the uterine involution acceleration in

the palm juice group is 5.40 with a mean difference between the rujak herbal group and the date palm juice

group of 0.67.

Table 3: The Effect of Rujak and Sari Kurma Herbs on the Acceleration of Uterine Involution.

Intervensi N Mean Beda Mean Z P

TFU H3 Sari kurma 15 9.67 0,73 -2.618 0.009

herbal rujak 15 10.40

TFU H7 Sari kurma 15 4.73 0,67 -2.079 0.038

herbal rujak 15 5.40

The results of the bivariate analysis in table 4.5 above show that there is an effect between the group of

herbal ingredients of rujak sauce and the palm juice group on TFU on day 3 with p value = 0.009 and a mean

difference of 9.67. While TFU on day 7 with a p value = 0.038 and a mean difference of 0.67 This proves that

the herbal soup rujak accelerates uterine involution.

Table 4: The relationship of external variables to the acceleration of uterine involution.

Source Type III Sum of

Squares

Df Mean Square F Sig.

Corrected Model 8.319a 3 2.773 5.322 .005

Intercept 329.486 1 329.486 632.335 .000

PERLAKUAN_KONTROL .494 1 .494 .948 .339

USIA 4.280 1 4.280 8.215 .008

PERLAKUAN_KONTROL *

USIA

.024 1 .024 .047 .830

Error 13.548 26 .521

Total 792.000 30

Corrected Total 21.867 29

Table 4 obtained from multivariate analysis shows that together it turns out that the intervention of rujak

herbal sauce, date palm juice and age affect uterine involution by 0.38%.

Yorenza, Mariati, Mizawati, Irawandi, Herbal Rujak Soup Accelerates Uterine Involution on Postpartum … 29

DISCUSSION

The results showed that the age category of

respondents 20-35 years was 14 people (93.3%),

and in the date palm juice group, respondents aged

20-35 years were 12 people (80%). The results of

this study illustrate that the average post partum

mother has a productive age which minimizes the

risk of complications in post partum mothers

including antonia uteri.

The results of this study also showed that in

the rujak soup herbal group there were 11 people

(73.3%) who had primipara/multipara parity and in

the palm juice group there were 10 people (66.7%)

had primipara/multipara parity. The results of this

study illustrate that post partum mothers have ideal

parity in having children which have a positive

impact on the pregnancy process. However, there

are still mothers who have grandemultipara parity

which can have an impact on the reproductive

system, one of which can inhibit the return of

uterine involution.

Based on the table above, it is also known that

in the herbal rujak soup group there were 5 people

(33.5%) who did not do IMD and in the palm juice

group there were 7 people (46.7%) who did not do

IMD. The results of this study indicate that the

average mother does IMD although there are still

many mothers who do not do IMD, this can happen

because of some problems that IMD cannot do.

There are still many mothers who do not do IMD,

this can be a problem in the process of uterine

involution which by doing IMD can respond to

hormones that can accelerate the process of uterine

involution.

Based on the table above, it is also known that

in the herbal rujak soup group there were 5 people

(33.5%) who did not do IMD and in the palm juice

group there were 7 people (46.7%) who did not do

IMD. The results of this study indicate that the

average mother does IMD although there are still

many mothers who do not do IMD, this can happen

because of some problems that IMD cannot do.

There are still many mothers who do not do IMD,

this can be a problem in the process of uterine

involution which by doing IMD can respond to

hormones that can accelerate the process of uterine

involution.

According to Kautsar (2011), many factors

can influence the involution process including

breastfeeding, early mobilization, nutritional status,

pariety and age. One of the factors that influence

uterine involution is age and parity. Mothers who

are older are much affected by the aging process.

undergo changes in metabolism, this will inhibit

uterine involution, mothers with high parity, the

process of involution becomes slower, because the

more often they are pregnant, the uterus will often

experience stretch.

The results showed that the average value of

acceleration of uterine involution on the third day

in the herbal rujak soup group was 9.67 and the

acceleration of uterine involution in the palm juice

group was 10.40 with a mean difference between

the herbal soup and dates group of 0.73. The

average acceleration of uterine involution on the

seventh day is known to be 4.73 in the herbal soup

rujak group and the uterine involution acceleration

in the palm juice group is 5.40 with a mean

difference between the rujak herbal group and the

date palm juice group of 0.67/

The results of this study illustrate that

postpartum mothers who are given the intervention

of rujak herbal sauce will experience accelerated

uterine involution faster than post partum mothers

who are given the intervention of date palm juice.

The puerperium lasts for approximately 6

weeks. This period the mother requires certain

actions that can speed up the involution process.

Uterine involution involves reorganization and

exfoliation of the decidua/endometrium and

exfoliation of the placental attachment site

characterized by a decrease in size and weight as

well as a change in the location of the uterus as

indicated by the color and number of lochia. If

there is failure of uterine involution to return to a

non-pregnant state, it will cause sub-involution.

The most common causes of uterine sub involution

are retained placental fragments, infection, and late

postpartum haemorrhage (Maritalia, 2014).

The results of this study found that there was

an effect between the group of herbal ingredients of

rujak sauce and the palm juice group on TFU on

day 3 with p value = 0.009 and the mean difference

was 9.67. While the TFU on day 7 with a p value =

0.038 and a mean difference of 0.67. This proves

that the herbal soup rujak accelerates uterine

involution more than giving date palm juice. The

results of this study are in accordance with the

research research of Nurkila, S. Rosida Hi.S, (2015)

with the title The Experience of Consuming Rujak

Rujak Herbs in Postpartum Mothers in the Ternate

City Region. The results of the study found that the

most important benefits felt by the mother was the

effect of Herbal Rujak soup on the postpartum

period, namely postpartum blood loss or lochia

such as blood flowing more smoothly, odorless

30 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 25-31

postpartum blood, no abdominal pain and other

benefits to the body.

The results of this study are in line with

research conducted by Anita (2020), postpartum

mothers who consumed traditional rujak spices

experienced a decrease in uterine diameter by

31.70% compared to postpartum mothers who did

not consume these herbal medicines.

Based on the multivariate analysis, it was

shown that together, the intervention of rujak herbal

sauce, date palm juice and age affected uterine

involution (0.38%). The results of this study

explain that together from the 2 variables analyzed

for the intervention of herbal rujak sauce and palm

juice which are supported with age, it will

accelerate uterine involution. The presence of this

slight influence can occur due to other factors

where in addition to these four factors there are still

many factors that can affect uterine involution in

postpartum women, such as maternal parity where

in this study many mothers who were respondents

had primiparous and multiparous parity.

The process of uterine involution is strongly

influenced by the age of the mother at delivery. The

age of 20-30 years is an ideal age for a good

involution process to occur. This is due to because

of the elasticity factor of the uterine muscles,

considering that mothers who are over 35 years old

have reduced muscle elasticity. In addition, the

action of mobilization causes circulation

improvement, makes deep breathing and stimulates

normal gastrointestinal function again. With early

mobilization, uterine contractions will be good so

that the uterine fundus is hard, so the risk of

abnormal bleeding can be avoided, because

contractions constrict open blood vessels (Elisabeth

Siwi, 2017).

CONCLUSION

Based on the results of the research

conducted, conclusions were drawn, In the group of

rujak herbal soups in the age category of

respondents 20-35 years as many as 14 people

(93.3%), and in the palm juice group respondents

aged 20-35 years as many as 12 people (80%). In

the herbal soup group, there were 11 people

(73.3%) who had parity of primipara/multipara and

in the palm juice group there were 10 people

(66.7%) who had parity of grandemultipara. In the

herbal soup rujak group there were 5 people

(33.5%) who did not have IMD and in the palm

juice group there were 7 people (46.7%) who did

not do IMD. The average acceleration of uterine

involution on the seventh day is known to be 4.73

in the herbal soup rujak group and the uterine

involution acceleration in the palm juice group is

5.40 with a mean difference between the rujak

herbal group and the date palm juice group of 0.67.

There was an effect between the group of herbal

ingredients of rujak sauce and the palm juice group

on the TFU on day 7 with a p value = 0.038 and a

mean difference of 0.67. This proves that the herbal

soup rujak accelerates uterine involution more.

Taken together, it turned out that the intervention of

rujak herbal sauce, date palm juice and age affected

uterine involution by (0.38%).

SUGGESTION

Give herbal rujak soup to every postpartum

woman to accelerates uterine involution will be the

best solution to this case.

ACKNOWLEDGEMENT

This research was conducted between the

research team and the enumerators so thank you to

the director, head of the midwifery department,

lecturer and the enumerator at the Bengkulu

Ministry of Health Polytechnic.

FUNDING

The research is independently funded by the

research team.

CONFLICTS OF INTEREST

The authors declares that there are no

conflicts of interest in this research.

AUTHOR CONTRIBUTIONS

The research team was divided into 3 people

where Ferly played a role in data collection and

data analysis, Afrina Mizawati played a role in

mmothers mortality rateng research results and

Mariati in mmothers mortality rateng discussions.

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