Influence of Antenatal Care 10T to the Statisfaction of Pregnant Maternal in Asyifa Clinic Meurah Dua Sub-District Pidie Jaya Regency

. The policy of Health Departmentin an effort to accelerate the reduction in Maternal Mortality Rate (MMR) and under-five Mortality rate (IMR) basically refers to the strategic intervention “the Four Pillars of the Safe Motherhood” (Family Planning, Antenatal Care,childbirth and Obstetric care Essential). Coverage K4 indonesia (2006 – 2018), the coverage of health services for expectant mothers K4 tend to increase. This study aimed to analyze the influence of antenatal care 10T to the satisfaction of pregnant women in the Clinic Asyifa Kecamatan Meurah Dua Pidie Jaya District.This stuay was a quantitaive with quasy experiment. It was conducted in Asyifa Clinic, Meurah Dua Sub-District Pidie Jaya District. The population was 20 respondents. The sample of this study was taken from all tottal population. Data were analyzed by using Wilcoxon Signed Rank Test.The result showed before intervention 10T, the number of satisfying and disatisfying of mothers of 10 respondents (50.0%). But after intervention 10T, the mother who satisfied increased to17 respondents (85.0%), and 3 (15.0%) respondents were dissatisfied. It was found influencing of Antenatal Care 10T to satisfying of maternal with p-value 0.000.The conclusion drowned the influence of antenatal care 10T to the satisfaction of pregnant women in the clinic Asyifa District MuerahDua Pidie Jaya District in 2019. It is suggested to health services can be a reference for improving the quality of service and degree of public health associated with the service of the ANC is better by applying standard 10T . Importance Performance Analysis Pregnant Women's Satisfaction Antenatal Services. This employed a cross sectional design. research the YB Balige clinic Samosir Regency using an analytical observational technique with a cross sectional approach. The whole sampling approach used to choose 32 respondents, meaning all pregnant women who the YB Balige Clinic in Toba Samosir Regency. Patients with the ANC YB Balige


INTRODUCTION
The development of the nation's health is an essential aspect of its overall growth. The SDGs (Sustainable Development Goals) that must be completed by 2030 may be It's one of the development goals to reduce the maternal mortality rate (MMR). We need require effective antenatal care in order to lower the MMR (pregnancy, delivery, and postpartum) by at least four times throughout pregnancy; one time in the first trimester, one in the second, and two in the third (Fitrayeni et al., 2017).
Strategic intervention "Four Pillars of Safe Motherhood" is referred to as the Ministry of Health's policy to reduce the Maternal Mortality Rate (MMR) and the Underfive Mortality Rate (IMR) (Family Planning, ANC, clean and safe delivery, essential obstetric services) Initiation of Actions MMR can be reduced faster if pregnant women and new mothers have access to high-quality maternal health services, including as prenatal care, labor assistance from medical professionals, and additional support in the event of difficulties during delivery.
Pregnant mothers and their fetuses benefit from antenatal care, which is a health service given by trained health personnel. If you have frequent, thorough antenatal care, you can catch any abnormalities or hazards that may occur throughout your pregnancy before they have a chance to cause harm. Indicators of prenatal care coverage are used to describe pregnant women's access to care. Health workers' initial contact with pregnant women is K1 (the first visit) and their fourth or more contact with competent health professionals is K4 (the fourth or more contact, according to standards) .
From 2006 to 2018, the K4 pregnant women's health coverage in Indonesia has steadily increased. 2018's success has met or exceeded the 88.03 percent goal set by the Ministry of Health Strategic Plan (Renstra) for 2018. K4 coverage in Aceh attained 79.14 percent in 2018 compared to the Restra target of 78 percent, which was established by the Indonesian government. The results demonstrate that this figure is quite close to meeting the national objective established by the government. Ten thousand-one When it comes to prenatal care, pregnant women's satisfaction with the quality of treatment is a major issue, since non-routine ANC visits can cause harm to pregnant women such as bleeding, because danger indicators of pregnancy are not noticed owing to the lack of ANC. Pregnant women are predicted to be more motivated and more satisfied with integrated ANC if it is provided on a more regular and routine basis, which is expected to result in more visits and more visits (1). Health checks, observations, and education are all part of the antenatal care program for pregnant women in order to ensure a safe and enjoyable pregnancy and birth. Antenatal care is a health service offered by health professionals to pregnant women and their fetuses to improve their overall health. When antenatal services are performed on a regular basis and completely, anomalies and hazards that may occur during pregnancy may be swiftly and adequately treated (Agustini, 2013).
To be considered high-quality, a woman's prenatal care must meet government standards, which include the following: 10 T (weighing and measuring weight and height; measuring blood pressure; assessing nutritional status (measuring upper arm circumference/LiLa); measuring uterine fundal height; screening for tetanus immunity; administering immunizations; administering blood-added tablets; (Agustini, 2013).
Adopting measures for prenatal care (pregnant women receive antenatal care at least 4 times). Pregnant women's access to health care and their degree of compliance in testing their pregnancies at least four times, in line with the visit time, is the focus of this activity. For pregnant women who participate in this activity, the goal is for early detection of pregnancy-related health issues and appropriate treatment. During prenatal care, health care providers assess a pregnant woman's nutritional state by evaluating her lipoprotein-to-amylase ratio (LiLA). 85.35% of pregnant women in 2016 and 86.35% of pregnant women in 2017 had had at least four visits to a prenatal care facility during their pregnancies (Direktoral Jenderal, 2017).
ANC service quality is one of the issues facing pregnant women's health care, and this may be considered as a problem with the availability of ANC services as a whole. ANC services are only as good as their providers and the people who utilize them. ANC coverage is an indicator of midwives' ability to deliver high-quality care to their patients, as well as of the general public's contentment with such services. If a patient is happy with the care they receive, that health service is considered high-quality. It is critical to conduct patient satisfaction surveys in combination with other measures of health service quality, such as quality of care (Lilis et al., 2019).
Quality of care is the most critical need in the health care industry. If a patient is happy with the service, it is considered high quality. Health care providers' (including midwives) easy-to-understand communication with patients goes a long way toward ensuring patient satisfaction. In other words, health care services are more than only medical treatment, but they are also communication-oriented since patients benefit much from it (Pohan, 2007).

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Women's needs, wants, and expectations in terms of prenatal care are addressed when they feel their service providers have met their needs, wants, and expectations. It's also possible to think about patient satisfaction in terms of how happy the patient is after comparing his actual sensations with his expectations. It's quite probable that a patient who is happy with the service's value will stick with it. After obtaining health care, the patient's contentment is a behavioral reaction. Decisions on whether or not to acquire the same service again in the future will be affected, as will the way in which information about the health care supplied is conveyed to others (Syafrudin & Taty, 2011).
For a health care facility's reputation and long-term viability, the level of satisfaction its patients express is critical. High levels of patient satisfaction show that the health care facility's vision and goal have been effectively implemented. Patients who are satisfied are more likely to return for more services in the future. There is a tendency to spread word of mouth recommendations from disgruntled patients in order to encourage others to use these health services (Walyani & Purwoastuti, 2015).
Interviews with 10 pregnant women who received antenatal care at the Syifa Clinic in Meurah two District, Pidie Jaya Regency, based on an initial survey conducted between May 8 and May 9, 2019, revealed that six respondents said that midwives did not respond to complaints from pregnant women, while four respondents said that responses to complaints from pregnant women, seven respondents said that the midwife was rushing to provide antenatal care. Customer satisfaction, according to Kotler's definition, is the degree to which the performance or outcomes (the services received and perceived) compare with what is expected. Parasuraman says that quality may be assessed in a number of ways, including responsiveness, trustworthiness, empathy, and the capacity to quantify one's work.
The purpose of the study was to analyze the effect of antenatal care 10T on the satisfaction of pregnant women at the Asyifa Clinic, Meurah Dua District, Pidie Jaya Regency in 2019

METHODS
Analytical survey research is quantitative study in which one representative result is compared to a research design that is not experimental in nature, allowing it to be applied to different populations. Quasi-experiments are generally referred to as quasiexperiments. They are research designs that purposefully assign various levels of certain independent variables to research subjects; in other words, the research subjects receive intervention using specific methods in order to maintain control of the research situation.
Obtaining this controlled study condition is analogous to what would occur in a pure experiment. The population for this study consisted of all pregnant women who received prenatal treatment at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in August, a total of twenty women. In this study, the complete population sampling methodology was applied, which means that the entire population was used as a sample. This study used a sample size of twenty respondents.
Questionnaires and nurse performance observation sheets are used to collect data. The acquired data was analyzed using univariate, bivariate, and multivariate analysis, as well as statistical analysis using the Statistical Package For The Social Sciences (SPSS).  Table 1 shows that of the 20 respondents, the majority of respondents aged 20-35 years were 16 people (80.0%), some respondents >35 years were 3 (15.0%), and a small proportion of respondents were <20 years old. 1 person (5.0%). According to Table 2, the majority of respondents have a secondary education (as many as 9 people, 45.0 percent), some have a higher education (as many as 7 people, 35.0 percent), and a minor number of respondents have a basic education (as many as 4 people, 45.0 percent) (20.0 percent ). Table 3, the majority of respondents (55.0 percent) work as many as 11 persons, while a minor percentage work as little as nine people (45.0 percent ).

According to
According to Table 4, the majority of respondents (70.0 percent) were Multiparas, whereas a minor number of Primipara respondents (up to 6 persons) were Multiparas (30.0 percent ). 5th Table According to the study's findings, direct evidence indicated that the majority of respondents were content with up to 12 persons (60.0 percent), whereas a minor percentage of respondents were dissatisfied with up to 8 people (40.0 percent ). In terms of dependability, it demonstrates that the majority of respondents are dissatisfied with as many as 14 persons (70.0 percent), while a tiny minority are happy with as few as six people (30.0 percent ). In terms of assurance, the majority of respondents are dissatisfied with as many as 13 persons (65.0 percent), whereas a tiny percentage of respondents are happy with as many as seven people (35.0 percent ). In terms of caring, the majority of respondents are dissatisfied with as many as 12 persons (60.0 percent), whereas a tiny percentage of respondents are content with as many as eight people (40.0 percent ). In terms of response, the majority of respondents (55.0 percent) are dissatisfied with as many as 11 persons, while a minor proportion are happy with as many as 9 people (45.0 percent ).
The Impact of 10T Antenatal Care Services on Pregnant Women's Satisfaction at Asyifh Clinic, Meurah Dua District, Pidie Jaya Regency, Indonesia in 2019 According to Table 6, the results of statistical testing using the Wilcoxon signed ranks test indicate a P value of 0.000 0.05, indicating that 10 T prenatal care has an influence on pregnant women's happiness at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019. According to the test findings, there was no negative change in patient satisfaction before and after prenatal care 10T with a negative rank value of 0. According to the test findings, all respondents reported a positive improvement (increased satisfaction) in their satisfaction levels before to and after getting 10T prenatal care, with a positive rank value of 20, indicating that 20 participants reported an increase in satisfaction following 10T services. For pregnant women, the average rise in satisfaction is 10.50, while the average number of positive reviews is 210.00. The test findings indicated that there was no correlation between the pretest and posttest values, specifically that theis value was 0. The man whitny test resulted in a p value of 0.000, showing that 10T prenatal care services had an influence on pregnant women's satisfaction at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency.

Effect before and after 10T Antenatal Care on Satisfaction of Pregnant Women
According to the findings of the research, the results of statistical test analysis using the Wilcoxon signed ranks test indicate a P value of 0.0000.05, indicating that there is an effect of 10T prenatal care on pregnant women's happiness at Asyifa Clinic in Meurah Dua District, Pidie Regency. 2019 Jaya. According to the test findings, there was no negative change in patient satisfaction before and after prenatal care 10T with a negative rank value of 0. According to the test findings, all respondents reported a rise in patient satisfaction before and after prenatal care 10T with a positive rank value of 20. For pregnant women, the average rise in satisfaction is 10.50, while the average number of positive scores is 210.00. According to the test findings, there was no correlation between pretest and posttest scores, with theis value equal to 0.
According to the author, the service that should be emphasized for improvement on the dependability dimension is the midwife's clarity in delivering counseling regarding pregnancy, labor, and postpartum, as well as any other information required by the patient, in this instance pregnant women. In terms of responsiveness, the midwife's clarity in presenting information about maternal problems and the midwife's service in eliciting patient concerns are considered. Services that need to be enhanced in the assurance dimension include guaranteeing patient safety and boosting patient trust in the services delivered. In terms of empathy, this refers to the midwife's service in providing patients with undivided attention, with the intention that the midwife will also feel what the patient is experiencing. And on a more practical level, services such as waiting room comfort and the clarity of information boards and directions need to be addressed.
To improve patient satisfaction, particularly among pregnant women, it is important to enhance prenatal care services at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019 and to maintain service quality that is deemed acceptable by patients. Because if a patient is happy, he or she will return to the service or make a repeat appointment. Pregnant women who are satisfied will undertake a pregnancy reexamination at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019.
The findings of this study corroborate those of Azizatul Hamidiyah (2018). Satisfaction with Antenatal Services Among Pregnant Women Using the Method of Importance Performance Analysis. This study employed a cross sectional design. 61 pregnant women who have received ANC treatment at the MCH Poly Pukesmas Bayu Putih were included in this research. The findings indicated that pregnant women were dissatisfied with the ANC services offered at the Banyuputih Health Center. The IPA research reveals that across the five aspects of dependability, responsiveness, assurance, empathy, and tangible (43 service indicators), seven services require improvement and fifteen ANC service quality standards require maintenance .
This study contradicts Ayu WulansariS's (2012) study, The link between prenatal care services and patient satisfaction at the YB Balige clinic in Toba Samosir Regency. The research was conducted at the YB Balige clinic in Toba Samosir Regency using an analytical observational technique with a cross sectional approach. The whole sampling approach was used to choose 32 respondents, meaning all pregnant women who visited the YB Balige Clinic in Toba Samosir Regency. Patients expressed dissatisfaction with the ANC treatments offered at the YB Balige clinic in Toba Samosir Regency.
Antenatal care is one of the program's activities; it is provided by midwives in polyclinics, BPMs (private practice midwives), and hospitals. Additionally, prenatal care can be offered throughout the implementation of posyandu, in maternity homes and health clinics (Mufdlilah, 2017).

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in 2019 was satisfactory. Additionally, there is a substantial association between the service quality characteristics and the clinic's degree of patient satisfaction. The researchers anticipate that the quality of health services, particularly 10T prenatal care, can be maintained and enhanced, resulting in further increases in patient satisfaction. However, in order to analyze patient satisfaction in this manner, it must be conducted on a regular and continuous basis as a basis for assessing midwives' performance in delivering health services and the quality of services at the Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019.

Relationship between training and nurse performance
Training is one instance. According to the findings of the research, the results of statistical test analysis using the Wilcoxon signed ranks test indicate a P value of 0.0000.05, indicating that there is an effect of 10T antenatal care on pregnant women's satisfaction at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019. According to the test findings, there was no negative change in patient satisfaction before and after prenatal care 10T with a negative rank value of 0. According to the test findings, all respondents reported a rise in patient satisfaction before and after prenatal care 10T with a favorable rank of 20. For pregnant women, the average rise in satisfaction is 10.50, while the average number of positive scores is 210.00. According to the test findings, there was no correlation between pretest and posttest scores, with theis value equal to 0.
According to study conducted at the Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019, the average number of 10T services delivered by midwives was 1, and no one reported a drop in satisfaction before to or during the 10T service. the standard of service 10T surpasses pregnant women's expectations. No pregnant woman encounters a disconnect between her expectations and reality. This is a positive development. Given that a gap indicates a bad rating, the service must be continually improved. Gaps can emerge for a variety of reasons, including divergent perspectives on which services are critical and should be prioritized. Certain services are deemed critical by patients but have gotten insufficient attention from the service, resulting in them falling short of patient expectations. This might result in the patient being unhappy and disengaged to the point of unwillingness to return for more appointments. As a result, periodic reviews are important to ensure that service quality meets patient expectations.
According to the author, the service that should be emphasized for improvement on the dependability dimension is the midwife's clarity in delivering counseling regarding pregnancy, labor, and postpartum, as well as any other information required by the patient, in this instance pregnant women. In terms of responsiveness, the midwife's clarity in presenting information about maternal problems and the midwife's service in eliciting patient concerns are considered. Services that need to be enhanced in the assurance dimension include guaranteeing patient safety and boosting patient trust in the services delivered. In terms of empathy, this refers to the midwife's service in providing patients with undivided attention, with the intention that the midwife will also feel what the patient is experiencing. And on a more practical level, services such as waiting room comfort and the clarity of information boards and directions need to be addressed.
To improve patient satisfaction, particularly among pregnant women, it is important to enhance prenatal care services at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019 and to maintain service quality that is deemed acceptable by patients. Because if a patient is happy, he or she will return to the service or make a repeat | 17 appointment. Pregnant women who are satisfied will undertake a pregnancy reexamination at Asyifa Clinic in Meurah Dua District, Pidie Jaya Regency in 2019.
The findings of this study corroborate those of Azizatul Hamidiyah (2018). The Importance Performance Analysis Method is Used to Determine Pregnant Women's Satisfaction with Antenatal Services. This study employed a cross sectional design. 61 pregnant women who have received ANC treatment at the MCH Poly Pukesmas Bayu Putih were included in this research. The findings indicated that pregnant women were dissatisfied with the ANC services offered at the Banyuputih Health Center. The IPA research reveals that across the five aspects of dependability, responsiveness, assurance, empathy, and tangible (43 service indicators), seven services require improvement and fifteen ANC service quality standards require maintenance .
This study contradicts Ayu WulansariS's (2012) study, The link between prenatal care services and patient satisfaction at the YB Balige clinic in Toba Samosir Regency. The research was conducted at the YB Balige clinic in Toba Samosir Regency using an analytical observational technique with a cross sectional approach. The whole sampling approach was used to choose 32 respondents, meaning all pregnant women who visited the YB Balige Clinic in Toba Samosir Regency. Patients expressed dissatisfaction with the ANC treatments offered at the YB Balige clinic in Toba Samosir Regency (34).
Antenatal care is one of the program's activities; it is provided by midwives in polyclinics, BPMs (private practice midwives), and hospitals. Additionally, prenatal care can be offered during the posyandu implementation process, in maternity homes and puskesmas (Mufdlilah, 2017).
There are six standards for the delivery of antenatal care services, including the following: (1) Identification of Pregnant Women; Midwives visit and interact with the community on a regular basis to counsel and motivate mothers, husbands, and family members to check their pregnancy early and regularly. (2) Prenatal Care (ANC) Examination and Monitoring; Midwives give at least four types of antenatal care. The examination involves anamnesis and monitoring of the woman and fetus. Additionally, the midwife must be knowledgeable with high-risk pregnancies, vaccination, advise, and counseling, and must keep accurate records at each visit. If an abnormality is discovered, it must be capable of taking appropriate action and referring it for further investigation.
(3) Abdominal palpation. Midwives carefully examine and palpate the abdomen to determine gestational age and, as gestational age increases, to check the position, the lowest portion of the fetus, and the fetal head's entrance into the pelvic cavity, looking for anomalies and making prompt referrals. (4) Management of anemia during pregnancy. Midwives take measures to prevent, detect, treat, or refer all instances of anemia throughout pregnancy. (5) Early care of preeclampsia, Midwives detect early any increase in blood pressure during pregnancy and recognize other signs and symptoms of preeclampsia, and take necessary action and refer. (6) Preparation for birth, Midwives counsel expectant women, husbands, and families on how to guarantee a clean and safe delivery, transportation arrangements, and referral expenses. In the case of an unexpected emergency, the midwife should make a home visit (Kusumawati, 2014).
Prenatal care is intended to monitor the course of pregnancy in order to ensure the mother's health and the growth and development of the fetus. To promote and sustain the physical, emotional, and social health of the mother. Recognizing and resolving any problems or issues that may arise during pregnancy, such as a history of general disease, obstetrics, or surgery, as early as possible. Prepare for term labor and a painless delivery.