The Students’ Comprehension on the Philosophy of Maternity Care “Women Centered Care” Based on the Report of Continuity of Care (COC)

Background: The mortality rate of maternal woman in Indonesia has significantly increased reaching 359 per 100.000 live births. One solution to decrease the number of mortality rate of maternal woman is through high quality maternity care. The qualified midwifes come from a standard of education based on the philosophy of maternity care. Continuity care (COC)maternal clinic model of learning is proven in giving wide chances for the student to learn the philosophy. Objectives: reveals the level and form of students’ comprehension toward the maternity care “woman centered care”philosophy, the application of PKK-CoC, and the quality of maternity careCoC in STIKES Estu Utomo Boyolali. Method: this study is carried under mixed method and sequential explanatory strategy. The quatitative parts are fulfilled by the use of analitic descriptive design, while the quantitative side is carried under case study design. The population and sample of this study is 55 students of STIKES Estu Utomo Boyolali who have taken PKK-CoC. The sample for qualitative design is taken using mixed purposive sampling which are criterion and intensity sampling. Result: qualitatively, students overall comprehension is good. However, the documentation of maternity carein partnership care is still ineffective. Quantitatively, students overall comprehension on personalized care, holistic care, collaborative care, and evidence based care is also good. Partnership care is the only aspect considered in effective. Conclusion: the maternitycare continuity of care shows that client and family are in good heatlth, all the caregiven shows zero mortality rate, client fells safe and comfortable, and client has correct and fast care. It is also found that students’ confidence, skills, and comprehension are increased. It is suggested that the stakeholder can include the PKK-CoC model into curriculum of midwife education.


INTRODUCTION Background
The mortality rate of maternal womanin Indonesia, based on Indonesian health demography survey, reaches 359 / 100.000 live births on 2012. The efforts to decrease AKI include the provision of competent and professional midwife. This provision is preceded by building a qualified educational institution which is able to deepen the students' comprehension on midwife philosophy "womwn centered care" and facilitate the students in experience gathering and fuillfil their duty to public.
The practice of midwife cliniccontinuity of care (PKK CoC) is proven in widening the chance of the students to enhance their comprehension of maternitycarephilosophy. The effort to enhance students comprehension is carried by theoretical addition and practical implementation to give broad, real and comprehensive experients for the students.
Maternity careon most of the midwife education institution is still using maternity care case target (report quantity evaluation) without any preparation and experience on maternity care continuity (continuity of care) which is unrelated to the philosophy of maternity care.
Thus, a study revealing students' comprehension of maternity care philosophy using continuous maternity care (continuity of care) report is needed.

Method
This study is carried under mixed method design and sequential explanatory strategy in which the quantitative data collection and analysis is applied first then followed by qualitative analysis. Quantitative aspect of this study is carried under descriptive analytics while qualitative aspect is carried under case study design.
The sample used for quantitative study is the whole population which is 55students of STIKES Estu Utomo Boyolali who have done PKK-CoC.While qualitatively, the sample is 5 students from 4 th semester of STIKES Estu Utomo Boyolali in praktik klinik kebidanan continuity of care taken using mixed sampling method (criterion and intensify sampling).

Result
Qualitatively, the comprehension of students on every aspect (personalized care, holistic care, partnership care, collaborative care and evidence based care) is good. The problem occurs on documentation the report of maternity care on partnership care aspect. Quantitatively, the researcher found similar problem in partnership care.
The result of quantitative study can be seen on table 4.5. below. From the table, the best comprehension is collaborative care and evidence based care aspect. Students'comprehension that still needs to improve is partnership care aspect.However, overall understanding of the aspects in the philosophy of maternity care "women centered care" is good.

DISCUSSION
The results of this study are in line with Anue (1) and Gray (6) learning model midwife clinic Continuity of Care (PKK-CoC). This model is proven in giving broad chances to improve students' comprehension on the philosophy of maternity care"women centered care".
Brooke (2) and Carolan (3) stated that the philosophy of "women centered care"consists of cares that fulfill clients' needs, attend clients' physical, psychological, psychosocial, spiritual and cultural needs, collaborate with clients, consult and collaborate with other health institution when needed, and give case based on the latest literature available. Maternity care reports of D III midwife students of STIKES Estu Utomo Boyolali contain every aspect of philosophy of maternity care "women centered care"and the data contained are good written and clear.

CONCLUSION
The practice of midwife clinic continuity of care in STIKES Estu Utomo Boyolali has applied the philosophy of maternity care "women centered care". The comprehension of students of D III Kebidanan STIKES Estu Utomo Boyolali based on maternity care continuity of care reports can be categorized as good. Every student has good level of comprehension, especially on personalized, holistic care, collaborative care and evidence based care aspects. However, the comprehension on partnership care aspect need to be improved, The students' comprehension can be seen through their application of every aspect and their ability on describing the procedure and function of every aspect. The quality of maternity care "Continuity of Care" in STIKES Estu Utomo Boyolali is good since the clients and their family arein good condition and there are zero mortality rates. The clients are also feel comfortable, safe and cared since they got correct and fast responses. The students then become more confidence, more skillful, and more competent.